Securing a rural health workforce for the next generation of rural Australians

The value of investing in advancing rural training pathways should not be forgotten

The establishment of rural-based academic networks in health was a key initiative of the incoming federal Coalition government in 1996 to help overcome the shortage of medical and other health professionals in rural and remote Australia. University departments of rural health1 were initially established in medical schools to increase the capacity of rural health services to provide high-quality education and clinical training of students from multiple disciplines, and support the delivery of clinical services to communities. In a second phase of development from 1999, the addition of rural clinical schools expanded the network to provide at least 1 year of clinical training for 25% of Australian medical students in a rural community.

Now, 18 years on, rural Australia has access to an unprecedented network of 28 academic departments invested in clinical training. This represents a substantial footprint across each state and the Northern Territory. The rural academic network delivers rural-based clinical training in both hospital and community settings for more than 5500 medical, nursing and allied health students annually and includes access to interprofessional learning and simulation training. In some university departments of rural health and rural clinical schools, there are opportunities for students to contribute to service delivery to underserved rural communities through service learning. In this educational approach, students deliver clinical care under supervision to patients with high health need and poor access to services, in student-led clinics or in an assisting role.2 Progressively, academic teams have also formed to undertake research, evaluation and development work on the rural health agenda, including carrying out studies on the effectiveness of rural training in delivering rural health workforce outcomes and health service redesign for rural and remote communities.

Developing rural health as a career path

Academic departments contribute to the development of rural training pathways using multiple strategies that are sequenced through the different phases of career development; from promoting health careers to secondary school students in rural communities, delivering rural-based clinical training for undergraduate students, through to providing professional development for rurally located practitioners across the different disciplines. Vocational training in medicine for a career in rural health has benefited from the expansion of prevocational training opportunities managed by rural health services, the regionalisation of general practice training,3 and growing acceptance of rural generalism as an occupational classification and potential career path for medical graduates. The rural training of medical students is integral to the pathway and is starting to deliver workforce outcomes for rural health services and communities, as evidenced by the increasing number of these graduates undertaking prevocational and vocational training in rural areas.4,5 The development of rural training pathways for nursing, dentistry, pharmacy and other allied health disciplines to build a generalist workforce is not as well advanced.

The 2013 Review of Australian Government Health Workforce Programs6 reported on the importance of creating a coherent pathway for rural and regional education and training — for medical training in the first instance and then for nursing, allied health and dentistry. The report concluded that these developments had the potential to achieve better health workforce outcomes for rural Australia, as well as promote generalist medicine and integrated primary care. The policy direction is clear, yet there is uncertainty in an environment where there will be increasing competition for funds. How the establishment of primary care networks and rebuilding of general practice training will affect the ongoing development of rural training pathways has yet to be determined. The decision to invest during a previous period of fiscal constraint delivered an internationally regarded rural academic network; it is timely to now invest in the advancement of training pathways to secure a rural health workforce for the next generation of rural Australians.