Geographical classifications to guide rural health policy in Australia

The Australian Government's recent decision to replace the Rural Remote and Metropolitan Area (RRMA) classification with the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA) system highlights the ongoing significance of geographical classifications for rural health policy, particularly in relation to improving the rural health workforce supply. None of the existing classifications, including the government's preferred choice, were designed specifically to guide health resource allocation, and all exhibit strong weaknesses when applied as such. Continuing reliance on these classifications as policy tools will continue to result in inappropriate health program resource distribution. Purely 'geographical' classifications alone cannot capture all relevant aspects of rural health service provision within a single measure. Moreover, because many subjective decisions (such as the choice of algorithm and breakdown of groupings) influence a classification's impact and acceptance from its users, policy-makers need to specify explicitly the purpose and role of their different programs as the basis for developing and implementing appropriate decision tools such as 'rural-urban' classifications. Failure to do so will continue to limit the effectiveness that current rural health support and incentive programs can have in achieving their objective of improving the provision of health care services to rural populations though affirmative action programs

Will Australian rural clinical schools be an effective workforce strategy? Early indications of their positive effect on intern choice and rural career interest

Objective: To use short-term indicators (hospital internship choice, and interest in a future rural career) to assess how the University of Queensland rural clinical school is meeting its program objectives. Design: Cross-sectional quantitative data collected through self-report questionnaires. Setting: University of Queensland rural clinical school (UQRCS). Participants: Year 4 students who attended the UQRCS for their entire clinical year in 2006. Results: Most students were from an urban background. Over the year, interest in a future rural medical career increased measurably across the cohort. The most important factors in choosing to study at the UQRCS were the quality of teaching, level of student contact with clinical teachers, increased patient access, and accommodation facilities. Comparison of graduates’ choice of internship location for 2006 compared with 2005 showed a trend away from urban or metropolitan toward regional or rural hospitals. Conclusions: Our results suggest that the primary attraction of UQRCS is the quality of education, and rural undergraduate training is a popular choice for urban students. Although the long-term effect on rural medical workforce remains to be determined, the trend at UQRCS of new graduates choosing non-urban internships is encouragin

Primary medical care workforce enumeration in rural and remote areas of Australia: Time for a new approach?

The rural and remote primary medical workforce continues to struggle to meet community needs. This paper looks at the strengths and weaknesses of the various datasets used to measure workforce. The analysis concludes that no current data set adequately describes workforce from a community need perspective. In particular, activity based data sets based on claims data do not capture issues such as service mix or the importance of issues outside activity collections, such as time on call. The paper calls for a new approach to workforce measurement based on a community needs model.Robert W. Pegram, John S. Humphreys and Gordon Calcin

Overseas-trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains

Objective: To examine how OTDs and staff in rural and remote Indigenous health contexts communicate and negotiate identity and relationships, and consider how this may influence OTDs' transition, integration and retention. Method: Ten case studies were conducted in rural and remote settings across Australia, each of an OTD providing primary care in a substantially Indigenous practice population, his/her partner, co-workers and Indigenous board members associated with the health service. Cases were purposefully sampled to ensure diversity in gender, location and country of origin. Results: Identity as 'fluid' emerged as a key theme in effective communication and building good relationships between OTDs and Indigenous staff. OTDs enter a social space where their own cultural and professional beliefs and practices intersect with the expectations of culturally safe practice shaped by the Australian Indigenous context. These are negotiated through differences in language, role expectation, practice, status and identification with locus with uncertain outcomes. Limited professional and cultural support often impeded this process. Conclusion: The reconstruction of OTDs' identities and mediating beyond predictable barriers to cultural engagement contributes significantly not only to OTDs' integration and, to a lesser extent, their retention, but also to maximising effective communication across cultural domains. Implications: Retention of OTDs working in Indigenous health contexts rests on a combination of OTDs' capacity to adapt culturally and professionally to this complex environment, and of effective strategies to support them