Rural health career pathways: research themes in recruitment and retention
Karin A. Fisher A C and John D. Fraser A BA Hunter New England Area Rural Training Unit, Hunter New England Health Service, Locked Bag 9783, New England Mail Sorting Centre, Tamworth, NSW 2348, Australia. Email: jfrase22@une.edu.au
B University of New England, School of Rural Medicine, Armidale, NSW 2351, Australia.
C Corresponding author. Email: karin.fisher@hnehealth.nsw.gov.au
Australian Health Review 34(3) 292-296 https://doi.org/10.1071/AH09751
Submitted: 2 March 2009 Accepted: 3 November 2009 Published: 25 August 2010
Abstract
Objective. This paper describes stages in the research literature related to recruitment and retention of health professionals to rural health careers.
Data sources. Electronic databases accessed included Medline, CINAHL, Social Sciences and Humanities. Key search terms included ‘high school’, ‘career choices’, ‘rural’, ‘attachment’, ‘recruitment’ and ‘retention’.
Data synthesis. We identified four stages: (1) making career choices; (2) being attached to place; (3) taking up rural practice; and (4) remaining in rural practice. This is termed the ‘rural pipeline’. However, as some stages of the ‘rural pipeline’ refer specifically to the medical profession, we propose an extension of the notion of the medical ‘rural pipeline’ to include other professions such as nursing, midwifery and allied health.
Conclusions. Utilising the ‘rural pipeline’ as a template for medicine, nursing and allied health would strengthen current approaches to the recruitment and retention of professionals in rural areas and provide a consolidated evidence base that would assist in policy development to improve availability and service provision of the rural health workforce. Future research that utilises a multidisciplinary approach could explore how the role and relationship between place and identity shape needs of career choices and would provide important information to advance the practical aspects supporting rural health career pathways.
What is known about the topic? A universal shortage of rural health professionals is a significant issue and is becoming critical in rural areas of Australia. Although there have been many studies, internationally and in Australia, there are several gaps in recruitment and retention of rural health professionals that require further attention.
What does this paper add? This paper examines workforce studies related to recruitment and retention of health professionals to rural health careers. The pipeline, however, refers mainly to the medical profession. The stages in this paper extend the notion of the medical ‘rural pipeline’ to include other professions such as nursing and allied health. This paper focusses on literature concerning developed countries such as Australia, New Zealand, Europe, the USA and Canada and identifies several proposed areas of future research.
What are the implications for practitioners? The literature clearly identifies important issues for the rural health workforce. Having an understanding of the key issues underpinning the recruitment and retention of health professionals in rural areas allows the development and enhancement of appropriate workforce strategies. Utilising the ‘rural pipeline’ as a template for medicine, nursing and allied health would strengthen current approaches to the recruitment and retention of professionals in rural areas and provide a consolidated evidence base.
Additional keywords: health workforce, health professionals.
[1]
[2] Millsteed J. Issues affecting Australia’s rural occupational therapy workforce. Aust J Rural Health 2000; 8(2): 73–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed | [verified 2 June 2009].
[29]
[30]
[31] Pathman DE, Konrad TR, King TS, Taylor DH, Koch GG. Outcomes of states’ scholarship, loan repayment, and related programs for physicians. Med Care 2004; 42(6): 560–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[32] Bärnighausen T, Bloom D. Financial incentives for return of service in underserved areas: a systematic review. BMC Health Serv Res 2009; 9(1): 86.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[33] Rabinowitz HK, Diamond JJ, Markham FW, Paynter NP. Critical factors for designing programs to increase the supply and retention of rural primary care physicians. JAMA 2001; 286(9): 1041–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[34] Wilkinson D, Laven G, Pratt N, Beilby J. Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors. Med Educ 2003; 37(9): 809–14.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[35] Wilkinson D, Birks J, Davies L, Margolis S, Baker P. Preliminary evidence from Queensland that rural clinical schools have a positive impact on rural intern choices. Rural Remote Health 2004; 4 340.
| PubMed |
[36] Chan BTB, Degani N, Crichton T, Pong RW, Rourke JT, Goertzen J, McCready B. Factors influencing family physicians to enter rural practice: does rural or urban background make a difference? Can Fam Physician 2005; 51(9): 1247.
[37] Playford D, Larson A, Wheatland B. Going country: rural student placement factors associated with future rural employment in nursing and allied health. Aust J Rural Health 2006; 14(1): 14–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[38] Daniels ZM, VanLeit BJ, Skipper BJ, Sanders ML, Rhyne RL. Factors in recruiting and retaining health professionals for rural practice. J Rural Health 2007; 23(1): 62–71.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[39] Tolhurst HM, Adams J, Stewart SM. An exploration of when urban background medical students become interested in rural practice. Rural Remote Health 2006; 6(1): 452.
| PubMed |
[40] Lea J, Cruickshank M. Factors that influence the recruitment and retention of graduate nurses in rural health care facilities. Collegian: Journal of the Royal College of Nursing Australia 2005; 12(2): 22–7.
| Crossref | GoogleScholarGoogle Scholar |
[41] Guion WK, Mishoe SC, Taft AA, Campbell CA. Connecting allied health students to rural communities. J Rural Health 2006; 22(3): 260.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[42] Dunbabin JS, Levitt L. Rural origin and rural medical exposure: their impact on the rural and remote medical workforce in Australia. Rural Remote Health 2003; 3 212.
| PubMed |
[43] Levett-Jones T, Lathlean J. Belongingness: a prerequisite for nursing students’ clinical learning. Nurse Educ Pract 2008; 8(2): 103–11.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[44] Levett-Jones T, Lathlean J, McMillan M, Higgins I. Belongingness: a montage of nursing students’ stories of their clinical placement experiences. Contemp Nurse 2007; 24(2): 162–74.
| PubMed |
[45] Sedgwick MG, Yonge O. ‘We’re it’, ‘we’re a team’, ‘we’re family’ means a sense of belonging. Rural Remote Health 2008; 8 1021.
| PubMed |
[46] Latham H, Hamilton M, Manners J, Anderson J. An innovative model improving success at university for regional Australians suffering educational and social disadvantage. Rural Remote Health 2009; 9 1128.
| PubMed |
[47] Ellsbury KE, Baldwin LM, Johnson KE, Runyan SJ, Hart LG. Gender-related factors in the recruitment of physicians to the rural northwest. J Am Board Fam Pract 2002; 15(5): 391–400.
| PubMed |
[48] Ozolins IZ, Greenwood G, Beilby J. Keeping women doctors in the country. Rural Remote Health 2004; 4(2): 268.
| PubMed |
[49] Bushy A, Leipert B. Factors that influence students in choosing rural nursing practice: a pilot study. Rural Remote Health 2005; 5(1): 387.
| PubMed |
[50] Schoo AM, McNamara KP, Stagnitti KE, Schoo A. Clinical placement and rurality of career commencement: a pilot study. Rural Remote Health 2008; 8 964.
| PubMed |
[51] Richards HM, Farmer J, Selvaraj S, Selvaraj H. Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish highlands. Rural Remote Health 2005; 5(1): 365.
| PubMed |
[52] Tracy S, Barclay L, Brodie P. Contemporary issues in the workforce and education of Australian midwives. Aust Health Rev 2000; 23(4): 78.
| PubMed |
[53] Fahey CM, Monaghan JS, Monaghan CFJ. Australian rural midwives: perspectives on continuing professional development. Rural Remote Health 2005; 5 468.
| PubMed |
[54] Kearns R, Myers J, Adair V, Coster H, Coster G. What makes ‘place’ attractive to overseas-trained doctors in rural New Zealand? Health Soc Care Community 2006; 14(6): 532–40.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[55] Hays R, Wynd S, Veitch C, Crossland . Getting the balance right? Gps who chose to stay in rural practice. Aust J Rural Health 2003; 11(4): 193–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[56] Denz-Penhey H, Murdoch J. A student view of the difference between general practice and rural and remote medicine. Rural Remote Health 2007; 7 641.
| PubMed |
[57] Spenny ML, Ellsbury KE. Perceptions of practice among rural family physicians: is there a gender difference? J Am Board Fam Pract 2000; 13(3): 183–7.
| PubMed |
[58] Lea J, Cruickshank MT. The experience of new graduate nurses in rural practice in new south wales. Rural Remote Health 2007; 7 814.
| PubMed |
[59] Pathman DE, Konrad TR, Dann R, Koch G. Retention of primary care physicians in rural health professional shortage areas. Am J Public Health 2004; 94(10): 1723–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[60] Humphreys JS, Jones MP, Jones JA, Mara PR. Workforce retention in rural and remote Australia: determining the factors that influence length of practice. MJA 2002; 176(10): 472–6.
| PubMed |
[61] Eley D, Young L, Shrapnel M. Rural temperament and character: a new perspective on retention of rural doctors. Aust J Rural Health 2008; 16(1): 12–22.
| PubMed |
[62] Smith T, Cooper R, Brown L, Hemmings R, Greaves J. Profile of the rural allied health workforce in northern New South Wales and comparison with previous studies. Aust J Rural Health 2008; 16(3): 156–63.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[63] O’Toole K, Adrian S, Karen S, Kate C. Rethinking policies for the retention of allied health professionals in rural areas: a social relations approach. Health Policy 2008; 87(3): 326–32.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[64] Mills J, Francis K, Bonner A. Getting to know a stranger – rural nurses’ experiences of mentoring: a grounded theory. Int J Nurs Stud 2008; 45(4): 599–607.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[65] Duchscher JB. A process of becoming: the stages of new nursing graduate professional role transition. J Contin Educ Nurs 2008; 39(10): 441–50.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[66] Scott ES, Smith SD. Group mentoring: a transition to work strategy. J Nurses Staff Dev 2008; 24(5): 232–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[67] Smith R, Pilling S. Supporting the transition from student to professional – a case study in allied health. Aust Health Rev 2008; 32(1): 134–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
