The Reality of Rural Staffing

Rural and remote medicine is a lifeline for communities which are situated far from the hustle and bustle of cities and large hospitals. Yet, despite its importance, most countries are facing a perplexing shortfall in medical professionals eager to take up roles in these areas.

Reasons for The Shortage

Several factors contribute to this reluctance of doctors to practice in rural and remote locations:

1. Professional Isolation

Doctors in rural settings often work in small practices or hospitals (less than 50 beds) which can lead to a sense of professional isolation and limited career progression opportunities. There are few colleagues to consult for support or second opinions and specialist back up may be a considerable distance away and not readily available. This places doctors in a position where they must manage complex medical cases and serious trauma alone.

General Practitioners (GPs) and other physicians working in remote healthcare facilities often have to make urgent and difficult decisions about patient referral and transfer to urban hospitals for specialist care, balancing the patient need with the exorbitant costs of the patient transfer over long distances, usually by air. This requires lengthy experience and confidence in one's own capabilities.

2. Clinical Complexity

The sense of professional isolation is compounded with the issue touched upon above, that of managing difficult and complicated medical disorders. Far from the cities where most patients benefit from readily available medical care and preventative advice and present with relatively straightforward conditions, rural patients often pose a considerable diagnostic challenge. Lack of healthcare access, self neglect and delays in seeking treatment results in advanced and complicated disease. Doctors working in remote areas regularly see gross, untreated disease and serious trauma (snake bites etc) which is rare in the urban areas.

For some doctors this is a rewarding challenge and unrivalled opportunity to enhance diagnostic and procedural skills and rapidly gain confidence in managing patients with a broad range of clinical conditions. For others it is a challenge too far and exceeds their comfort zone.

3. Resource Limitations

Rural and remote hospitals lack the resources of large city hospitals, even when modern and well equipped. Shortages of staff and range of equipment places limitations on the medical care which can be provided. This leads to frequent patient transfers to larger hospitals.

4. Restricted Educational Opportunities

Limited access to continued professional development or training programmes can be a disincentive for doctors looking to advance their careers. Local educational resources are often basic and attendance at national or international events involves time consuming travel.

5. Stress and Burnout

The high workload, complex clinical challenges and the pressure of being one of the few healthcare providers can affect personal lives and lead to excessive stress and eventual burnout.

6. Family and Social Issues

Working in a rural or remote area means living locally and this can be problematic for a doctor's family. Schooling options are limited and may require travel across long distances. The local housing stock may be in short supply and even inadequate and the options for cultural pursuits and hobbies restricted. Even if a doctor relishes the challenges of this work, his family may resist the lifestyle.

Forging a Path to Solutions

Rural and remote healthcare organisations face severe, often seemingly insurmountable, challenges to recruitment. But finding solutions is essential if the healthcare inequalities are to be addressed in a meaningful way.

1. Incentivise Rural Practice

Financial incentives can be effective in attracting doctors to rural areas, even if only for a limited time. The following are examples which are often used successfully:

• higher rates of pay - at a significant rate above national rates
• sign up bonuses - a one off payment at the start of a contract
• rural bonuses - annual payments for working in hard to fill jobs
• retention bonuses - paid after a defined amount of service, usually annually
• relocation packages - refund expenses of moving and finding local accommodation
• relocation services - assist doctors to find accommodation, cars and schools
• loan repayment programmes - repayment of student loans
• reduced moratoriums- reduction of geographical practice restrictions for time spent in rural areas

2. Enhance Professional Support Available

Initiatives to combat professional isolation and increase the availability of appropriate support are immensely helpful and include:

• telemedicine - rapid, secure connections to specialists in city hospitals for immediate advice
• networking opportunities - provide a sense of community and shared purpose
• mentorship programs - more senior and experienced physicians can provide valuable advice

3. Create Flexible Work Schedules

Flexible work rotas which permit extended time off duty provide more time for rest and educational activities. This reduces the incidence of stress related disorders and burnout. Longer shifts worked in series with leave allows doctors to return to family homes in the cities.

4. Promote Continuing Professional Development

The inauguration of the Australian College of Rural and Remote Medicine and development of the rural and remote medical fellowships within the Royal Australasian College of General Practitioners has created the distinct medical speciality of Rural and Remote Medicine as a subspeciality of primary care medicine with its own training programs, specialist accreditation and continuing professional development (CPD) programs which are tailored to the development of the enhanced skills required by the rural generalist physicians.

These programs prepare doctors for the unfamiliar clinical presentations which they will meet whilst working off the beaten track and give them the confidence to manage them whilst the award of dedicated formal qualifications elevates the status of the field. The Colleges and their associated educational structures have created fresh career opportunities for doctors who wish to progress in clinical or academic practice.

The Essential Role of Recruitment

As recruiters specialising in the rural and remote medicine sector, we see the value in offering a bespoke matchmaking service which ensures a perfect fit for both the organisation and the professional. Establishing a successful and fulfilling career in rural medicine is a commitment and a path we are dedicated to facilitating with expertise and genuine care.

Looking Forward

The journey towards resolving the doctor shortage in rural areas is not a simple one. It is nuanced, challenging, and requires innovation in recruitment, retention strategies, and support systems. But it is possible, and with the right approach, incredibly rewarding.

If you are a General Practitioner or Rural Medicine Physician considering your next career move, or a rural healthcare organisation looking to address staffing challenges, please contact us. Together, we can explore how your skills and aspirations can meet the needs of communities who need them most and how we can support you in overcoming the hurdles that come with rural healthcare.