3.22 Recruitment and retention of staff
Why is it important?
The capacity to recruit and retain appropriate staff is critical to the appropriateness, continuity and sustainability of health services including Aboriginal and Torres Strait Islander primary health care services. Staff recruitment and retention is particularly important in rural and remote areas as 65% of Indigenous Australians live outside the major cities.
In 2013, there were 91,467 medical practitioners registered in Australia (excluding provisional registrants), of whom 90% were currently employed in medicine. Many of those not working in medicine were overseas, retired or on extended leave. The overall supply of clinicians increased between 2004 and 2013 (from 299 to 365 FTE per 100,000 population). Supply was not uniform across the country; it was greater in major cities (426 FTE per 100,000 population) than in remote/very remote areas (257 FTE per 100,000 population). While GP rates per 100,000 were similar across geographic areas, the main differences were in the supply of specialists—with lower rates in remote/very remote areas (AIHW 2014s).
A survey of the rural workforce in November 2013 found that of the 7,638 GPs working in rural Australia, an estimated 38% had been in their current practice for less than two years. In remote and very remote areas, 42–44% of GPs had been working in their current practice for less than two years.
National Health Workforce Data indicate that in 2013, 86% of nurses were currently employed in nursing (AIHW 2014x). In 2012, 89% of dental and oral health therapists were employed in dentistry. For other health professionals, the proportions working in their field were as follows: physiotherapists (84%), pharmacists (85%), psychologists (87%), Aboriginal and Torres Strait Islander health practitioners (88%), optometrists, chiropractors and osteopaths (89%), and occupational therapists and podiatrists (92%) (AIHW 2013a). Many of those not working in their field were not looking for work in their field.
In 2013, the number of employed psychologists was lowest in areas with high proportions of Indigenous Australians in the population (49 per 100,000 in areas with 20% or more Indigenous Australians in the population compared with 112 per 100,000 in areas with less than 1%). The pattern was similar for pharmacists.
As at 30 June 2013, there were around 4,000 full-time equivalent health (clinical) staff and 2,600 full-time equivalent administrative and support staff positions within Aboriginal and Torres Strait Islander primary health care organisations funded by the Australian Government. In the period 1999–2000 to 2012–13, there was an increase of 238% in the workforce of the Australian Government funded Aboriginal and Torres Strait Islander primary health care organisations. Despite this growth, the vacancy rate has remained steady with an estimated 6% of health positions and 2% of administrative and support staff positions vacant at 30 June 2013, compared with 7% and 3% at June 2000.
The highest number of health staff vacancies in June 2013 was for Aboriginal health workers (58) followed by emotional and social wellbeing workers (35), and nurses (30). In June 2013, the proportion of health staff positions that were vacant ranged from 9% in outer regional areas to 4% in major cities and very remote areas. For other positions, 3% were vacant in remote areas to 1% in outer regional areas.
A senate inquiry into factors affecting the supply of health services and medical professionals in rural areas (SCARC 2012) has identified a complex interplay between environmental, personal and work-related factors. For medical practitioners, professional considerations include: heavy workloads and on-call hours, limited professional development opportunities, and inadequate remuneration. Other factors include loss of anonymity, professional isolation, and lack of opportunities for spouses and children. A growing trend towards medical specialisation was also identified as reducing generalist training pathways—the area of medical practice most required in rural and regional areas.
A 2007 study identified doctors who were satisfied with their current medical practice intended to remain in rural practice for 40% longer than those who were not satisfied (11.5 years compared with 8.2 years). GPs content with their life as a rural doctor intended to remain in rural practice 51% longer than those who were not content (11.8 years compared with 7.8 years) (Alexander et al. 2007).
Recruitment and retention of allied health professionals is also influenced by opportunities for training, development and career progression; remuneration and recognition; supervision and support; and workload/task variety. Additional challenges in delivering services in non-metropolitan areas include funding arrangements, social barriers and isolation, employment for spouses and schooling/childcare for children, and access to appropriate, affordable and secure accommodation (SCARC 2012). Many of these factors can, at least in part, be addressed by effective management and community support (Schoo et al. 2005). Rural lifestyle, diverse caseloads, autonomy and community connectedness have been cited as positive influences (Campbell et al. 2012).
A study of drug and alcohol workers found that Indigenous workers experienced above average levels of job satisfaction and relatively low levels of exhaustion; however, they also experienced lower levels of mental health and wellbeing and greater work/family imbalance. The report highlighted the importance of workforce development strategies that focus on culturally appropriate, equitable and supportable organisational conditions including addressing stress, salaries, benefits and opportunities for career and personal growth (Roche et al. 2012).
Better national data are needed on this important issue. The statistics analysed here focus on a few aspects of a complex set of issues. Recruitment and retention issues are significant for health services located in rural and remote Australia. Little is known about the turnover of staff in Aboriginal and Torres Strait Islander primary health care services and how this compares with mainstream services. Another issue is achieving incomes for doctors in rural and remote locations that are competitive with incomes earned by GPs in metropolitan private practice.
The National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework (2011–2015) provides a mechanism to assist planning, prioritising, target setting, monitoring and reporting of progress in Aboriginal and Torres Strait Islander health workforce capacity building. One of the key aims of the framework is to support the recruitment and retention of the Aboriginal and Torres Strait Islander health workforce and non-Indigenous health practitioners working in Aboriginal and Torres Strait Islander health settings.
In the Health and Hospitals Fund Regional Priority Rounds, funding of $53.4 million was allocated for 8 projects to specifically attract, train and retain health practitioners and students by building staff accommodation in rural, regional, and remote areas.
The Remote Area Health Corps has been in operation since October 2008. The programme assists delivery of primary health care services in remote NT Indigenous communities by supplementing the efforts of Aboriginal Medical Services and the Northern Territory Department of Health to recruit health professionals from urban-based practices and deploy them for short-term placements in remote NT communities, where health resources are in high demand.
The Indigenous Australians' Health Programme, which started on 1 July 2014, consolidates existing funding streams for primary health care, child and maternal health programmes, Stronger Futures in the Northern Territory and the Aboriginal and Torres Strait Islander Chronic Disease Fund (see Policies and Strategies section).
The Australian Government provides GP registrar training posts in Aboriginal health services.
Recognition of Aboriginal and Torres Strait Islander health as an identifiable specialty is also considered to be important in improving services and retaining highly skilled clinicians. Strong cooperation and collaboration between the health and education portfolios is vital for improving recruitment and retention of health staff.
Figure 3.22-1 shows the number of employed medical practitioners (FTE per 100,000 population) by remoteness and main field of medicine in 2013. Data are presented on the following fields of medicine: general practitioner, hospital non-specialist, specialist, specialist-in-training, other clinician and non-clinician. Data are presented separately for: major cities; inner regional; outer regional; remote/very remote; and Australia as a whole. Supply was not uniform across the country, being greater in major cities than in remote/very remote areas. While GP rates per 100,000 were similar across geographic areas, the main differences were in the supply of specialists—with lower rates in remote and very remote areas.
Source: National Health Workforce Data Set: Medical Practitioners 2013 (AIHW 2014s)
Figure 3.22-2 shows the proportion of GPs, by length of stay in current practice and remoteness area as at 30 November 2013. Data are presented separately for: inner regional; outer regional; remote; very remote; and total. Data are presented for GPs who have been in their current practice for: less than 12 months; 1-2 years; 2-3 years; 3-5 years; 5-10 years; and 10-20 years. The figure shows that of the GPs working in rural Australia, 38% had been in their current practice for less than two years. In remote and very remote areas, 42–44% of GPs had been working in their current practice for less than two years.
Source: AIHW analysis of Rural Workforce Agencies NMDS
Figure 3.22-3 shows the number of health (clinical) and administrative and support staff vacancies as a proportion of total positions (FTE) in Indigenous primary health care organisations as at 30 June 2013. The figure shows that the proportion of health staff vacancies ranged from 9% in outer regional areas to 4% in major cities and very remote areas. For administrative and support positions, 3% were vacant in remote areas to 1% in outer regional areas.
Source: AIHW OSR data collection (AIHW 2014a)
Figure 3.22-4 shows vacancies, as a proportion of total positions, for health/clinical positions, administrative/support positions and total positions, in Indigenous primary health care organisations. Data are presented annually from the year ending 30 June 2000 to 30 June 2013. The data shows that during this period, vacancy rates have remained fairly steady with 6% health/clinical positions vacant and 2% admin/support positions vacant at 30 June 2013 compared to 7% of health positions and 3% of admin/support positions being vacant at 30 June 2000.
Source: AIHW analysis of SAR, DSR and OSR data collections