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Money can’t buy everything

It will take more than higher wages to get workers to the bush, reports Annie May.

Financial incentives alone will not attract more health workers to the bush, a new report has found.

Instead, governments need to offer incentive “bundles” that address other important factors that influence the decision-making of workers regarding whether they will go to, stay, or leave rural and remote areas. These factors include living environments, working conditions and environments and development opportunities.

“Our study shows non-financial incentives may be just as important if not more important,” said John Humphreys, co-author and researcher at the Australian Primary Health Care Research Institute.

Humphreys said governments should consider “comprehensive strategies” that cover housing, transport, infrastructure and professional support, as well as remuneration.

“Incentives bundled in a strategic workforce retention strategy are likely to be the most effective,” the report said.

Housing is a good example, he said.

“The cost of renting a house in central Queensland for a nurse is huge – far more than their salary,” he said.

“So you need to have subsidised housing or provide housing.”

While professional autonomy, responsibility, and variety have been identified as positive aspects of rural practice, the isolation of health workers in rural and remote locations may also limit professional development, the report found.

Survey studies have revealed lack of continuing professional development (CPD) opportunities and limited career pathways contribute to the decision of health workers to leave an area. However, where these opportunities and resources are available, these factors have been associated with the decision to stay, said the report.

A number of strategies have been used to address the professional development needs of rural health workers including traineeships, CPD outreach, telehealth, distance learning and library access.

Newly emerging technologies can assist with distance learning which in turn may help reduce the sense of professional isolation for rural and remote health workers.

“The benefit of that approach was the infrastructure support stayed in the community even when the worker left, Humphreys said.

Family is a major factor in the recruitment process, as it’s not just the individual that is moving but the entire family.

Support in securing housing and spousal employment has been suggested as mechanisms which may help attract and retain workers, the report said. Limited educational opportunities for children are also a factor.

Along with focusing on financial initiatives, the government has made going bush for a few years a condition of study or a requirement of receiving a visa.

But Humphreys said that approach wasn’t supported by the evidence.

The report found requiring health workers to go bush for a set time - as part of a visa requirement, for example - was effective for the duration of the obligation period “but probably not beyond”.
Humphreys said high workforce turnover translates to “very high recruitment costs”.

It costs $74,000 to replace a doctor, $30,000 to replace a health service manager and $20,000 to replace a nurse.

Therefore offering a bundle of support to keep existing workers can be cost neutral.

“It’s about using resources better,” Humphreys said.

The cost can’t just be measured in dollars.

“High workforce turnover also results in significant indirect costs such as loss of skills and experience, restricted access to health services and compromised quality of care,” he said.

“Increasing the length of service for rural and remote health workers through financial incentives alone is unlikely to adequately address the problem.”

Rural and Regional Health Minister Warren Snowdon, who launched the report, said the study was “timely”.

But he warned improving retention rates was only half the solution.

“We’ve got huge issues with recruitment as well as retention,” he said.

“The average age of most GPs working in rural communities is well over 50. People are wondering who’s going to replace them.”

Report co-author, Professor Wakerman, director of the Centre for Remote Health in Alice Springs, said a comprehensive workforce strategy was needed.

“To have any chance of success, a strategy needs to consider effective management, governance and leadership, sustainable and flexible funding and well supported information management systems and infrastructure,” he said.

“Appropriately targeted incentives such as paid housing could result in a greater length of service for health workers and consequently improved patient care without additional cost to health services.”

The retention strategies report was released alongside a complementary report: Improving Workforce Retention.

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