Coping with medical workforce shortages in the bush

Associate Professor Richard Murray of the Rural Clinical School at James Cook University in Townsville examined the rural solution to medical workforce shortages in an article for the latest issue of the Medical Journal of Australia.

Currently 34 per cent of all Australians and 70 per cent of Aboriginal and Torres Strait Islander peoples live outside major cities.

But Assoc Prof Murray says the ratio of health workers to population outside urban areas is much lower. The national and international shortage of doctors and nurses will widen the areas affected.

"As the workforce tide recedes, … it will further expose the poor and the disadvantaged as well as the populations of regional and outer metropolitan areas and the less alluring suburbs," he said.

"What lessons might be adapted from the bush?

"And how are the health care needs of rural, remote and Indigenous communities to be met?"

Practitioners already affected by workforce shortages in rural and remote communities have been forced to take a more flexible approach to health care.

Assoc Prof Murray says the 'jack of all trades' doctor is characteristic of rural and remote areas and will need to be more generally used across the health system. Also, the circumstances of practicing in a remote community mean that clinical task delegation and a team-oriented approach - two suggested methods of tackling the wider workforce shortage - are already widely in use.

"Mutual reliance and teamwork are essential, and workforce flexibility is well accepted in rural and remote areas," he added.

"There is room for expanding the scope of clinical practice by non-medical clinicians, both in an independent codified manner (eg, nurse practitioners), or through flexible local medical delegation of clinical tasks (eg, involving practice nurses, Aboriginal health workers, and therapists)."

The rural medical generalist should be properly recognised as a distinct medical specialty, and shorter training pathways should be created to equip a range of other health workers for expanded clinical roles, Assoc Prof Murray said.

"We know what needs to be done to build rural workforce," he added. "Rural and regional recruitment and education of students, linked with regional pathways for training in specialties after graduation are strategies that are backed by evidence here and overseas."

"Health leaders would do well to study rural solutions - they will be needed in cities before too long."

The Medical Journal of Australia is a publication of the Australian Medical Association.