Preferred solution to workforce shortages

There were a number of consistent themes that emerged from these interviews. In particular, these can be summarised as follows:

• There is a major shortage of suitably trained and experienced doctors to meet the current needs of rural and regional emergency medicine.

• This shortage is expected to worsen in the near future.

• The heavy reliance on doctors educated in other countries creates additional problems relating to standard of training, language and communication, cultural issues, and resources required to support their professional development.

• There has to be more to recruiting and retaining than simply offering larger remuneration.

Not surprisingly, there was considerable divergence in opinion on what could or should be done to improve the situation. There were four broad, but

somewhat contradictory, themes expressed on future directions for the EM workforce. Some of those interviewed expressed opinions with varying

degrees of support for more than one alternative. Four of those interviewed did not express any particular solution. ‘Radical’ views included all those

suggestions not encompassed by existing training schemes. The principal preferred option has been used to categorise opinions into the four broad themes (Figure 4.26).

1. The ‘more specialists’ view (22% of interviewees): “By providing funding and expanding the number of specialist trainees, as well as

making conditions more attractive for rural specialists, will ultimately translate into a highly skilled EM workforce in the rural and regional hospitals raising them to the same standard as major city hospitals. This will also have a flow-on effect of more accredited hospitals and more training opportunities outside the existing training institutions”. 2. The ‘more general practitioners’ view (30% of interviewees): “The

rural and regional workforce is the domain of generalist practitioners and there needs to be more funded GP training posts. Existing training schemes encompass emergency medicine and this is quite appropriate for most rural and regional areas together with existing short course certificates and locally based training”.

3. The ‘more Overseas Trained Doctors’ view (10% of interviewees):

“As there will be insufficient locally trained staff for the foreseeable future, there should be aggressive recruiting from other countries with a ‘fast-tracking’ process to expedite visas and registration for these doctors. This should be linked to an education system to bring them up to the required standard as soon as possible”.

4. The ‘radical’ view (38% of interviewees): “Traditional specialist college based education systems have failed to meet the emergency medicine workforce needs of rural and regional communities. The flow-on effect from additional undergraduate and specialist training positions is uncertain. Therefore alternative and innovative ways of addressing the problem are a matter of urgency”.

Suggested strategies included: more comprehensive generalist training; university based courses; distance education modules; alternative pathways to the FACEM qualification; automatic recognition of

overseas EM qualifications; expanded short course training; alternative emergency medicine qualifications; expanded nurse practitioner

programs and other alternative service delivery.

While these interviews looked mainly at the training and education needs of the EM workforce, there was also opportunity to reflect on other aspects of recruitment and retention that require consideration. The issues identified by specialists and GPs, and outlined in the Literature Review were frequently mentioned. These included:

• Remuneration that reflected the complexity and responsibility of the work undertaken

• The onerous on-call and fragility of services that were key person dependent or at risk when there were few individuals to share rosters

• The need for adequate and appropriate Continuing Professional Development

• The importance of support for partners and dependents to address social, educational, cultural and employment needs

In addition, there were also more cynical views expressed that perhaps reflected the frustration of those who have many years of experience of difficulty recruiting suitable medical staff. These views included:

• “The reliance on OTDs has caused difficulties in many areas and greater effort should be made to recruit more appropriate junior and specialist medical staff”.

• “Remuneration for medical staff is quite adequate by community standards and the demands for higher and higher locum rates and salary packages reflect the greed of some individuals and

organisations”.

• “There are too many players in the education/training of the medical workforce. As a result, too much time and money is spent on

professional rivalry and duplication of schemes with unproven outcomes”.

Interviewees by preferred workforce solution

'Radical' solutions 38% More OTDs 10% More GPs 30% More specialists 22%

Figure 4.26 Interviewees by preferred solution to address rural EM workforce shortages (n = 49)

4.3.5 Summary

While the number of people interviewed was relatively small, it seemed there was considerable pessimism about existing education and recruiting strategies meeting the needs of rural and regional emergency medicine. This was also reflected in the divergence of views expressed on solutions to the workforce shortage. Only a small proportion saw the increased use of OTDs as

beneficial. All agreed that there must be at least some changes in existing strategies – but no clear agreement as to one preferred strategy. Similarly held views were expressed in Canada and New Zealand although with a greater tendency to support the ‘More GPs’ view. This perhaps reflected the additional EM training pathways for non-specialists in those countries.

Generally, the opinions expressed in these interviews mirror those barriers to recruitment and retention found in the literature, the responses to the

4.4

Research Question 4

What relevance do other medical training programs and delivery