Geographic health workforce distribution from 1986: have policies made a favourable difference?

A range of policies have been initiated over the years to address geographic health workforce maldistribution. These include rural exposure through clinical placement, rural education, rural scholarships and rural practice incentives. Although evidence suggests that rural clinical education has a positive impact on attracting health professionals to rural practice, the effect on long term retention is not so clear. It is also not clear whether the apparent success of individual programs and initiatives has translated into a system wide impact of better geographic distribution. This research uses Census data from 1986 to 2011 to demonstrate how the geographic distribution of medical practitioners, nurses and allied health professionals has changed, and to examine why particular distribution patterns may persist despite (or even because of) rural workforce policies.

It is possible that rural clinical education to obtain an initial professional qualification may need supplementation of access to tailored and ongoing professional development that supports rural and regional career pathways. If career paths are aligned with local health service needs then the chances that health professionals will stay in, or return to, rural practice throughout their careers are likely to be enhanced. Thus far, approaches to address these issues tend to have a narrow focus. Rural clinical education that is followed by access to tailored professional development (based on local and regional health service needs) could be part of a suite of strategies that form a more integrated approach to optimising the rural health workforce and associated health service provision that can be supported by policy. The success of such an integrated approach will depend on policy guided leadership and professional and education systems to go beyond traditional health professional education, and to engage with rural communities and broader community development interests.