The value of survival analyses for evidence-based rural medical workforce planning

Human Resources for Health

Peter J Williams²  W Ian Cameron²  Matthew R McGrail¹  John S Humphreys³  Deborah J Russell³ 

[1] Gippsland Medical School, Monash University, Northways Road, Churchill, Victoria 3842, Australia;NSW Rural Doctors Network, Head Office, Suite 19, Level 3, 133 King Street, Newcastle, New South Wales 2300, Australia;Centre of Research Excellence in Rural and Remote Primary Health Care, School of Rural Health, Monash University, PO Box 666, Bendigo, Victoria 3552, Australia

关键词: Retention;    Primary health care;    Policy making;    Personnel turnover;    Health workforce;    Health policy;    Health manpower;    General practitioner;    Family practice;    Family physician;    Cohort studies;    Australia;   

Others  :  822106
DOI  :  10.1186/1478-4491-11-65

 received in 2013-08-19, accepted in 2013-11-13,  发布年份 2013

【 摘 要 】

Background

Globally, abundant opportunities exist for policymakers to improve the accessibility of rural and remote populations to primary health care through improving workforce retention. This paper aims to identify and quantify the most important factors associated with rural and remote Australian family physician turnover, and to demonstrate how evidence generated by survival analysis of health workforce data can inform rural workforce policy making.

Methods

A secondary analysis of longitudinal data collected by the New South Wales (NSW) Rural Doctors Network for all family physicians working in rural or remote NSW between January 1^st 2003 and December 31^st 2012 was performed. The Prentice, Williams and Peterson statistical model for survival analysis was used to identify and quantify risk factors for rural NSW family physician turnover.

Results

Multivariate modelling revealed a higher (2.65-fold) risk of family physician turnover in small, remote locations compared to that in small closely settled locations. Family physicians who graduated from countries other than Australia, United Kingdom, United States of America, New Zealand, Ireland, and Canada also had a higher (1.45-fold) risk of turnover compared to Australian trained family physicians. This was after adjusting for the effects of conditional registration. Procedural skills and public hospital admitting rights were associated with a lower risk of turnover. These risks translate to a predicted median survival of 11 years for Australian-trained family physician non-proceduralists with hospital admitting rights working in small coastal closely settled locations compared to 3 years for family physicians in remote locations.

Conclusions

This study provides rigorous empirical evidence of the strong association between population size and geographical location and the retention of family physicians in rural and remote NSW. This has important policy ramifications since retention grants for rural and remote family physicians in Australia are currently based on a geographical ‘remoteness’ classification rather than population size. In addition, this study demonstrates how survival analysis assists health workforce planning, such as through generating evidence to assist in benchmarking ‘reasonable’ lengths of practice in different geographic settings that might guide service obligation requirements.

【 授权许可】

   
2013 Russell et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Dussault G, Franceschini M: Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Hum Resour Health 2006, 4:12. BioMed Central Full Text
• [2]World Health Organization: The World Health Report 2006: Working Together for Health. Geneva: WHO; 2006.
• [3]World Health Organization: Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention – Global Policy Recommendations. Geneva: WHO; 2010.
• [4]Humphreys JS, Jones MP, Jones JA, Mara PR: Workforce retention in rural and remote Australia: determining the factors that influence length of practice. Med J Aust 2002, 176:472-476.
• [5]Buykx P, Humphreys J, Wakerman J, Pashen D: Systematic review of effective retention incentives for health workers in rural and remote areas: towards evidence-based policy. Aust J Rural Health 2010, 18:102-109.
• [6]Scott A, Witt J, Humphreys J, Joyce C, Kalb G, Jeon S-H, McGrail M: Getting doctors into the bush: General Practitioners’ preferences for rural location. Soc Sci Med 2013, 96:33-44.
• [7]Russell DJ, McGrail MR, Humphreys JS, Wakerman J: What factors contribute most to the retention of general practitioners in rural and remote areas? Aust J Prim Health 2012, 18:289-294.
• [8]Garnett ST, Coe K, Golebiowska K, Walsh H, Zander K, Guthridge S, Li S, Malyon R: Attracting and Keeping Nursing Professionals in an Environment of Chronic Labour Shortage: A Study of Mobility Among Nurses and Midwives in the Northern Territory of Australia. Darwin: CDU Press; 2008.
• [9]Russell DJ, Wakerman J, Humphreys JS: What is a reasonable length of employment for health workers in Australian rural and remote primary healthcare services? Aust Health Rev 2013, 37:256-261.
• [10]Pick W: Lack of evidence hampers human-resources policy making. Lancet 2008, 371:629-630.
• [11]Lagarde M, Blaauw D: A review of the application and contribution of discrete choice experiments to inform human resources policy interventions. Hum Resour Health 2009, 7:62. BioMed Central Full Text
• [12]Dal Poz MR, Kinfu Y, Drager S, Kunjumen T, Diallo K: Counting Health Workers: Definitions, Data, Methods and Global Results (HRH Discussion Paper). Geneva: World Health Organization; 2007.
• [13]Wilson NW, Couper ID, De Vries E, Reid S, Fish T, Marais BJ: A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health 2009, 9:1060.
• [14]Barnighausen T, Bloom DE: Financial incentives for return of service in underserved areas: a systematic review. BMC Health Serv Res 2009, 9:86. BioMed Central Full Text
• [15]District of Workforce Shortage Factsheet. [ http://www.health.gov.au/internet/main/publishing.nsf/Content/work-pr-dws-fact webcite]
• [16]Russell DJ, Humphreys JS, Wakerman J: How best to measure health workforce turnover and retention: five key metrics. Aust Health Rev 2012, 36:290-295.
• [17]Monash University Centre for Rural Health: GP Workforce and Skills Data Set. Final Report. Melbourne: Monash University; 2000.
• [18]Commonwealth of Australia: Australian Standard Geographical Classification (ASGC). Canberra: Australian Bureau of Statistics; 2010.
• [19]Kalbfleisch JD, Prentice RL: The Statistical Analysis of Failure Time Data. New York: Wiley; 1980.
• [20]Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R: Continuity of care: a multidisciplinary review. Br Med J 2003, 327:1219-1221.
• [21]Prentice RL, Williams BJ, Peterson AV: On the regression-analysis of multivariate failure time data. Biometrika 1981, 68:373-379.
• [22]Cleves M, Gould W, Gutierrez R, Marchenko Y: An Introduction to Survival Analysis using Stata. Texas: Stata Press; 2008.
• [23]Humphreys JS, McGrail MR, Joyce CM, Scott A, Kalb G: Who should receive recruitment and retention incentives? Improved targeting of rural doctors using medical workforce data. Aust J Rural Health 2012, 20:3-10.
• [24]Humphreys JS, Jones JA, Jones MP, Mildenhall D, Mara PR, Chater B, Rosenthal DR, Maxfield NM, Adena MA: The influence of geographical location on the complexity of rural general practice activities. Med J Aust 2003, 179:416-420.
• [25]Mason J: Review of Australian Government Health Workforce Programs. Australian Government Department of Health: Canberra; 2013.
• [26]Gibbon P, Hales J: Review of the Rural Retention Program. Final Report. Australian Government Department of Health and Ageing: Kent Town SA; 2006.
• [27]McGrail MR, Humphreys JS, Joyce CM, Scott A: International medical graduates mandated to practise in rural Australia are highly unsatisfied: results from a national survey of doctors. Health Policy 2012, 108:133-139.
• [28]McGrail MR, Humphreys JS, Scott A, Joyce CM, Kalb G: Professional satisfaction in general practice: does it vary by size of community? Med J Aust 2010, 193:94-98.
• [29]Pathman DE, Konrad TR, Ricketts TC 3rd: The comparative retention of National Health Service Corps and other rural physicians. Results of a 9-year follow-up study. JAMA 1992, 268:1552-1558.
• [30]Kringos DS, Boerma W, van der Zee J, Groenewegen P: Europe’s strong primary care systems are linked to better population health but also to higher health spending. Health Aff 2013, 32:686-694.