1. 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

2. Rural medical workforce
Key theme ( ):
(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

3. The recipe…ingredients

4. 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

5. 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

6. 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

7. 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

8. 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%

9. 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)?