Recruitment and Retention of Rural Physicians

Abstract

What is known? • Recruitment and retention initiatives for rural physicians can address health inequities in rural and remote communities. Report: Recruitment and retention initiatives for rural medical workforce Spatial Determinants of Health Lab 2 DOI: BACKGROUND Rural and remote communities comprise around 32% and 22% of Australia's and Canada's population. However, only 14% and 16% of family physicians in Australia and Canada, respectively, practice in these communities, resulting in a disproportion in access as compared with urban areas. An erosion of health services occurs when the number of physicians and other health care providers in a region is insufficient or these professionals are non-existent. Even when existing in a rural and remote region, providers are often overburdened. Inaccessibility to services in rural and remote communities' results in poor health outcomes for all involved. In Canada, 1 in 7 physicians will leave rural practice within two years. Strategies to address these turnover rates and the lessening interest in entering rural practice have focused on supporting recruitment and retention initiatives (RnR) to first bring physicians into rural practice and then encourage physicians to continue in rural practice beyond the short-term. These programs have so far been insufficient or ineffective to address the lack of physicians in rural and remote areas. A review of recent literature related to RnR initiatives focused on rural physicians in Australia and Canada was conducted to investigate the strengths and limitations of initiatives. Further, this review critically examines the short and long-term feasibility of initiatives and develops a conceptual framework for designing or examining RnR initiatives. KEY FINDINGS Recruitment based on rural origin alone is insufficient Being a medical student with rural origin is no longer the strongest predictor of future rural practice. Future strategies may consider alternatively targeting rural secondary students. Rural exposure is identified as key for increasing RnR Rural exposure has been shown to increase interest in future rural practice and can help shift urban-born perspectives on rural practice or lifestyle. Renumeration as an RnR strategy must be revaluated Rural GPs report willingness to receive lower salary in exchange for better administrative support, discouraging programs focusing on monetary compensation. More attention should be paid to social dimensions Spousal influence, resources for the physician's child(ren), and rural lifestyle may be important influences on both retention and departure from rural practice. Strong community support and appreciation encourages retention Community support may aid in physician transition from urban setting and provide tangible support. Multiple RnR methods can be implemented and adapted Given that previous initiatives are ineffective, innovative RnR methods may be adapated and could be informed from multiple frameworks.