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

While Australia faces a national shortage of healthcare workers, rural, regional, and remote communities are experiencing the greatest challenges. Compared to major cities, which average 2248 full-time clinical workers per 100,000 people, non-metropolitan areas—home to 28% of the population—have as few as 1846. This disparity contributes to poorer health outcomes and shorter life expectancies.

Professor Jennifer Martin, President and Chair of the Royal Australasian College of Physicians, believes the current approach of recruiting overseas and metro-based workers offers only a temporary solution. She emphasizes the need for more comprehensive support to address the wide-ranging limitations.

Supporting Integration and Combating Racism

Prof. Martin highlights racism as a significant challenge for healthcare workers migrating to Australia’s regions:

"Patients have requested not to be treated by non-white doctors, which is extremely humiliating. Additionally, the children of these doctors have faced social exclusion and bullying at school."

She advocates for cultural support programs to help healthcare workers and their families feel welcome in rural, regional, and remote communities. Ideally, these programs should be overseen by professional bodies like the relevant training colleges.

"The College of Physicians has a strong overseas-trained physician pathway and support team, but this level of supervision is not present in all colleges. Unfortunately, recent legislation by the Medical Board of Australia and AHPRA has weakened the support for overseas-trained doctors, which could compromise patient safety."

Infrastructure Challenges

A lack of social infrastructure in rural areas is another deterrent for healthcare workers and their families. Prof. Martin notes that some communities lack secondary schools, forcing families to relocate as their children grow older.

"This under-investment in infrastructure affects primary residents but is felt more profoundly by city-dwellers who are used to higher levels of service."

Ethical Concerns with Recruitment

Prof. Martin raises ethical concerns about recruiting healthcare workers from countries like New Zealand, PNG, and the Pacific Islands, which are also experiencing workforce shortages:

"While Australia offers attractive salaries and working conditions, actively poaching resources from already stretched healthcare sectors is problematic."

Limitations of Non-Medical Staffing

Using less senior or non-medical staff as a temporary solution is not ideal, Prof. Martin warns:

• Nurse Practitioners: While quicker to train, they cannot provide the same level of care as physicians, potentially perpetuating healthcare disadvantages.
• Technical Assistants: May cause harm if escalation of care is not recognized.

"Conditions like rheumatic fever, antimicrobial resistance, and type 2 diabetes require urgent medical input. A deficiency in qualified staff could be dangerous."

A Better Way: Training Local Communities

Prof. Martin and colleagues in the Rural Workforce Agency are exploring a long-term solution: educating and training people who already live in rural, regional, and remote areas.

"Local communities are happy to stay where they are—it’s their home. We are working with universities to bring training hubs to them."

While this initiative has received Commonwealth funding and shows promise, Prof. Martin emphasizes the need for ongoing support throughout the lengthy training process.

"Physicians in the bush provide more generalist care, so their training may not need to be as long as subspecialists. However, adequate support is still essential."

Join the Debate

Prof. Jennifer Martin will discuss her recommendations for Medicare reform and rural workforce solutions at the upcoming National Health Workforce Summit, hosted by Informa. The event will take place on 21-22 October 2024 at the Swissotel Sydney.

Joining Prof. Martin on the speaker faculty are 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, CEO, Australian Society of Anaesthetists.

Learn more and register your tickets here.

About Professor Jennifer Martin

Jennifer Martin is a physician based in Newcastle and the current President of the Royal Australasian College of Physicians. She is passionate about addressing healthcare inequities in rural, regional, and remote Australia.