Thanks to Greg Mundy, CEO of Rural Health Workforce Australia * for this reflection on the changing nature of the rural health workforce.
Despite what you read in the media, a good thing is happening to the medical workforce in rural and remote Australia.
It’s actually growing.
Since 2009, the number of GPs working in rural areas has increased by 23 per cent. So it would appear that more rural people are getting better access to doctors, that recruiters are succeeding and that Government policies to build a stronger rural health workforce are working.
While this is partially true, there is a more complex story playing out on the ground. Not all communities have been fortunate enough to secure the services of a permanent doctor and there are a number of workforce trends that pose challenging questions for policy makers.
Let’s start with women. The feminisation of the medical workforce is in full swing across the nation including in the country. Since 2010, the proportion of female GPs working in rural and remote areas has increased from 35 to 39 per cent.
We believe this trend will continue given the fact that the proportion of female medical students is approximately 50 per cent.
So what does this mean? On the one hand, balancing out the genders increases the pool of talent to draw from. On the other, women tend to work fewer hours in paid work than men. This is confirmed in annual surveys by our Rural Workforce Agency network where female GPs in regional, rural and remote Australia report working on average 7.8 hours per week less than males.
Childcare and family responsibilities are clearly factors in the mix. So the development of more flexible employment models such as job-sharing and part-time positions need to be considered by country practices looking to attract female doctors.
A preference for part-time work, of course, is not the exclusive preserve of women. Changing societal attitudes to work-life balance are seeing more men looking to scale back their working hours.
This may explain why hours worked by GPs are declining across all areas of regional, rural and remote Australia. GPs in these areas are working an average of 1.3 hours less per week than they were four years ago (although on the whole they still tend to work longer hours than their city counterparts). This equates to around 250 fewer full-time equivalent GPs across a rural medical workforce of 7,975 GPs.
Herein lies the real challenge for future workforce development. At current rates of demand and workforce productivity, hundreds more GPs will be required in rural and remote Australia simply to maintain the level of services being provided today.
Then there is great grey demographic glacier that is inexorably grinding its way through the workforce landscape. We know that 34 per cent of GPs working in rural and remote Australia are aged 55 or over. Many of their patients are older too, requiring more care and adding to the demand for health professionals.
This starts to become problematic as older doctors move towards retirement over the next five to 10 years. We know from our research that the older country doctors – particularly those in remote areas – have traditionally worked longer hours so replacing them may not be as simple as a one-for-one equation.
It will require fine-tuning of workforce planning and succession strategies, not least in solo-GP towns. It may also repay us to look at alternative models of care, such as employing a nurse or allied health professional to help reduce the GP clinical workload. Along with this, practices may need to think creatively about ways of helping older GPs reduce their working hours so they can remain in the workforce and act as mentors for the next generation.
With more young doctors graduating from university than ever before, this passing of the baton takes on added significance as Australia seeks to meet the health needs of country people.
* Rural Health Workforce Australia is the peak body for the state and territory Rural Workforce Agencies. This not-for-profit network attracts, recruits and supports health professionals to work in rural and remote communities. Last year it placed 700 new doctors, nurses, dentists and allied health professionals in rural communities and provided support services to 5,000 new and existing health professionals.
Further data on the remote and rural medical workforce can be found here: Medical Practice in Rural and Remote Australia: National minimum data set report.
The medical establishment is, to a degree, its own worst enemy. When the Grattan Institute published its ‘Access all Areas” report, suggesting expanded roles for pharmacists and physicians assistants in rural areas, some of the medical interest groups went into meltdown.
Apparently the answer is to throw more money at doctors.