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Why is There a Rural Health Workforce Problem?

Chronic health workforce shortages and high turnover of health professionals are common challenges facing many rural communities.

The World Health Organisation has identified rural health workforce shortages as a leading cause of the inequitable access to healthcare that exists between rural and urban residents.

The rural health workforce problem is primarily one of maldistribution. There is an oversupply of health professionals in metropolitan areas and an undersupply in rural areas.

These health workforce shortages intensify the more remote the community is, particularly for the allied health and medical workforces.

In Australia, the impact of this maldistributed health workforce is that rural Australians experience poorer health outcomes than their city counterparts—living shorter lives, acquiring greater levels of chronic disease, sustaining more injuries, and experiencing poorer mental health.

What has been done and why hasn’t it worked?

Governments in high income countries have tended to consider their maldistributed health workforce problem primarily within the conceptual framework of economics (demand/supply) theory. Thus their policies have focussed on increasing supply to address unmet demand and ensuring the ‘optimal’ organisation of health workforce for different rural settings. The adoption of an economics framework has contributed to rural health workforce being predominately problematised as a ‘country doctor shortage’.

To improve the supply of rural health workforce, governments have implemented a rural pipeline strategy and focussed (until recently) on building the rural GP (family physician) workforce. The ‘rural pipeline’ is concerned with:

  1. prioritising the selection of students already sensitised to rural living
  2. exposing medical and health students during training to rural curriculum and rural practice (through clinical placements) and
  3. building regional post graduate training opportunities.

Despite substantial investment over the last 30+years by national governments in this ‘rural pipeline’ strategy overall the rural health workforce maldistribution persistsInarguably, as a stand-alone approach for addressing rural health workforce issues, the ‘rural pipeline’ strategy has failed.

What needs to change?

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