Why is it important?:The capacity to recruit and retain appropriate staff is critical to the appropriateness, continuity and sustainability of health services including Aboriginal and Torres Strait Islander primary health care services, particularly in rural and remote areas.
Findings:In 2010, there were 58,192 registered medical practitioners in Australia, of whom 90% were employed in medicine. Many of those not working in medicine in Australia were working in this field overseas, were retired or were on extended leave.
In 2010–11, 70% of full-time equivalent GPs worked in major cities and only 0.5% in very remote areas. A survey of the rural workforce conducted in November 2011 found that of the 6,372 GPs working in rural Australia, an estimated 34% had been in their current practice for two years or less. In remote areas, 42% of GPs had been in the current practice for two years or less. In 2009, 86% of nurses were currently employed in nursing, and 88% of dental therapists/oral health therapists were employed in dentistry. For other health professionals, the proportions working in their field were as follows: 80% for physiotherapists (2002 data), 86% for occupational therapists (2002–03 data), 87% for psychologists (2003 data), and 92% for podiatrists (2003 data). Many of those not working in their field were not looking for work in their field.
In 2010–11, there were 3,683 full-time equivalent health (clinical) staff and 1,856 full-time equivalent administrative and support staff positions within Aboriginal and Torres Strait Islander primary health care services funded by the Australian Government. In the 12 years to June 2011, there was an increase of 135% in the workforce of Aboriginal and Torres Strait Islander primary health care services funded by the Australian Government. An estimated 8% of health positions and 3% of administrative and support staff positions were vacant. The highest number of health staff vacancies in June 2011 were for Aboriginal Health Workers (74) followed by nurses (53) and allied health workers (50). In June 2011, health staff vacancies were highest in outer regional areas (24%) and very remote areas (23%) and lowest in major cities (9%). Vacancies for administrative and support positions were highest for positions located in very remote areas (5%), followed by outer regional areas (4%) and lowest in inner regional areas and major cities (1%). Of the 336 health staff positions that were vacant, 44% had been vacant for 26 weeks or more. Of the 60 administrative and support staff vacancies, 37% had been vacant for this length of time.
A study of GPs conducted in 2001 found that important factors determining retention in rural and remote areas were: professional considerations, particularly on-call arrangements; professional support; variety of rural practice; local availability of services; and regional attractiveness (Humphreys et al. 2002). Another study found that doctors who were satisfied with their current medical practice intended to remain in rural practice for 40% longer than those who were not satisfied (11.5 years compared with 8.2 years) (Alexander et al. 2007). GPs content with their life as a rural doctor intended to remain in rural practice for 51% longer than those who were discontented (11.8 years compared with 7.8 years). Continuing professional development, training opportunities, professional support and networking and financial support were identified as priorities for GPs. Training in Indigenous health was identified as a key information deficit.
A literature review of factors influencing the recruitment and retention of allied health professionals in rural and remote areas found that negative influences such as poor access to professional development, professional isolation and insufficient supervision were most frequently reported. Rural lifestyle, diverse caseloads, autonomy and community connectedness were cited as positive influences (Campbell et al. 2012). A study of drug and alcohol workers found that Indigenous workers experienced above average levels of job satisfaction and relatively low levels of exhaustion, however, they also experienced lower levels of mental health and well-being and greater work/family imbalance. The report highlighted the importance of workforce development strategies that focus on culturally appropriate, equitable and supportable organisational conditions including addressing stress, salaries, benefits and opportunities for career and personal growth (Roche et al. 2012).Top of Page
Implications:Better national data are needed on this important issue. The statistics analysed here focus on a few aspects of a complex set of issues. They suggest there are challenges for Aboriginal and Torres Strait Islander primary health care services in recruiting (particularly clinical) staff to meet the growth in the sector. Recruitment and retention issues are also significant for health services located in rural and remote Australia. Little is known about the turn-over of staff in Aboriginal and Torres Strait Islander primary health care services and how this compares with mainstream services. Another issue is achieving incomes for doctors in rural and remote locations that are competitive with incomes earned by GPs in metropolitan private practice.
In November 2008, COAG committed up to $1.6 billion over four years to the National Partnership on Closing the Gap in Indigenous Health Outcomes. Building the capacity of the health workforce is recognised as an essential element of this work. The capacity of the primary care workforce in Indigenous and mainstream health services will be expanded to increase the uptake of health services by Aboriginal and Torres Strait Islander peoples. Measures include communication and marketing activity to attract more Indigenous people to work in health; additional workforce including Aboriginal and Torres Strait Islander Outreach Workers, health professionals and practice managers; and additional nursing scholarships, registrar training posts and nurse clinical placement's.
The Pathways into the health workforce for Aboriginal and Torres Strait Islander people: a blueprint for action (NATSIHC 2008) is designed to provide Australian governments with advice and strategies to maximise Aboriginal and Torres Strait Islander participation in the health workforce through promoting and improving pathways between school, vocational education, training and higher education; and retaining and building the capacity of the existing workforce by addressing ongoing support and career development needs (NATSIHC 2008).
The Blueprint for Action provided the basis for the development of the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2011–2015). One of the key aims of the Framework is to support the recruitment and retention of Aboriginal and Torres Strait Islander and non-Indigenous health staff. This is being addressed through jurisdictions implementing career structures and pathways into the health workforce.
In the Health and Hospitals Fund Regional Priority Rounds, funding of $41.442 million was allocated for 10 projects to specifically attract, train and retain health practitioners and students by building accommodation in rural, regional, and remote areas. Examples include staff accommodation in Halls Creek (WA), Charleville and Mt Isa (Qld). By providing staff accommodation in these regional communities, it will help to improve access for Indigenous patients to essential health services in addition to allied health services such as nutrition, physiotherapy and speech pathology.
The Living Longer Living Better Aged Care Reform package includes funding of $1.2 billion to strengthen the aged care workforce by ensuring greater stability of the existing aged care workforce and improving the attractiveness of working in aged care. There will be a strong focus on addressing workforce pressures in regional, rural and remote areas, including action to improve the recruitment, retention and overall geographical distribution of aged care workers. The Remote Area Health Corps has been in operation since October 2008. The program assists in the delivery of primary health care services in remote NT Indigenous communities by supplementing the efforts of Aboriginal Medical Services and the Northern Territory Department of Health to recruit health professionals from urban based practices and deploy them for short term placement's in remote NT communities, where health resources are in high demand.
Recognition of Aboriginal and Torres Strait Islander health as an identifiable specialty is also considered to be important in improving services and retaining highly skilled clinicians. Strong cooperation and collaboration between the health and education portfolios is vital for improving recruitment and retention of health staff.Top of Page
Figure 203—Proportion of selected staff vacancies in Aboriginal health care services, by remoteness area, 2010–11
Source: AIHW analysis of OATSIH Services Report
Figure 204—Full-time equivalent health staff and administrative and support staff vacancies, Aboriginal primary health care organisations, by length of time vacant, 30 June 2011Top of Page
Source: AIHW analysis of OATSIH Services Reporting
Figure 205—Proportion of GPs, by length of stay in current practice and remoteness area, 30 November 2011
Source: AIHW analysis of Combined Rural Workforce Agencies National Minimum Data Set reportTop of Page