What is a reasonable length of employment for health workers in Australian rural and remote primary healthcare services?

Abstract

Background. Optimising retention of rural and remote primary healthcare (PHC) workers requires workforce planners to understand what constitutes a reasonable length of employment and how this varies. Currently, knowledge of retention patterns is limited and there is an absence of PHC workforce benchmarks that take account of differences in geographic context and profession.Methods. Three broad strategies were employed for proposing benchmarks for reasonable length of stay. They comprised: a comprehensive literature review of PHC workforce-retention indicators and benchmarks; secondary analysis of existing Australian PHC workforce datasets; and a postal survey of 108 rural and remote PHC services, identifying perceived and actual workforce-retention patterns of selected professional groups.Results. The literature review and secondary data analysis revealed little that was useful for establishing retention benchmarks. Analysis of primary data revealed differences in retention by geographic location and profession that took time to emerge and were not sustained indefinitely. Provisional benchmarks for reasonable length of employment were developed for health professional groups in both rural and remote settings.Conclusions. Workforce-retention benchmarks that differ according to geographic location and profession can be empirically derived, facilitating opportunities for managers to improve retention performance and reduce the high costs of staff replacement.What is known about the topic? Health services located in small rural and remote locations are likely to continue to experience workforce shortages and high costs of recruitment. Health workforce retention is therefore crucial. However, effective rural health workforce planning and use of strategies to maximise retention of existing health workers is hindered by inadequate knowledge about baseline employment-retention patterns. What does this paper add? Differences in health worker retention patterns by geographic location and profession are most evident after the first 6 months through until the end of the second year of employment. Health worker-retention benchmarks that differ according to geographic location and profession are proposed. What are the implications for practitioners? Benchmarking workforce retention in comparable health services can enable identification of best practice and the underpinning retention strategies. Workforce planners can use this, together with knowledge of baseline retention patterns and the high cost of staff replacement, to guide the design, timing and implementation of cost-neutral retention strategies.

Investigating the motivation and personal traits of allied health professionals working in remote and rural Australia: the Remote and Rural Allied Health Motivation and Personality (RRAHMP) study

“…Age-related differences, particularly with regard to higher levels of Harm Avoidance, may make younger AH professionals more vulnerable to reduced length of retention due to factors such as construed professional isolation and inadequate support. Conversely, despite high levels of Harm Avoidance, some AH professionals in this thesis were retained well beyond the 'reasonable' two years suggested in the literature (for example see Russell et al, 2013). However, it is acknowledged that higher levels of Novelty Seeking, common among this sample, may work against retention.…”

“…In total, this evidence provides a base on which to develop recruitment and retention policies and practices likely to be helpful in creating work environments where people can thrive. In keeping with Russell et al (2013), it is not suggesting that recruitment and retention issues can be totally eliminated, but rather that the suggested changes add another piece of the puzzle to optimise the fit of the workforce in remote.…”

“…Finally, the literature shows that Australian AH professionals are 78% more likely to leave employment in remote areas compared with nurses; the 24-month survival probability for remote AH professionals is 0.5, and the direct costs of replacing an AH professional are well over $20,000 (Russell et al, 2013). Australian remote health services have reported 30% annual turnover of AH staff, with newer professionals at a statistically significantly higher risk of leaving than more experienced professionals (Chisholm et al, 2011).…”

“…Data availability on the Australian AH workforce has long been recognised as problematic (Lowe, 2007;Mason, 2013;Russell et al, 2013). There is no national minimum dataset routinely collected for either a core or broader group of AH professionals (Lowe, 2007).…”

“… the lack of workforce data and profiling (Australian Institute of Health and Welfare, 2012;Lowe, 2007)  the influence of rural background (McGrail, Humphreys, & Joyce, 2011;McKernan, Kuthy, & Kavand, 2013;Playford, Larson, & Wheatland, 2006;Strasser & Neusy, 2010;Wilson et al, 2009)  recruitment of rural-origin students into healthcare training programs (McAuliffe & Barnett, 2009;Rodger et al, 2007;Strasser & Neusy, 2010;Wilson et al, 2009)  rural/remote student placement opportunities (Lyle et al, 2006;Playford et al, 2006;Schoo, McNamara, & Stagnitti, 2008;Strasser & Neusy, 2010)  alternative and more attractive models of service delivery including role re-development (Battye & McTaggart, 2003;Greater Northern Australian Regional Training Network, 2013;Productivity Commission, 2005;Turbett, 2006),  the length of retention and financial cost of turnover (Chisholm, Russell, & Humphreys, 2011;Russell, Wakerman, & Humphreys, 2013)  the influence of job satisfaction on retention and career path (Landon, Reschovsky, Pham, & Blumenthal, 2006)  the need to address current inadequacies in recruitment and retention packages (Humphreys, Wakerman, Pashen, & Buykx, 2009;Morell, Kiem, Millsteed, & Pollice, 2014).…”