Successful recruitment: What now?

Allied health such as physiotherapy has been recognised as an increasingly important part of the health workforce, particularly in the prevention and treatment of chronic diseases. Recruiting and retaining sufficient younger professionals in the health workforce, for example in physiotherapy,1 and providing equity to allied health services outside major urban areas is becoming an increasing challenge to workforce planners and health service managers. There is a maldistribution of health professionals between urban and rural Australia in favour of the cities. Many professionals commence their career in rural Australia, including expert practitioners and academics. Although the underlying reasons for commencing work in rural areas are likely to be different between individuals, the fact is that there were vacancies at the time that had enough appeal for applicants to apply. For that matter, rural regions have been described as ‘professional nurseries’ because that is where the positions exist for career starters are, and where they are able to earn sufficient salaries in their early career.2 Despite this, many leave rural areas. As an antidote to the lack of retention in rural areas, there are rural workforce capacity-building initiatives that include the recruitment of students from rural areas into undergraduate courses, the delivery of university courses outside urban areas and rural clinical placement as facilitated by University Departments of Rural Health. Although these strategies are associated with uptake of rural positions after graduation, it is of great concern that many young physiotherapists still intend to leave the profession within 10 years because they argue that there is a real need to improve recognition for skills and experience.2 Career enhancement has been associated with retention, but it is still the lack of recognition, stress and burnout that are associated with physiotherapists leaving rural areas. It is the mismatch between a range of factors that are attributed with the stress and burnout: caseload and available time, caseload and required paperwork, role as a professional and functioning within a bureaucracy, workload and work variety, workload and reward (including recognition), responsibility and control, communication and listening styles, and/or organisational skills and organisational support or community support. Other contributing factors may include lack of fairness, differences in personalities, values or expectations between individuals or role conflict. Lindsay, Hanson, Taylor and Mc Burney provide an analysis of these factors in their paper entitled ‘Workplace stresses experienced by physiotherapists working in regional public hospitals’. They set out to answer some of the critical issues associated with regional workplaces: what is the effect of work-related stresses on retention? How can young professionals after graduation be equipped with knowledge and skills to survive in a health workforce that needs to work smarter and harder to cope with increasing workloads? Can workload be quantified so that workforce capacity can be adjusted accordingly? Are there enough incentives for young professionals to stay in rural practice for longer? Are there differences between the public and private sectors in relation to work-related stresses? Finally, can health work environments be improved by health policies? Retaining allied health professionals in rural Australia and in the workforce is a challenge that warrants attention of policy makers as well as managers of health agencies, communities and professional bodies. It requires a preparedness to change traditional policies and practices to address the core issues of high caseloads, case complexity, waiting lists, isolation, staff shortages and lack of locum provision. For instance, matching available allied health labour with workload capacity and desired health outcomes,3 as employed in the private hospital sector, could protect the health workforce and contribute to a broader effort to meet the challenge of providing the required health services across the nation. Furthermore, as there is evidence to suggest that retention in the private sector is significantly better than in the public sector, there may be a need to develop more flexible policies that synchronise recruitment with specific retention strategies.4 Optimal workforce numbers and mix, and enhanced career options, such as provided by extended scope of practice, cannot only improve workforce retention but also improve the efficacy of the health services and equity of access to these services in Australia. In countries like the United Kingdom, New Zealand and the Netherlands, policy makers have embarked on creating environments conducive to organisational change that are based on primary care strategies and that use organisational incentives to invoke optimal performance.5 Alternative funding models can provide incentives for health agencies to develop better workforce and health service models that can be effective and efficient. There is a need for health agencies to work together and leadership is required on the macro as well as the micro level to address factors that impact on retention. Policy reform and targeted personal, team and organisational effectiveness skill training are likely to improve rural workforce capacity building.