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?

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 

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 

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

Defining remotenessFrom mid‐2009 until recently ASGC ‐Remoteness Areas (RA)

•RA1 = major cities•RA2 = inner regional•RA3 = outer regional•RA4 = remote•RA5 = very remote

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 

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.

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%

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?

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.

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

10-year retention Cohorts 1 & 2 (remote)

10-year retention Cohorts 3 & 4 (very remote)

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

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

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

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

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 %

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

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

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

Thank You