Conclusions

Current human resources practices in health care may well be unsustainable in the climate of increasing demand. Hawkins in Canada reports on a number of negative health trends identified at the 2006 Trilateral (UK, USA and Canada) Conference on Health Care [276]. As well as the increased demand for health services, public demand for ‘Mercedes/Cadillac’ health care and the increasing introduction of new technologies means health is consuming larger and larger proportions of government budgets. Hawkins suggests that, ultimately, it will be the rural and under-serviced areas that will be most affected by these unsustainable demands. The Australian electorate (and governments) have generally been unwilling to debate the value of introducing very expensive ‘cutting edge’ treatments and technology in tertiary hospitals to the detriment of spending on proven illness prevention and health treatments for other sections of the population.

It is currently a ‘sellers market’ in trying to recruit suitably trained medical staff to the large number of emergency medicine vacancies. Difficulties are also being experienced in recruiting emergency specialists to large

metropolitan hospitals, albeit to a lesser extent than the recruiting problems in rural and regional hospitals.

It is clear that improving the numbers and standards of the emergency medicine workforce in rural areas (or indeed, any other group of health professionals in rural areas), involves far more than simply placing an advertisement and picking out the best from a field of suitably qualified and enthusiastic applicants.

There will be a long lead time before new medical schools and increased numbers of undergraduate places impact on the rural workforce. Current evidence would suggest that additional medical school graduates will barely keep pace with population growth – exacerbated by reduced working hours and increasing attrition from the existing workforce for lifestyle reasons. The short term solution of recruiting more Overseas Trained Doctors from

developing countries raises moral and ethical issues as the supply from other affluent ‘western’ countries dries up. (These affluent countries are also recruiting in Australia to address their own shortages). Innovative practices such as Emergency Nurse Practitioners (ENP) and Expanded Scope

Paramedics are likely to have an increasing role particularly in small communities, but are still unlikely to fill the service delivery gaps between acute primary care and specialised emergency medicine practice. While it seems there will be further blurring of the traditional roles of doctors, nurses and other health professionals, it would appear that the role of ENPs will mostly be at the ‘minor’ end of injury and illness. No doubt this contributes to patient satisfaction but is unlikely to improve the major issues of access block and ED overcrowding.

Recurring themes of remuneration, peer support, locum relief, family needs, after-hours and on-call commitments, and access to training and professional development, are widespread in all rural health disciplines. Some of these factors are more easily addressed than others. More money is not always the answer – as evidenced by the Queensland Government’s ongoing difficulty in attracting new staff to ‘problem’ hospitals. Indeed, the inflated salary packages on offer may only serve to exacerbate problems elsewhere in the country by creating a more volatile and restless workforce.

Despite this, emergency medicine is a popular career choice for postgraduate training. The excitement, challenge and variety of clinical work all have strong appeal. The opportunity to undertake training part time and practice part time makes emergency medicine a specialist career more compatible with family life than many other career pathways. Translating this to the rural and regional environment is more difficult.

It comes as no surprise that a rural background, positive rural experiences as a student, and training relevant to rural practice will, at least, encourage the future workforce to consider practising outside the major metropolitan centres. A significant difficulty appears to be maintaining enthusiasm and interest in those attracted to rural practice in the first place. This research adds to the evidence that ongoing quality teaching in the rural and regional setting which leads to a recognised qualification and career structure, will help address significant deficiencies with the existing workforce. The RDAA concept of team based ‘specialised’ care rather than individual based ‘specialist’ care

seems especially relevant here. By working to retain the existing workforce, the recruitment of replacement and additional practitioners then builds on a stable and sustainable base. The principal focus here is on the long term outcome of producing a suitably trained and sustainable emergency medicine workforce for rural and regional areas, rather than the more narrow focus of curriculum development and examination.

In conclusion, the original hypothesis “that the training, education and support of emergency medicine doctors in rural and regional Australia is

inadequate for the level of services required”, is neither proved nor

disproved. It seems the current situation is far more complex than this simple statement suggests. As a generalisation, this statement is perhaps true, and is supported by the bulk, but by no means all, of the information collected in this study. There is a great deal of training and education available, the difficulty being that much of it is not easily accessible or attractive to those who need it. Little is known about the effectiveness of current programs. Levels of support are variable and range from enthusiastic within some organisations to minimal in others. There is insufficient information on the quality of care delivered. Logically, the level of care provided by less experienced or knowledgeable practitioners will fall short of that provided by more highly trained doctors. Emergency medicine services extend beyond just the medical profession, and the roles of other health professionals will increasingly blur traditional boundaries.