WHAT WORKS TO GET DOCTORS TO GO AND STAY RURAL? Summary of MABEL Evidence to Date Matthew McGrail Monash Rural Health MABEL Research Forum, 25th May 2017

Rural medical workforce Key theme (2012-17): (Improved) Rural Workforce Supply and Distribution Future focus (2018+): Optimising pipelines and pathways to medical practice Aim: The right mix of doctors and skills, appropriately distributed

The recipe…ingredients

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 demands Demands of practising in small rural / remote towns Locum support, professional development, skills General practice / rural generalist Positive career choices, rewarding

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 supply

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 supply

Regional specialists Importance of regional centres / service hubs Key role of general medicine / general surgery Mix of ‘resident’ and ‘outreach’ services, some telehealth Proceduralist GPs: smaller rural communities Outreach participation stems from rural ‘connections’ Distribution: Reliance on post-vocational mobility

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 25.4% 38.7% 58.6% 28.1% 74.6% 61.3% 42.4% 71.9% All GPs… % working rurally 30.0% 36.8% 47.7% 48.2% 25.8% 24.8% 24.3% 34.6%

Future focus – rural (GPs, other) Multi-site practice models Influence of U/G rural placements Advanced skills / proceduralists Corporate models Registrar supervisors Training pipelines / hubs Self-sustaining (right mix doctors / location)?