Summary of MABEL Evidence to Date Matthew McGrail Monash Rural Health MABEL Research Forum 25 th May 2017 Rural medical workforce Key theme 201217 Improved Rural Workforce Supply and ID: 620240
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WHAT WORKS TO GET DOCTORS TO GO AND STAY RURAL? Summary of MABEL Evidence to Date
Matthew McGrail
Monash Rural Health
MABEL Research Forum, 25
th
May 2017Slide2
Rural medical workforceKey theme (2012-17):
(Improved) Rural
Workforce Supply and
DistributionFuture focus (2018+):Optimising pipelines and pathways to medical practice
Aim:
The right mix of doctors and skills, appropriately distributedSlide3
The recipe…ingredientsSlide4
Key elements – rural workforce‘Rural interest’ [early career]
critical:
Rural origin, rural exposure, rural pipelines
Rural careers highly satisfying, but support essential to mitigate potential negative elements:Increased work hours, on-call demandsDemands of practising in small rural / remote townsLocum support, professional development, skillsGeneral practice / rural generalistPositive career choices, rewardingSlide5
WHAT WORKS TO GET DOCTORS TO GO RURAL AND STAY?
How malleable is GP location choice?
Most GPs are stable in their location type:
65% would never consider moving, for any incentive
On-call is a key disincentive to rural
Additional skills may be required for rural
uptake
Around 1 in 75 per-year “risk” of metro-to-rural move
Majority of mobility (in/out) among GPs <40 age
Re-distribution regional to small rural / remote problematic
Early career location decisions are critical to
long-term supplySlide6
WHAT WORKS TO GET DOCTORS TO GO
AND
STAY RURAL?
Most GPs stay rural, once settled
Small rural community GPs most
at risk of
leaving
Locum relief the most important incentive to stay
Increased annual leave associated with LOS
Proceduralists and principals/associates stay
Regional development, social isolation
Better targeted support: e.g. Modified Monash
Early career rural support critical to long-term supplySlide7
Regional specialistsImportance of regional
centres / service hubs
Key role of general medicine / general surgery
Mix of ‘resident’ and ‘outreach’ services, some telehealthProceduralist GPs: smaller rural communitiesOutreach participation stems from rural ‘connections’Distribution: Reliance on post-vocational mobilitySlide8
Rural supply GPs: AMGs versus IMGs
IMG = International graduates
AMG = Australian graduates
Graduation cohort (U/G
degree completed)
1970s
1980s
1990s
2000s
All GPs
IMGs
22.6%
29.8%
41.8%
21.9%
AMGs
77.4%
70.1%
58.2%
78.1%
Rural GPs
IMGs
25.4%
38.7%
58.6%
28.1%
AMGs
74.6%
61.3%
42.4%
71.9%
All
GPs…
% working rurally
IMGs
30.0%
36.8%
47.7%
48.2%
AMGs
25.8%
24.8%
24.3%
34.6%Slide9
Future focus – rural (GPs, other)Multi-site practice models
Influence of U/G rural placements
Advanced skills / proceduralists
Corporate modelsRegistrar supervisorsTraining pipelines /
hubs
Self-sustaining (right mix doctors / location)?