Financial incentives not effective in tackling rural GP shortages

Doug Hendrie

29/05/2019 1:34:38 PM

A new study has found non-financial factors to be more important when determining where to live and work.

Balance of home and money
Money isn’t everything when it comes to determining where to live and work, as a new study finds.

There has long been a persistent shortage of GPs in rural, remote and even outer-suburban Australia. How to effectively address the issue remains a key question.
In an effort to counter the ongoing shortage, local health authorities regularly offer huge financial incentives, including overall packages as high as $500,000.
But these incentives often do not work. The question is – why?
A new Human Resources for Health paper may have part of the answer: work–life balance.  
In short, GPs are less willing to relocate for financial incentives than authorities expect, with hours worked, on-call times and patient mix also playing an important role.  
Health economists have often assumed that financial enticements would help distribute newly trained doctors into underserved areas. But the new paper, authored by World Health Organization (WHO) economist Dr Michelle McIsaac, questions that assumption, finding financial incentives are ‘not very effective’ at getting established GPs to relocate.
The paper states that GPs practising in low-socioeconomic areas in Australia face higher levels of demand, have less time, see patients with more comorbidities, and experience greater levels of stress than those practising in high-socioeconomic areas.
‘[F]inancial considerations are part of a larger number of factors influencing location choice. For instance, practice ownership played almost as important a role in mobility as earnings,’ the paper states.
‘Previous policy simulations suggest financial incentives aimed at locating new doctors in specific areas could be an effective policy lever. This paper finds that established GPs are not very mobile, even when a financial incentive is offered.
‘[F]inancial incentives, which are being used widely, may have limited effectiveness in inducing GPs to relocate once they have made an initial location choice. This seems to be reflected by the current geographic distribution of physicians, even with financial incentive programmes being adopted by many countries.’
Using the Medicine in Australia: Balancing Employment and Life (MABEL) survey of around 10,000 doctors, the study predicts that if GPs were given a 10% increase in earnings to move to a low-socioeconomic area, or remain if already living there, only 0.8% would be influenced.
The paper raises questions for incentive-based programs tackling GP workforce shortages.
‘Financial incentives to influence the recruitment and retention of health workers to underserved areas are becoming a widespread policy option; however, clear evidence of their effectiveness is lacking,’ the paper states.

incentives rural health workforce shortage

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Kovats   30/05/2019 7:05:02 AM

If there is at least three months compulsory rural term in the first two years after graduation there would be an exposure to the benefits and fun of rural medicine
If 1:100 were to remain or return or give it a go we would have better numbers in rural areas and would be sharing the care
Fear of the unknown , fear of being alone and a big financial debt after graduation is causing the Aussie grads to sick to safe areas and never risk going rural - and miss out on the benefits

David Carruthers   30/05/2019 8:59:08 AM

I don't think the issue in that financial incentived don't work,it just that sufficiently high financial incentives havn't been tried. The incentive scheme hasn't accounted for the loss of income that may be incurred by the GP's spouse or partner. If you have a professional couple a 10% increase in the GP income isn't going to go anywhere close to off setting the loss of income for a lawyer or accountant spouse who moves with the GP. The single income familly where the GP is the only earner is a rairity now.

Cathy   30/05/2019 9:28:33 AM

Both earlier comments are spot on -early exposure and partner employment. Most policies are lazy, cynical & inadequate and for headlines or responding to lobby groups. The “strengthening rural healthcare” for instance to allegedly target rural areas is insufficient and merely punished other low SES practices (presumably benefitting the budget bottom line)

Tom   30/05/2019 9:47:45 AM

Being exposed to rural medicine / lifestyle in medical school / residency might encourage some to move to the bush to practice. But it might just as easily backfire - experience of living there has convinced some (including a few doctors I know) that they will never willingly work in regional areas given the choice.

Overall, I don't think rural experience programs are worthwhile.

Peter Bradley   30/05/2019 1:41:51 PM

Maybe they need to offer total cancellation of their HECS if they stay say 5 years,, and also provide a generous spousal allowance, as well, possibly even tax free..? Taking into account the above comments.

Wayne Shipley   30/05/2019 9:31:26 PM

Again, let’s see if that works! It won’t. City born doctors will not be persuaded to go rural because the air is cleaner. The study is flawed. Make the money $700000 a year and I will assure you there will not be a shortage of doctors rurally again, it just still is not enough to lure doctors away, you can make more money working long hours in the city suburbs than as a rural doctor with no on call.

Dr Michiel Mel   4/06/2019 6:20:10 PM

Ask the rural doctors that have left the country what the real story is. Why did they go? There is a good report from Rural Health West in WA, which did highlight what else apart from incentives could work. It's called "Finding My Place". However this report went of the radar in WA. The reason why these reports don't receive focus is in my opinion the reason why we're struggling. Not just an incentive story alone!

Dr Rod Street   15/06/2019 4:59:51 PM

There are two standards of medicine in Australia. State of the art cutting edge world class medicine in capital cities.91The rest of Australia and their practitioners have services approaching the third world. My rural practice has lost 6 doctors this year. I am not holding my breath before these vacancies are filled. Perhaps it’s time to go back to the city.
Rod Street