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Carrots and Sticks – The (not so) nuanced art of attracting doctors to rural Australia

It’s not a new problem. Australia, with it’s metro-educated medical workforce, attractive coastal cities and ‘daunting’ outback, often finds it hard to lure doctors away from friends, family and their café latte lifestyles.

Here is a synopsis of historical strategies tried:

  • Pay them more to go bush – rural incentive schemes
  • Make them go bush – bonded medical school schemes
  • Import them from overseas, then send them to rural areas – provider number restrictions
  • Recruit students from country towns – then train them in the cities and hope they go back
  • Train them on site – rural medical schools, then hope they stay
  • Just train more of them – increase in overall medical school numbers

Despite all of the above (over several incarnations) there remains a stubborn imbalance – about 400 patients for every doctor in metro areas vs. up to 3,000 in rural and remote areas.

In 2015 the GP Rural Incentives Program (GPRIP) rolled out the latest scheme to try to tempt doctors into 450 small towns across the country. In essence, the annual incentive to work in towns with under 5,000 residents increased from $12,000 to up to $23,000, and for those working in remote areas, an increase from $47,000 to as much as $60,000.

Nice carrots, on the face of it, but there is a stick or two in there. The qualifying time to receive the incentive increases from 6 months to 2 years for doctors in rural and regional areas, while doctors in remote locations will have to wait 12 months, where before there was no wait. Also, up to 5,000 doctors working in regional centres with populations over 50,000 lose previous incentives.

So will it work? If the past is any guide to the future, ‘unlikely’ seems the most appropriate response. After tax, the cash-in-hand incentive ranges from $7000 – $15,000 (about a 5-10% increase in income, at best, based on an average doctors income). The longer qualification period might even lead to an overall negative impact.

You may have gathered that I am skeptical of the financial incentives on offer, but I would suggest, further, that I am not sure that money is the solution at all.

When I first talk to a doctor looking to move I always open with the same question, “What is your primary motive for wanting to change jobs?” I swear – no one ever said money. ‘Lifestyle, professional satisfaction, career advancement, better family life, security, community, more time off…’ you name it – anything but money.

It strikes me that any scheme designed to attract Australian doctors into rural areas needs to understand what their real motivations are, and then address them. It’s hard work – it requires a robust marketing strategy to attract interest in the first place and then a tailored solution for each doctor based on his or her individual needs. Now that’s a carrot worth considering!

And carrots should work. May I point out that there are plenty of doctors working in rural and remote Australia that wouldn’t have it any other way. Many of them, if asked, would happily act as advocates for the lifestyle.

In the absence of a decent recruitment strategy I regret that I must predict that good old-fashioned coercion of overseas doctors to go bush in exchange for the privilege of living and working in Australia is likely to continue as the most effective programme on offer.

Stick wins again.

Dr John Bethell, Director – Wavelength International

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