Recruitment and retention in very remote health: the recruitment – reality gap, preparation and mainstream primary health care
Dr Fred McConnel, Northern Territory General Practice Education, Australia*
Dr Dean Carson, Charles Darwin University, Australia
This paper notes the critical differences between very remote health service delivery and rural health service delivery, which impact on the linked but separate issues of recruitment and retention. Recruitment patterns are very different, and the time frame of retention has a different meaning in the very remote context. Enticing doctors and nurses to migrate to remote areas requires unique strategies, and local recruitment of Aboriginal Health Workers is also difficult.
The harsh realities of very remote work are often not acknowledged in recruitment strategies because they might deter new arrivals, so these new arrivals face a recruitment-reality gap which they must reconcile. The expectation of short lengths of stay means that new arrivals tend to adjust to local conditions by attempting to impose a compromised service delivery model based on mainstream practice. This model is ineffective in the remote cultural context, providing poor patient care and essentially marginalising the potentially pivotal AHW role.
Appropriate preparation for new arrivals to work in Primary Health Care teams with a predominantly Aboriginal workforce might reduce the gap between expectation and reality, and facilitate better adaptation of practitioners to local conditions. This has the potential to reduce turnover for both newcomers and local staff. Is this preparation the responsibility of the employer, and who has the expertise to give it? Does accreditation of services, training posts, supervisors, and training according to mainstream standards paradoxically make this situation more difficult? Are there lessons in this context for the different styles of multidisciplinary practice in Primary Health Care centres in mainstream health services? Interviews with practitioners, service managers and AHWs provide some insights into the need for change and the potential pathways to change.
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