Introduction by Croakey: Australia is facing a critical policy window for health workforce policy in general – and the allied health workforce in particular, especially for rural and remote communities.
The potential for an allied health rural generalist (AHRG) pathway to help address longstanding and escalating health inequities for rural, regional and remote communities was a major focus at the recent 15th National Conference for Rural and Remote Allied Health.
The #SARRAH2024 conference was hosted by Services for Australian Rural and Remote Allied Health (SARRAH) in the Victorian regional city of Mildura, and Marie McInerney was there to report for the Croakey Conference News Service.
Marie McInerney writes:
As the Federal Government considers implementation of several wide-ranging health policy reviews, allied health leaders are calling for national implementation of an allied health rural generalist (AHRG) pathway to help develop this critical workforce for rural, regional and remote communities.
The benefits of the AHRG pathway were centre stage at the recent National Conference for Rural and Remote Allied Health hosted by Services for Australian Rural and Remote Allied Health (SARRAH).
The conference highlighted efforts to address longstanding maldistribution of the health workforce in Australia that results in poorer access to essential health services for people living in rural and remote areas, who bear a heavier burden of disease than metropolitan Australians.
Although allied health professionals make up approximately 25 percent of Australia’s overall health workforce, they are largely concentrated in cities, according to the 2020 report from then Rural Health Commissioner Professor Paul Worley, who delivered a keynote at #SARRAH2024.
Of an estimated 195,000 allied health professionals, less than 15,000 (7.7 percent) work in rural and remote locations, Worley’s report said.
The report raised the rural generalist pathway as one mechanism to improve recruitment and retention, enhance career opportunities and support post-graduate learning for allied health professionals – aligning with the broad principles of the rural generalist doctors’ pathway.
A number of states, led by Queensland, have implemented a pathway. But what’s needed, proponents say, is a national pathway so there is a single structure, standards and governance in all jurisdictions and across public health, primary care, mental health, aged care and disability sectors.
This is “critical to avoid siloing and ensure the flexibility and mobility of the allied health workforce across sectors and providers”, SARRAH has said.
Funding cut shock
However, ahead of the crucial development of a national Allied Health Workforce Strategy, the Federal Government remains uncommitted. This year it defunded the allied health rural generalist pathway in the primary care sector that has been implemented by SARRAH since 2019, most recently through The Allied Health Rural Generalist Education and Training Scheme (TAHRGETS).
SARRAH, the peak body for rural and remote allied health which is struggling for its own financial future, was aghast, saying the decision put at risk progress over more than a decade towards a single national generalist pathway.
“The withdrawal of funding will constrain training and career opportunities for rural and remote allied health professionals, limit workforce mobility and sustainability, and increase siloing and fragmentation of health and social care in rural and remote areas,” it said earlier this year.
Some in the sector question the Federal Government’s capacity to deliver on key reforms, including the recommendations in the Scope of Practice Review, GP Practice Incentives Program and the Working Better for Medicare Review, if it does not recognise the value of the pathway.
With minor variations state to state, the allied health generalist pathway generally offers two years of targeted training and education in rural generalism, with dedicated study time and clinical supervision.
Trainees also have the opportunity to apply their learning through workplace-based service development or quality improvement projects that produce tangible benefits for their service and community.
They can also use real life examples from their practice to deep dive into the best evidence for assessment and intervention, all adapted for a rural or remote setting that may mean the service is provided by telehealth or through collaboration with another service.
In a keynote to the conference, Queensland’s Chief Allied Health Officer Liza-Jane McBride urged delegates to stay the course, saying the federal cut was disappointing and a roadblock, but did not take the sector back to square one.
“Allied health practitioners now introduce themselves as rural generalists. Jobs are advertised as rural generalist speech pathologists or rural generalist podiatrists,” she said.
“It is not yet fully formed, but rural generalism is an identity and emerging formal career path for allied health. This was not the case even five years ago,” she said.
Voices of experience
Dylan Wilson is among a small but growing group of allied health rural generalist alumni around Australia and other health experts who are building the evidence for the generalist pathway as a key to better healthcare and to address chronic allied health workforce shortages in rural and remote areas.
Appointed early this year as Program Manager of SA Health’s Allied Health Rural Generalist Pathway, Wilson had worked for the previous six years as a physiotherapist in regional South Australia.
Each day at work took him into a variety of settings requiring a variety of skillsets for patients across the life course. He would often work in an inpatient setting, in community health, palliative care and with children in a paediatric space, all “wrapped up in one 7.5 hour shift,” he said.
That need for a unique breadth of skills and capacity to be able to quickly “chop and change” in different health settings and sectors is what has made him a champion for rural generalist pathway.
“What the pathway is about is supporting early graduate staff to explore, develop and become more confident in those (generalist) skills”, to match them with the services that are required for their local community, and “ultimately achieve greater health outcomes for their health consumers,” he said.
According to the SA Rural Allied and Scientific Health Workforce Plan 2021–26, the average yearly turnover among early career allied health professionals in rural and remote areas in the state is around 40 percent, “attributed to complex clinical presentation, limited career opportunities, access to clinical support, and geographical and professional isolation”.
Undertaking the rural generalist pathway had enabled him to address those sorts of issues.
In his case, he’d been able to develop skills in mental health first aid, “how to unpack that in a safe way that was within the scope of my physio practice”, while a topic on community-based cancer care had allowed him to “work more respectfully and more effectively in the end of life space, which I’ve really appreciated”.
Importantly, the pathway also helped him to grow as a leader, to become a better supporter of peers and students, and gave “some really valuable experiences that have set me up to progress in my career,” he said.
He is not alone. Wilson told the conference that a survey last year of SA rural generalist graduates found that 89 percent had progressed their allied health professional classification, and that 56 percent had been promoted to either a clinical senior, a team leader or a program manager role.
Stronger career paths suggest better retention and that’s “obviously going to have a massive impact on care for consumers and wait lists”, he said.
Many families are going without
The need is clear. Session after session at #SARRAH2024 pointed to the need for action on workforce shortages and the toll for rural and remote communities.
“A lot of our families are having to travel long distances to get services, for instance some families are going to Sydney which is five and half hours away just to seek services for their children or for themselves,” said physiotherapist Zoe Tyack from Forbes in regional New South Wales.
Her practice partner Matiese Byrnes talked about the costs to local families, in time, travel and loss of school or work attendance, from having to travel for hours, on a weekly basis, for allied health consultations, particularly around mental health.
“A lot of families are going without for a long time,” she said.
Mildura speech pathologist and rural generalist trainee Emma Livingstone also presented on her efforts to address waitlists, where there was a 15-month wait time for a small child needing early support.
Her solution was to step up the role of an allied health assistant, an option also highlighted by Queensland’s BUSHkids and the Play Partners allied health group in South Australia’s Clare Valley.
One of the priorities for the sector is to see more allied health education based in rural and remote areas – a hope echoed by Shadow Minister for Rural and Regional Health Dr Anne Webster at the conference.
Flinders University has been doing that, this year introducing a rural allied health degree based in three South Australian regional centres: Mt Gambier, Renmark and Port Pirie.
The three centres were thrilled, saying “please come, we’ll do anything to get you here”, said Dr Ali Dymmott, Academic Lead in Rural Allied Health at Flinders, who helped lead the course creation.
“They had resources. They had facilities we could use. We knew we had enough students.”
“So we are now training occupational therapists, physiotherapists and speech pathologists to study in their hometowns for their whole undergraduate degree,” Dymmott said, echoing other #SARRAH2024 speakers in saying “we know that if people leave their hometown to study, they often don’t come back”.
Dymmott’s work is also crucial to building the evidence base for the allied health rural generalist pathway, having focused her PhD on rural workforce strategies.
Her ongoing research into SA’s pathway found it was “economically very viable – it actually doesn’t cost much compared to the benefits that the organisations get, and the benefits in terms of career development, confidence, competence for graduates”.
Qualitative research also found rural generalism had positive impacts on trainees’ ability to manage complexity and solve problems and that patients, consumers and organisations benefitted from “more accessible, consistent, and high quality services”, she said.
Dymmott said there are challenges with the pathway – including protecting study time at work, workload pressures, higher than expected study load, levels of managerial support and concerns about taking time away from study while wait lists remained heavy.
Also, unlike rural generalist medical pathways – which offer formal processes and outcomes for doctors, including associated specialisation and career advancement – she said the allied health pathway has not yet been able to offer clear promotion, pay rises or formal recognition of rural generalist skills.
But Dymmott sees generalism as representing “the future” of allied health in rural and remote regions and as one of the key factors for addressing acute and chronic workforce shortages, by enabling graduates to expand their scope of practice.
“If we don’t support our early career allied health professionals to be able to work across that full scope confidently and competently, we’re not going to keep them,” she told Croakey.
“So, governments have to support this pathway in order to sustain an allied health workforce and also to meet the needs of their communities.”
Mindful that the national rural generalist pathway is “in its infancy”, Dymmott has been urging the sector to “undertake more research to measure the allied health rural generalist pathway outcomes and impacts in different jurisdictions so that we can have this body of evidence that people can rely on”.
Contested pathways
It’s in the evidence where some of the problems with federal support now lie.
The Department of Health and Aged Care told Croakey that the Budget decision to defund The Allied Health Rural Generalist Education and Training Pathway (TAHRGET) followed “some successes and challenges with implementation of the program over time”.
“There has been a high number of withdrawals, and significant numbers of positions not able to be filled,” the Department said in a statement. “There has also been limited take-up by Aboriginal Community Controlled Health Organisations and low completion rates to date.” (Read the full statement.)
Asked whether the AHRGP will be a key component in the forthcoming Allied Health Workforce Strategy, a spokesperson said the strategy is “still in the process of drafting and as such key components have not been decided”. It would also consider the findings of the Scope of Practice, General Practice Incentives, After Hours, and Working Better for Medicare reviews, they said.
In a statement in response (see in full here), SARRAH said it was disappointed the Government has “misrepresented the strategy as a ‘scholarship’”.
“The Allied Health Rural Generalist Pathway is a comprehensive workforce and service development strategy” and funding streams that supported the pathway “should not be misconstrued as funding for professional development courses”, SARRAH said.
“Rural Generalist Trainees are practising in their organisation and their community as they are training,” SARRAH says. “The skills that they learn in the morning are applied in practice that afternoon. There is no lag period between investing in early career rural practitioners and securing a return in terms of improved services for patients and the community, and increased capability and capacity of the healthcare team.”
It said that despite challenges including the COVID-19 pandemic, the fledgling SARRAH program created 62 AHRG Training Positions across Australia, 60 in mainstream healthcare organisations (meeting the target set by government) and two in ACCHOs.
It agreed that limited take-up by ACCHOs was disappointing but said feedback and program data indicated that many “reported being unable to source adequate funding to develop allied health clinical positions within the organisation’s business model, despite interest in expanding service capacity and in hosting a training position”.
SARRAH also said the Government’s decision to discontinue funding for the program was “premature”, ahead of the results of an evaluation by Flinders University, due in early 2025.
SARRAH is calling on the Government for:
- Funding for allied health rural generalist training positions in private and non-government organisations delivering primary care, Aboriginal health, aged care, disability, mental health and early childhood services in Modified Monash Model 3-7 locations, which determine whether a location is metropolitan, rural, remote or very remote.
- Commonwealth-supported places for trainees completing the Graduate Diploma in Rural Generalist Practice
- The establishment of the Australian College of Rural and Remote Allied Health, like the Australian College of Rural and Remote Medicine (ACRRM), to develop and maintain a single national AHRG Pathway structure, standards and governance framework in all jurisdictions and across public health, primary care, mental health, aged care and disability sectors.
Long-term SARRAH member Robyn Adams, who led a workshop ahead of the conference to explore next steps for a College and a sustainable AHRG pathway, acknowledged that some people are initially confused about what a generalist pathway is – “confusing generalist with generic”.
The lightbulb moment comes when they realise it “enables skilled clinicians to provide appropriate, responsive, place-based care in rural and remote communities”, she said.
“Because for us, it’s not that you can see a cow out the window that makes you a rural practitioner. It’s that you have rural generalist skills, clinical and non-clinical, and you develop services that are responsive to the community.”
Analytics of #SARRAH2024
Analysis by Tweetbinder shows 34 contributors made a total of 479 posts using the #SARRAH2024 hashtag around the time of the conference, creating an estimated economic value for the conference hashtag of more than $14,500. Read more in this report.
This is our final article from #SARRAH2024; check this this link for our prevous coverage. Follow this list on X/Twitter for ongoing news from #SARRAH2024 presenters and participants.
