Rural retention is notoriously hard to predict, but these three clinicians are giving it a crack.
Australia’s rural health workforce crisis would be a lot easier to solve if there was an ironclad way to work out which medical students and registrars will stay living and working rural.
Until such an algorithm exists, though, here’s what three rural clinicians and research teams had to say at this year’s Rural Medicine Australia conference in Adelaide.
Benchmarking retention
Monash University rural health researcher Associate Professor Peter Bock presented on an ongoing project attempting to define what “good” retention means for the bush.
“Rural healthcare in Australia relies primarily on GPs and RGs, and retaining doctors in the communities is a subject of extensive national intervention and extensive funding,” he told delegates.
“A lot of investment has gone into it.
“The problem that we identified is Australian studies use widely varying retention definitions, data sets, and analytical methods.”
These inconsistent methods and metrics mean that it is “almost impossible” to get a nation-wide picture of which universities or training programs are delivering the best outcomes in terms of rural workforce.
For example, one university may measure only where its graduates are practising three years after graduation and call it “retention”, and another may define “retention” as practising location 10 years post-fellowship.
“The absence of clarity directly hinders understanding of the situation, and therefore allocation of resources,” Professor Bock said.
Across the literature, Professor Bock said his team identified 10 different definitions of retention.
His progress toward a single definition continues.
End to end training
Reflecting on the first two years of Flinders University’s South Australia Rural Medical (SARM) program, rural generalist and program lead Associate Professor James Padley said the end-to-end rural clinical training pathway was designed with generalism in mind.
One of the immediate problems with standing up an undergraduate rural training program was finding staff to teach it; SARM eschewed the traditional model and focussed on recruiting local doctors.
“What we have done is gather a team of academics who live rurally in Renmark and Mount Gambier, and they teach across year one and two [post grad],” Professor Padley told delegates.
“And forget if they have a PhD in biochemistry, they can teach other things as well … we’re encouraging those academics to be generalist educators in medical education.
“Discipline specialists still teach, and they value add with what we call masterclass sessions. And we’ve had very positive student feedback, and we have evaluation programs ongoing.”
Students were also selected based on rural interest, suitability and rural background.
Because SARM has only been running for two years, it is still unclear whether it will result in greater rural retention; but Professor Padley was hopeful.
SARM students already significantly outperform their metro-based peers on standard academic multiple-choice exams that all Flinders medical students sit four times per year, despite SARM students having lower baseline GAMSAT scores.
“You’re looking at students who’ve come in slightly academically under the bar, but they’re really kicking goals,” he said.
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When service needs meet training needs
Former National Rural Health Commissioner Associate Professor Ruth Stewart presented alongside RG obstetrician and acting director of medical services for Queensland’s South West Hospital and Health Service Dr Sally Street.
Both currently work on improving recruitment and retention for doctors working across Queensland’s regional southwest.
“[You’ve got to] grow your own, and to do this, you’ve got to give learners meaningful experiences that build their skills and confidence to work where you are, not just tell them stuff,” Professor Stewart said.
“They’ve got to actually experience it. You’ve got to show them what’s possible. And in doing this, we need learners to come to the southwest.
“We need them to learn in the southwest, not just learn in situ, but learn what we need them to know to work in the southwest. And we need them to stay.”
The requirements of medical service delivery, such as minimum staffing levels, are often pitted against training needs, with Dr Street describing it as “two matching sides of the magnet” pushing against each other.
“I often get a response from the clinicians on the ground saying, ‘no, no, we can’t do that training, do you not realise we don’t have enough doctors to deliver our services’ … and my thing has always been ‘yes, but if you engage in training, you will have the workforce for the future, and you will have an engaged workforce now who know that they’re being upskilled, that they have current high-quality knowledge levels and skill set, and that even though they’ve come to the back of beyond, they’re learning and expanding their skills’,” she said
Dr Street said she had worked to create a culture where registrars received training which aligned with their individual needs and goals, and where other doctors were happy to swap shifts or rotations in order to help each other out.
“If an amazing opportunity comes up to assist on a caesarean or to attend the operating theatre or to do something that you know that your trainees are still needing for their logbooks or for their other training requirements, [try] building in a bit of a culture of saying, ‘all right, well if you’re rostered to the ward that day when this great opportunity comes up, and the person who’s rostered for that opportunity happens to not be on a training pathway, let’s just work together and ensure that the person with a logbook requirement [gets in there]’,” she said.
Rural Medicine Australia 2026, jointly hosted by ACRRM and the RDAA, is being held at the Adelaide Convention Centre from 22 to 24 October.
