Why is it important?:The capacity to recruit and retain appropriate staff is critical to the sustainability of Aboriginal and Torres Strait Islander primary health care services, particularly in rural and remote areas. Recruitment and retention is also an important issue for mainstream services and GPs in rural and remote areas.
Findings:In 2007, there were 77,193 registered medical practitioners in Australia of which 87% were employed in medicine. Many of those not working in medicine were working in medicine overseas, were retired or were not working.
In 2008–09, 73% of full-time equivalent GPs worked in capital cities or other metropolitan areas and only 2% in remote areas. A survey of the rural workforce conducted in November 2008 found that of the 4,626 GPs working in rural Australia, an estimated 34% had been in the current practice for two years or less. In remote areas, between 49% (remote centres) and 52% (other remote areas) had been in the current practice for 2 years or less (Health Workforce Queensland & New South Wales Rural Doctors Network 2009).
In 2007, 86% of nurses were currently employed in nursing, and in 2006, 86% of dental therapists/oral health therapists were employed in dentistry.
For other health professionals, the proportion working in their field ranged were as follows: 80% for physiotherapists (2002 data), 86% for occupational therapists (2002–03 data), 87% for psychologists (2003 data), and 92% for podiatrists (2003 data). Many of those not working in their field were not looking for work in their field.
In 2008-09, there were 2,839 full-time equivalent health (clinical) staff and 1,589 full-time equivalent administrative and support staff positions within Aboriginal and Torres Strait Islander primary health care services funded by the Australian Government. An estimated 8% of health positions and 3% of administrative and support staff positions were vacant.
In the 15 years from 1995–96, Australian Government funding for these services has increased by 255% in real terms. In the six years to June 2009, there has been an increase of 60% in the workforce of Aboriginal and Torres Strait Islander primary health care services funded by the Australian Government.
The highest number of health staff vacancies in June 2008 were for Aboriginal Health Workers (84), followed by social and emotional wellbeing workers (47), nurses (39) and doctors and specialists (34). For services located in major cities and regional areas, between 8 and 9% of health positions were vacant, but for remote and very remote areas, vacancies were between 10 and 12%. Vacancies for administrative and support positions were highest for positions located in major cities (7%) followed by remote areas (5%).
Of the 256 health staff positions that were vacant, 66% had been vacant for 26 weeks or more. Of the 64 administrative and support staff vacancies, 51% had been vacant for this length.
A study of GPs conducted in 2001 found that important factors determining general practice retention in rural and remote areas were: professional considerations, particularly on-call arrangements; professional support; variety of rural practice; local availability of services; and regional attractiveness (Humphreys et al. 2002).
Another study found that doctors who were satisfied with their current medical practice intend to remain in rural practice for 40% longer than those who are not satisfied (11.5 years compared with 8.2 years) (Alexander & Fraser 2007). GPs content with their life as a rural doctor intend to remain in rural practice for 51% longer than those who are discontented (11.8 years compared with 7.8 years). Continuing professional development, training opportunities, professional support and networking as well as financial support were identified as priorities for GPs, and training in Indigenous health as a key information deficit.
Implications:The measures reported here focus on a few aspects of a complex set of issues. They suggest there are challenges for Aboriginal and Torres Strait Islander primary health care services in recruiting particularly clinical staff to meet the growth in the sector. There are no data on state and territory health services in equivalent circumstances, although it is known they also face significant recruitment and retention issues. Recruitment and retention issues are most significant for Aboriginal and Torres Strait Islander health services and mainstream services located in rural and remote Australia. Little is known about the turn-over of staff in Aboriginal and Torres Strait Islander primary health care services and how this compares with mainstream services. Another issue is doctors’ incomes and achieving rates that are competitive with metropolitan private practice.
In November 2008, COAG committed up to $1.6 billion over four years to the National Partnership on Closing the Gap in Indigenous Health Outcomes. Building the capacity of the health workforce is recognised as an essential element of this work. The capacity of the primary care workforce in Indigenous and mainstream health services will be expanded to increase the uptake of health services by Aboriginal and Torres Strait Islander peoples. Measures include communication and marketing activity to attract more Indigenous people to work in health and more people to work in Indigenous health; additional workforce including Aboriginal and Torres Strait Islander Outreach Workers, health professionals and practice managers; and additional nursing scholarships, registrar training posts and nurse clinical placements.
The Pathways into the health workforce for Aboriginal and Torres Strait Islander people: a blueprint for action is designed to provide Australian governments with advice and strategies to maximise Aboriginal and Torres Strait Islander participation in the health workforce through promoting and improving pathways between school, vocational education, training and higher education; and retaining and building the capacity of the existing workforce by addressing the ongoing support and career development needs (NATSIHC 2008b). 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. The need for a cross portfolio approach is reinforced by the Blueprint for Action as well as the Higher Education Review.
Figure 187 – Proportion of selected staff vacancies in Aboriginal health care services, by remoteness area, 2008-2009
Source: AIHW analysis of Service Activity Reporting
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Figure 188 – Full-time equivalent health staff and administrative and support staff vacancies, Aboriginal and Torres Strait Islander primary health care organisations, by length of time vacant, 30 June 2008
Source: AIHW analysis of Service Activity Reporting
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Figure 189 – Proportion of GPs in practice by length of service and remoteness, November, 2008
Source: AIHW analysis of Combined Rural Workforce Agencies National Minimum Data Set report
Text description of figure 189 (TXT 1KB)