It’s more than money: policy options to secure medical specialist workforce for regional centres

Objectives Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of 'regional' hub-and-spoke specialist models of service delivery.Methods The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies.Results This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives.Conclusions Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists.What is known about the topic? Rural origin increases likelihood of long-term retention to rural locations, with rural clinical school training associated with increased rural intent. Recruitment and retention policy has been directed at general practitioners in rural communities, with little focus on regional centres or medical specialists.What does this study add? Rural origin is associated with regional centre recruitment. Professional, social and locational factors are all moderately important in both recruitment and retention. Specialist medical training for regional centres ideally requires both generalist and subspecialist skills sets. Workforce policy needs to address modifiable factors with four groups, namely commonwealth and state governments, specialist medical colleges and local communities, all needing to align their activities for achievement of long-term medical workforce outcomes.What are the implications for practitioners? Modifiable factors affecting recruitment and retention must be addressed to support specialist models of care in regional centres. Modifiable factors relate to maintenance of a critical mass of practitioners, training a fit-for-purpose workforce and coordinated effort between stakeholders. Although remuneration is important, the decision to stay relates primarily to non-financial factors

The role of gender in the migration practices and aspirations of Australian rural youth

Youth out-migration, and youth net migration loss, have been prevailing trends in Australia’s population geography since the early decades of the twentieth century (Hugo 2004). In the second decade of the twenty-first century this trend has become more entrenched, with it being almost de rigueur for many Australian youth to leave their rural towns and regions in search of new opportunities and experiences elsewhere (Argent and Walmsley 2008). In recent years there has been much public and academic debate around why rural youth, both in Australia and in other countries, have a higher propensity to migrate than their metropolitan counterparts and what this means for those communities they leave behind (Argent and Gibson 2008, Connell and McManus 2011, Stockdale 2006). Concern centres not just on the sheer loss of young people from demographically and economically struggling regions and communities but also on the extent to which they can be encouraged to return at some later stage of their life course and assume, inter alia , key local leadership and volunteer roles (Stockdale 2006). Gender has formed an important dimension in analyses of rural youth out-migration (Ni Laoire 1999, 2001, Alston 2004). However, the prevalence of return migration among young out-migrants, and the role of gender in influencing this process, has largely remained anecdotal. This chapter focuses on the contemporary rural population issue of youth out-and- return-migration in Australia with a specific concern to understand how gender influences the ‘cultures of migration’ that inform decisions to leave rural locations and how gender might influence the return migration aspirations of rural youth out-migrants