What can we do to support the healthcare workforce in rural, regional and remote areas?

While a national shortage of healthcare workers is being felt across Australia, nowhere is doing it tougher than the country’s rural, regional and remote communities.

Compared to major cities, which have on average 2248 full-time clinical workers per 100,000 people, non-metropolitan areas – which host 28 percent of the national population – have as few as 1846. In return, health outcomes are generally poorer and life expectancies shorter.

Prof Jennifer Martin, President and Chair of the Royal Australasian College of Physicians, says the current approach of recruiting overseas and metro-based workers might be helping to fill the gaps temporarily. However, more support is needed to address the wide-ranging limitations.

“When doctors arrive in rural, regional and remote areas, they are often up against some major challenges. And unless we address these or find a different approach, then we don’t really have a long term solution,” she said.

Support with integration

Racism can be a particular challenge faced by some people migrating to Australia’s regions. Prof Martin says this shows up in many ways, and that even passive (i.e. non-aggressive) examples can be deeply distressing.

“There have been some terrible stories, where patients have requested not to be treated by a doctor who is not white, which is extremely humiliating for the doctor. We’ve also heard of the children of these doctors being socially excluded or bullied at school.

“We need to do more work, as a country, to ensure healthcare workers and their families are not exposed to this kind of racism and disrespect,” she said.

Prof Martin also recommends more cultural support for healthcare workers entering rural, regional and remote communities, to ensure they and their families feel welcome.

Ideally, this support should be overseen by a professional body such as the relevant training College, she says.

“The College of Physicians is basically 30,000 physicians who happily volunteer their time to supervise overseas trained doctors and ensure they are well acculturated and safe to practice in a new setting.

“In our college we actually have a very good overseas trained physician pathway and support team. But, due to size, that’s not present in all the colleges and this supervision certainly does rely on a volunteer workforce,” she said.

Prof Martin says it is concerning that the Government, via the Medical Board of Australia and AHPRA, has now legislated against colleges supervising OTPs, through the expedited specialist IMG pathway.

“Both of these regulatory organisations are there to protect patients and communities. In my view, this will weaken the support for doctors in rural, regional and remote areas. It will also remove a safety guard for patients, as these doctors have not been observed in Australian practice.

“Most of us remember the harm caused by Dr Patel in Rockhampton, which is ironically what prompted the tightening of regulations for OTPs, and increased requirements for the Colleges’ supervision of doctors when arriving in Australia.”

More infrastructure

When young families move from cities to rural, regional and remote areas, some are shocked to discover a lack of social infrastructure.

“There are communities which have a primary school, but not a secondary school, for example. So naturally, families that have relocated from the city will be looking to move somewhere else as their children get older,” Prof Martin said.

This under-investment in infrastructure is a broader, systemic issue, which also affects primary residents of these areas. However, it is felt more profoundly by former city-dwellers, who are used to higher levels of service and facilities that bigger populations have.

“I imagine it would a big deterrent for anyone who might otherwise be interested in a healthcare job opportunity in one of these areas,” Prof Martin added.

Ethical concerns

Even if migrant workers are adequately supported and flourish in rural, regional and remote communities, there are ethical concerns with recruiting them there.

“The healthcare worker shortage is a global problem. So when we poach from the likes of New Zealand, PNG and the Islands, we are leaving those countries in the lurch too,” Prof Martin said.

“Of course, many workers from these countries prefer Australia because of the attractive salaries and good working conditions. But it’s definitely an ethical concern to actively poach resources from their already stretched healthcare sector.”

Other options?

Prof Martin says servicing rural, regional and remote areas with less senior or non-medical staff – as an interim strategy – is not ideal either.

“Giving people access to a nurse practitioner instead of a doctor certainly has shortfalls. From a government perspective, I can understand the temptation, given that nurses require three years of training, whereas physicians require up to sixteen years. However, we are perpetuating healthcare disadvantage with this approach.

“Likewise, technical assistants [sometimes called physician or hospital assistants] may be better than no health workforce, but are not equivalent to medical care, and may cause harm if the need for escalation of care is not noted.”

Amid a rise in conditions like rheumatic fever, antimicrobial resistance, and type 2 diabetes, a deficiency in medical staff could be particularly dangerous, she warns.

“We hardly used to see rheumatic fever, but we are seeing it a lot now, particularly in First Nation communities. People with this condition are often really sick and need urgent cardiology input; with qualified medical help to get them there.”

While non-medical staffing options may be a temporary solution, Prof Martin says these groups will also require support and infrastructure to remain in the bush.

Additionally, unlike GPs and physicians who are used to being on call for extended periods, the non-medical workforce is more shift based.

“This requires a larger number of staff to work a roster and cover days off,” she said.

A better way

In light of these concerns, Prof Martin in the College of Physicians and colleagues in the Rural Workforce Agency have been exploring another way to support the non-metropolitan healthcare workforce.

“We are focussed on educating and training people who already live in these areas. Local communities are happy to stay where they are – it’s their home – so we are finding a way to bring university to them, alongside several Universities who are already supporting regional training hubs,” she said.

While this initiative has already received Commonwealth funding and is showing promise, Prof Martin says it is not a silver bullet.

“We need to make sure local people and the specialist colleges they attend are adequately supported throughout their long education and training lifespan, which can be up to sixteen years, longer for surgeons.

“That said, physicians who work in the Bush probably don’t need to spend that long, because they are providing more generalist care and any of the rarer subspecialty work probably does entail a trip to a bigger center.

“But it’s definitely something we need to consider as a sector.”

Join the debate

Talking more about this option and her recommendations for Medicare reform, Prof Martin will speak at the upcoming National Healthcare Workforce Summit, hosted by Informa.

Joining Prof Martin on the speaker faculty are the likes of Monita Mascitti-Meuter, Inclusion Diversity Equity Lead, St Vincent’s Health Australia; Dr Nicole Higgins, President, Royal Australian College of General Practitioners; and Dr Matthew Fisher, Chief Executive Officer, Australian Society of Anaesthetists.

This year’s event will be held 21-22 October 2024 at the Swissotel Sydney.

Learn more and register your tickets here.

About Professor Martin

Jennifer Martin is a physician in Newcastle and current President of the Royal Australasian College of Physicians.