doctors in remote queensland - ruralhealth.org.auqueensland: minimum data set report at 30 november...
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Chris MitchellDavid WellmanDaniel Gullo
To ensure optimal health workforce to enhance the health of Queensland communities
Doctors in remote Queensland:They don’t stay, do they?
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Health Workforce QueenslandHealth service
development
•Research •Data collection and analysis•Understanding/insight•Workforce planning •Workforce development •Evaluation•Advocacy
Placement
• Attraction • Recruitment (locum and permanent)
• Migration • Settlement
Retention
• Client support services
• Family support • Professional development
• Networking and events
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Health Workforce QueenslandHealth service
development
•Research •Data collection and analysis•Understanding/insight•Workforce planning •Workforce development •Evaluation•Advocacy
Placement
• Attraction • Recruitment (locum and permanent)
• Migration • Settlement
Retention
• Client support services
• Family support • Professional development
• Networking and events
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Rural/remote health workforce retention• Retaining workers is a global problem (WHO, 2010)• Attraction of workers to rural/remote also difficult• Government programs target attraction and retention strategies • Research increasing, much focussed on medical practitioners
Evidence of Retention strategies• Geographic location• Size of community, attributes of available health services• Rural background of practitioner• Rural placements during training
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Defining remotenessFrom mid‐2009 until recently ASGC ‐Remoteness Areas (RA)
•RA1 = major cities•RA2 = inner regional•RA3 = outer regional•RA4 = remote•RA5 = very remote
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Defining remoteness• From mid‐2009 until recently ASGC ‐ Remoteness Areas (RA)• RA1 = major cities• RA2 = inner regional• RA3 = outer regional• RA4 = remote• RA5 = very remote
• This year moved to Modified Monash Model (MMM), 7 levels of remoteness
• Prior to 2009, Rural Remote & Metropolitan Areas (RRMA), 7 levels of remoteness = going gradually as well
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What is known about Dr Movements in remote, rural and regional Qld?
Health Workforce Queensland, 2014. Medical practice in remote, rural and regional Queensland: Minimum data set report at 30 November 2013.
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Medical practitioner arrivals/commencements
Number of arrivalsInner regional
nOuter regional
n Remote
nVery remote
nTotal
Arrived at 1 practice 286 200 49 21 556
Arrived at 2 practices 38 20 4 1 63
Arrived at 3 practices 7 1 1 ‐‐ 9
Arrived at 4 practices 1 1 ‐‐ 1 3
Arrived at 5 practices 1 ‐‐ ‐‐ 1 2
Practitioner n 333 222 54 24 633
% of total RA practitioners 32% 29% 60% 55% 32%
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Research questionsHigh churn of practitioners in remote/very remote is known, BUT:
• Where do they come from?• Where do they go after their placement ends? • During 10 years of practice, how much time is spent in rural/remote?
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MethodRetrospective longitudinal cohort analyses using 10 years of data from the MDS database of Qld medical practitioners:
• Cohort 1: 2003 RA4 commencements• All ‘remote’ practitioner commencements from 1 Dec, 2002, to 30 Nov, 2003
• Cohort 2: 2004 RA4 commencements• All ‘remote’ practitioner commencements from 1 Dec, 2003, to 30 Nov, 2004
• Cohort 3: 2003 RA5 commencements• All ‘very remote’ practitioner commencements from 1 Dec, 2002, to 30 Nov, 2003
• Cohort 4: 2004 RA5 commencements• All ‘very remote’ practitioner commencements from 1 Dec, 2003, to 30 Nov, 2004.
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Results
Number of medical practitioners and commencements by cohort.
CohortPractitioner
n
Commencements during cohort year
n
Practitioners with multiple commencements
nCohort 1 RA4 2003 18 19 1Cohort 2 RA4 2004 27 33 5Cohort 3 RA5 2003 21 22 1Cohort 4 RA5 2004 31 38 6
N = 97
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10-year retention Cohorts 1 & 2 (remote)
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10-year retention Cohorts 3 & 4 (very remote)
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Mean length of stay at commencing practice by cohort group
CohortCommencement
nYears M SD Range
Cohort 1 RA4 2003 19 2.30 3.11 0.04 ‐ 11.27 years
Cohort 2 RA4 2004 33 3.10 3.71 0.16 ‐ 10.54 years
Cohort 3 RA5 2003 22 1.30 1.38 0.09 ‐ 5.91 years
Cohort 4 RA5 2004 38 2.02 2.80 0.03 ‐ 10.54 years
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MDS history of placements
Practice commencements
Cohort 1 2 3 4 5 6+ Total
Cohort 1 RA4 2003 7 4 1 2 1 3 18
Cohort 2 RA4 2004 6 7 4 5 1 4 27
Cohort 3 RA5 2003 7 7 1 2 3 1 21
Cohort 4 RA5 2004 9 5 7 3 2 5 31
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Where did they come from?From urban From remote, rural and regional
Other locations
Unknown location
Cohort Urban
QH urban transfer
QH rural
transfer
Other rural
location
ACCHS(mainly rural & remote)
QH RA5 transfer
Over‐seas
Inter‐state
Unknown QH
transfer Unknown
Cohort 1 1 1 ‐ 4 1 3 4 ‐ 3 1
Cohort 21
‐ 6 11 1 2 4 2 6 4
Cohort 3 ‐ ‐ 4 1 ‐ 3 3 1 6 3
Cohort 4 ‐ 1 6 2 ‐ 4 6 ‐ 11 4
Total 2 2 16 18 2 12 17 3 26 12
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Where did they go to over the next 10 years?
To urban To remote, rural and regional Qld Other locations Unknown/other
Cohort Urban RA2 RA3 RA4 RA5Over‐seas
Inter‐state
Un‐known
Retired or leave
Cohort 1 1 7 10 11 1 ‐ 1 8 ‐
Cohort 2 1 8 21 14 2 ‐ ‐ 8 2
Cohort 3 ‐ 3 4 2 5 2 2 9 1
Cohort 4 4 5 21 3 9 ‐ 2 10 1
Total 6 23 56 30 17 2 5 35 4
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How many years of practice covered by MDS data and how many of those years spent in rural/remote practice?
Cohort Years rural Years total % rural
Cohort 1 122 yrs 141 yrs 86.5 %
Cohort 2 195 yrs 230 yrs 84.8 %
Cohort 3 124 yrs 133 yrs 93.2 %
Cohort 4 202 yrs 223 yrs 90.6 %
Total 643 yrs 727 yrs 88.4 %
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What was their AHPRA registration site in Jan, 2015?
No longer registered
Qld urban
Interstate urban
QLD RA2
QLD RA3
QLD RA4
QLD RA5
Interstate RA2‐3
Interstate RA4‐5
Cohort 1 5 3 1 ‐ 4 2 ‐ 1 2
Cohort 2 5 5 2 ‐ 6 6 1 ‐ 2
Cohort 3 5 6 2 1 2 ‐ 3 2 1
Cohort 4 4 8 1 2 7 1 3 3 1
Total 19 22 6 3 19 9 7 6 6
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Discussion
•Poor retention rates in remote/very remote Qld•Many doctors came from a rural/remote placement •Many doctors DO stay rural/remote over the next 10 years
•Underlying employment / staffing model of remote rotations are common and often doctors return after a period in rural/regional
•Very few doctors went urban
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Future implications• Improved selection processes for remote placements•Short term placements selected on previous exposure to rural/remote communities
• Improved support and career management for doctors interested in remote practice
•Tiered approach to placements so that remote/very remote is generally not a first non‐urban placement
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Thank You