Introduction by Croakey: On the lands of the Latji Latji and Barkindji peoples in Mildura this week, delegates at the 15th National Conference for Rural and Remote Allied Health heard rousing calls for fundamental changes to address rural and remote health workforce crises.
Below, Marie McInerney reports for Croakey Conference News Service on the keynote delivered by Professor Paul Worley, who spoke of the challenges and opportunities in rural and remote allied health.
We will in the coming weeks bring more news, views and interviews from the conference, which featured keynotes from Kylie Stothers, deputy CEO of Indigenous Allied Health Australia (IAHA), Professor Jenny May, National Rural Health Commissioner, Chief Allied Health Officer Anita Hobson-Powell, and Shadow Regional Health Minister Anne Webster.
Marie McInerney writes:
Professor Paul Worley, leading rural health clinician and advocate and former National Rural Health Commissioner, has urged rural and remote allied health professionals to look for “radical transformation” in their workforce, to see themselves as “quality of life specialists”, and to pursue allied health rural generalist pathways that best support their communities.
In a rallying speech at this week’s 15th National Conference for Rural and Remote Allied Health conference, Worley urged delegates to use workforce crises to introduce fundamental changes and to shift the narrative and approach to recruitment to rural and remote areas – from appealing for ‘help’ from metropolitan professionals to demonstrating excellence and rich career possibilities.
Worley said rural and remote health has outsourced the supply chain of its most valuable resource – “our people” – to metropolitan areas, relying on cities to do the educating and training of health professionals and then hoping somehow to convince graduates to come to rural and remote Australia.
“What type of people do you get when you do that? Mercenaries, missionaries and misfits?”, he said to much laughter. Worley told delegates he would leave it to them to determine which category they fitted, but he guessed they were probably “missionaries” to the cause of rural health.
Seriously though, he followed on, recruitment practices that play down the strengths of rural and remote health practice and offered incentives could easily attract the wrong people.
“Let’s be honest, look at the mercenaries that have also been attracted and what damage they’ve done, and look at the misfits that have been forced or have managed to get there and look at the damage they’ve done.”
Addressing workforce crisis
Worley, who is now Executive Director of Clinical Innovation at the Riverland Mallee Coorong Local Health Network (LHN) based in Murray Bridge, south-west of Adelaide, was a keynote speaker at the two-day conference hosted by Services for Australian Rural and Remote Allied Health (SARRAH) in the north-west Victorian city of Mildura, on the lands of the Latji Latji and Barkindji peoples.
His address touched on key issues raised in many of the presentations and other speeches at the event, which was firmly focused on addressing the workforce crisis facing allied health in rural and remote areas.
Many sessions looked particularly at the promise and importance of building the allied health rural generalist pathway, similar to the National Rural Generalist Pathway for doctors, providing training and support to allied health professionals to respond to a wide range of clinical presentations from across the age spectrum and in a variety of clinical settings (inpatient, ambulatory care, community).
SARRAH says allied health workforce shortages in rural and remote Australia are twice as severe as for GPs per head of population, and that “even near large regional centres, people can wait 12 months or more to get services they need now”.
One award-winning presentation at the conference described a 15 month wait time faced by a small child and his family for speech pathology in Mildura, which was dramatically cut by the employment of an Allied Health Assistant, a role that many see as critical to future capacity and career building.
Other themes over the two days included the importance of multidisciplinary care; Aboriginal and Torres Strait Islander health, knowledges, leadership and workforce; training ‘in place’; and the broader community roles that allied health workers play in remote and rural areas.
Workforce disruption from the National Disability Insurance Scheme (NDIS), and the role of telehealth, artificial intelligence (AI) and robotics in the future were also discussed.
Coming together
But amid all that, the sold-out conference – the first face to face gathering of the sector since 2018 and which SARRAH worries might be its last – was for many a powerful and much-needed chance to come together as an extended family of professionals, to share stories of challenges and success and showcase excellence in their ranks.
“Shout loud, shout proudly, it’s about doing well, being together,” said SARRAH President Lisa Baker.
Working on the theme ‘Going the distance: thriving in rural and remote communities’, the conference was formally opened with a sunset smoking ceremony and Welcome to Country from Latji Latji woman Vanessa Peterson and Barkindji men, Thomas Harrison and Mike Gilby, near the banks of the Murray/Millewa River.
“I hope many of you stay and make my Country your country and work, play and raise your families on my beautiful Country as I have with my children,” Peterson said.
Ahead of his keynote, Worley introduced himself in the language of the Ngarrindjeri, the Traditional Owners of the lands on which he works along the Murray, known there as Murundi, downstream from Mildura.
He asked the audience that, if they took any wisdom from his speech, to remember it has been in this country for 60,000 years.
“We have so much that we can learn from the Aboriginal Torres Strait Islander understandings of what needs to be healthy, and apply that to our workforce policy, to our training policy, to our health service delivery policy because, I’m sure you know, that health is not just a biological construct, it’s not just a social or emotional construct,” he said.
“It’s also a spiritual construct [that] Aboriginal people articulate so much better than us, but I have a feeling it is in us as well, is connected to Country, and it’s connected to where we call home.
“We may call it place-based learning, but it’s more powerfully articulated, I think, as Country and I acknowledge the Aboriginal people in this room who know that so much better than I do.”
Three prongs
With the conference told, including by his successor as Rural Health Commissioner, Dr Jenny May, that his 2020 final report continues to guide policy, Worley outlined three main prongs to building a strong rural and remote allied health workforce.
Local selection by local people – not according to a university saying “we’ll select students according to some rubric and then we’ll try to encourage them to be rural”.
Training, in a way that the rural generalist pathway articulates well, with the capacity for allied health professionals to do all their undergraduate study, early career and pathway through to post-graduate qualifications locally.
“Every time a person is forced to go away to do that, they’re unlikely to come back,” he said.
“And we know that, and we deny it, because it’s an uncomfortable truth that we feel good about having 12 weeks of our undergraduate curriculum based in our rural community, and we don’t think we’re good enough to have the whole of it.”
The third prong was jobs. Again, he said, the rural generalist pathway shows the way. “The jobs have to be really attractive and they have to be the sort of jobs that lead somewhere…We’re not selling the job that you’re doing now, we’re selling what you can do in the future.”
Drawing a colourful rural analogy, Worley likened the outsourcing of much rural and remote health workforce development to metropolitan areas as “shearing only half the sheep” – “if we’re only doing a bit of (student) selection, if we’re only doing a bit of early career work, if we’re only doing a bit about the jobs, if we’re only doing a little bit of the undergraduate program, we’re just shearing part of the sheep.”
“What happens to sheep if you only shear half of the fleece? They get sick, they die,” he said.
Worley added that rural allied health leaders in universities and health services, and their nursing and medicine counterparts, are “giving ourselves a big pat on the back…while our systems continue to die, drip by drip by drip, maggot by maggot by maggot..”
Successes
Worley highlighted success that the Riverland Mallee Coorong LHN was having with workforce.
In two years, he said, it had increased its full time equivalent (FTE) medical workforce by more than 30 percent, around 30 new staff, and would next year have “an extra 40 FTE domestically trained, not visa dependent people who could have chosen to go anywhere else but said ‘that’s the place I want to be for my career’.”
That level and pace of workforce expansion “changes everything”, he said. “Suddenly models of care become an opportunity…Everyone suddenly has ideas because they’ve got a workforce. They’ve got time.”
Returning to the analogy, he said: “If we do shear the whole sheep, it works, and it works radically.”
But deep change doesn’t come overnight, he said, talking about how Riverland Mallee Coorong LHN has had to navigate crises, workforce issues, and practitioners leaving.
The service’s approach, led by CEO Wayne Champion, and which Worley urged on other health professionals, was: “Don’t waste a crisis” – to not return to business as usual, but be prepared to make fundamental change.
He gave an example where Riverland Mallee Coorong had experienced a rapid exit of podiatrists. Rather than just hire new podiatrists through agencies or as locums, it saw there had been a more strategic gap and created leadership positions in each of its disciplines, which previously had only been held at the state level.
Additionally, he said, the LHN had established the Riverland Academy of Clinical Excellence, a multidisciplinary division to take responsibility for training its own clinical workforce, creating and improving relevant evidence bases for clinical practice, and bringing the benefits of integrated teaching, research and clinical care to its communities.
This was also its strong brand, he said.
“Not only is that something we have to keep ourselves accountable when we are working and developing our policies and recruiting, but it says something to people who want to join us,” Worley said.
“How do you attract 40 new people into a region, all of whom can go elsewhere? You make it attractive and you make it aspirational.”
Too often rural and remote health recruitment appeals “are asking people to come and solve a problem for you,” Worley told the conference. “We’re not doing that. We’re saying, ‘Do you want the adventure of your life?’ ‘Do you want to be the best that you can be?’”
Different doesn’t mean worse, he said.
“Different means you stand up tall and you say, ‘are you good enough to join us?’ And that’s the question we ask in our selection panels,” he said, noting that the LHN makes sure it has an Aboriginal staff member on each of its selection panels. “They can sort the wheat from the chaff,” he said.
Worley said rural and remote allied health professionals also have a great story to tell, dubbing them “qualify of life specialists”.
However, mounting the case for allied health rural generalist pathways, Worley said growing urbanisation over the past 100 years had also driven health specialisation, to the point, for example, where physiotherapists specialise in a range of areas, respiratory, neuro, rehab, sports medicine and other fields. That’s great for cities, he said, but rural communities “cannot afford it”.
“In our small rural towns, the best practice is a rural generalist, a professional who is working to the full scope that they were trained to work with, is prepared to put all of that training into practice, who is developed in their career, and can see a career ahead of them in that rural area.”
From social media
Bookmark this link to follow ongoing coverage via the Croakey Conference News Service, and also follow this list on X/Twitter for ongoing news from #SARRAH2024 presenters and participants.
