Approaches to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review Protocol

Document Type: Study Protocol

Authors

1 Division of Health Professions Education, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia

2 Western Australian Centre for Rural Health, The University of Western Australia, Perth, WA, Australia

3 School of Allied Health, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia

4 The Rural Clinical School of WA, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia

Abstract

Background
Medical workforce scarcity in rural and remote communities is a global problem, severely challenging healthcare delivery and health equity. Both developed and developing countries report geographically uneven distributions of the medical workforce. This scoping review synthesizes evidence from peer-reviewed and grey literature concerning approaches implemented to improve the recruitment, development, and retention of the rural medical workforce in both developed and developing countries.

 
Methods
We will utilize the Arksey and O’Malley (2005) framework as the basis for this scoping review. The databases to be searched include Medline, Embase, Global Health, CINAHL Plus, and PubMed for articles from the last decade (2010-2019). Searches for unpublished studies and grey literature will be undertaken using the Google Scholar - Advanced Search tool. Quantitative and qualitative study designs will be included. Two authors will independently screen and extract relevant articles and information, with disagreements resolved by a third. Quantitative and qualitative analyses (thematic) will be conducted to evaluate and categorize the study findings.

 
Discussion
The scoping review will aid in mapping the available evidence for approaches implemented to advance the process of recruitment, development, and retention of the medical workforce in the rural and remote areas in developed and developing nations.

 
Registry
This protocol has been registered to Open Source Framework (https://osf.io/e83hp/).

Highlights

Supplementary File 1 (Download)

Supplementary File 2 (Download)

Supplementary File 3 (Download)

Keywords


  1. World Health Organization. WHO priorities. http://www.who.int/dg/priorities/en/.  Accessed July 30, 2018. Published 2018.
  2. Strasser R, Neusy AJ. Context counts: training health workers in and for rural and remote areas. Bull World Health Organ. 2010;88(10):777-782.
  3. Versteeg M, du Toit L, Couper I. Building consensus on key priorities for rural health care in South Africa using the Delphi technique. Glob Health  Action. 2013;6:119-126. doi:10.3402/gha.v6i0.19522
  4. Wakerman J. Defining remote health. Aust J Rural Health. 2004;12(5):210-214. doi:10.1111/j.1440-1854.2004.00607.x
  5. Strasser R. Social accountability and the supply of physicians for remote rural Canada. CMAJ. 2015;187(11):791-792.
  6. Rabinowitz HK, Diamond JJ, Markham FW, Rabinowitz C. Long-term retention of graduates from a program to increase the supply of rural family physicians. Acad Med. 2005;80(8):728-732.
  7. Hing E, Hsiao CJ. US Department of Health and Human Services. State Variability in Supply of Office-based Primary Care Providers: United States 2012. NCHS data brief No 151. Hyattsville, MD: National Center for Health Statistics; 2014.
  8. Rheault H, Coyer F, Jones L, Bonner A. Health literacy in Indigenous people with chronic disease living in remote Australia. BMC Health Serv Res. 2019;19(1):523. doi:10.1186/s12913-019-4335-3
  9. National Rural Health Alliance. How many doctors are there in rural Australia? Deakin West, ACT: National Rural Health Alliance; 2013.
  10. Canadian Institute for Health Information. Physicians in Canada, 2018. Ottawa, ON: CIHI; 2019.
  11. Downey LH. Rural Populations and Health: Determinants, Disparities, and Solutions. Prev Chronic Dis 2013;10:130097. doi:10.5888/pcd10.130097
  12. Ely DM, Driscoll AK, Mathews TJ. Infant mortality rates in rural and urban areas in the United States, 2014. NCHS data brief, no 285. Hyattsville, MD: National Center for Health Statistics; 2017.
  13. Robinson LR, Holbrook JR, Bitsko RH, et al. Differences in Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders Among Children Aged 2–8 Years in Rural and Urban Areas — United States, 2011–2012. MMWR Surveill Summ. 2017;66(SS-8):1-11. doi:10.15585/mmwr.ss6608a1external
  14. Zhao Y, You J, Wright J, Guthridge SL, Lee AH. Health inequity in the Northern Territory, Australia. Int J Equity Health. 2013;12(79). doi:10.1186/1475-9276-12-79
  15. Lavergne M, Kephart G. Examining variations in health within rural Canada. Rural and Remote Health. 2012;12:1848.
  16. Australian Institute of Health & Welfare (AIHW). National Key Performance Indicators for Aboriginal and Torres Strait Islander primary health care: results from June 2016. Canberra: AIHW; 2017.
  17. NPR, The Robert Wood Johnson Foundation, The Harvard T.H. Chan School of Public Health. Life in Rural America. NPR, The Robert Wood Johnson Foundation, The Harvard T.H. Chan School of Public Health; 2018.
  18. Clarke J. Difficulty accessing health care services in Canada. Health at a Glance. Statistics Canada Catalogue; 2016.
  19. Australian Institute of Health and Welfare. Survey of Health Care: selected findings for rural and remote Australians. Canberra: Australian Institute of Health and Welfare; 2018.
  20. Singh GK, Siahpush M. Widening rural-urban disparities in life expectancy, U.S., 1969-2009. Am J Prev Med. 2014;46(2):017.
  21. Phillips A. Health status differentials across rural and remote Australia. Aust J Rural Health. 2009;17:2-9. doi:10.1111/j.1440-1584.2008.01029.x
  22. Kumar R, Pal R. India achieves WHO recommended doctor population ratio: A call for paradigm shift in public health discourse! J Family Med Prim Care. 2018;7(5):841-844. doi:10.4103/jfmpc.jfmpc_218_18
  23. Anand S, Fan V. The health workforce in India. Human Resources for Health Observer Series No. 16. Geneva: World Health Organization; 2016.
  24. Mourya DT, Yadav PD, Ullas PT, et al. Emerging/re-emerging viral diseases & new viruses on the Indian horizon. Indian J Med Res. 2019;149(4):447-467. doi:10.4103/ijmr.IJMR_1239_18
  25. Bachani D. Need for Strategic Revamping to Prevent and Control Non-communicable Diseases in India. Indian J Community Med. 2017;42(1):1-3. doi:10.4103/0970-0218.199803
  26. Marchant T, Beaumont E, Makowiecka K, et al. Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India. CMAJ. 2019;191(43):E1179-E1188. doi:10.1503/cmaj.190219
  27. Woolley T, Cristobal F, Siega-Sur J, et al. Positive implications from socially accountable, community-engaged medical education across two Philippines regions. Rural Remote Health. 2018;18(1):4264.
  28. Siega-Sur JL, Woolley T, Ross SJ, Reeve C, Neusy AJ. The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce. Med Teach. 2017;39(10):1084-1091. doi:10.1080/0142159x.2017.1354126
  29. Halili S Jr, Cristobal F, Woolley T, Ross SJ, Reeve C, Neusy AJ. Addressing health workforce inequities in the Mindanao regions of the Philippines: Tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school. Med Teach. 2017;39(8):859-865.
  30. Reeve C, Woolley T, Ross SJ, et al. The impact of socially-accountable health professional education: A systematic review of the literature. Med Teach. 2017;39(1):67-73. doi:10.1080/0142159x.2016.1231914
  31. Widyaningsih V, Khotijah K. The patterns of self-reported maternal complications in Indonesia: are there rural-urban differences? Rural Remote Health. 2018;18(4):10.
  32. Rahmawati R, Bajorek BV. Access to medicines for hypertension: a survey in rural Yogyakarta province, Indonesia. Rural Remote Health. 2018;18(3):15.
  33. Fernandez RC, Awofeso N, Rammohan A. Determinants of apparent rural-urban differentials in measles vaccination uptake in Indonesia. Rural Remote Health. 2011;11(3):8.
  34. World Health Organization (WHO). The 2018 update, Global Health Workforce Statistics. Geneva: WHO; 2018.
  35. Efendi F. Health worker recruitment and deployment in remote areas of Indonesia. Rural Remote Health. 2012;12(2):2008.
  36. Strasser R, Neusy AJ. Context counts: training health workers in and for rural remote areas. Bull World Health Organ. 2010;88:777-782.
  37. Rourke J. Social accountability: a framework for medical schools to improve the health of the populations they serve. Acad Med. 2018;93(8):1120-1124. doi:10.1097/ACM.0000000000002239
  38. Playford D, Ngo H, Gupta S, Puddey IB. Opting for rural practice: the influence of medical student origin, intention and immersion experience. Med J Aust. 2017;207(4):154-158. doi:10.5694/mja16.01322
  39. Playford DE, Evans SF, Atkinson DN, Auret KA, Riley GJ. Impact of the Rural Clinical School of Western Australia on work location of medical graduates. Med J Aust. 2014;200(2):104-107. doi:10.5694/mja13.11082
  40. O’Connell HP. Spicing up medical education: six cornerstone in teaching medical students today. BMJ. 2009;338:b2390. doi:10.1136/sbmj.b2390
  41. Rourke J. How can medical schools contribute to the education, recruitment and retention of rural physicians in their region? Bull World Health Organ. 2010;88(5):395-396. doi:10.2471/BLT.09.073072
  42. Kapadia RK, McGrath BM. Medical school strategies to increase recruitment of rural-oriented physicians: the Canadian experience. Can J Rural Med. 2011;16(1):13-19.
  43. Rabinowitz KH, Diamond JJ, Markham WF, Wortman RJ. Medical school programs to increase the rural physician supply: a systematic review and projected impact of widespread replication. Acad Med. 2008;83(3):235-243. doi:10.1097/ACM.0b013e318163789b
  44. Emery A, Hurley S, Williams J, Pougnault S, Mercer A, Tennant M. A seven-year retrospective analysis of students entering medicine via a rural student recruitment program in Western Australia. Aust J Rural Health. 2009;17(6):316-320. doi:10.1111/j.1440-1584.2009.01105.x
  45. McDonnel Smedts A, Lowe MP. Efficiency of clinical training at the Northern Territory clinical school: placement length and rate of return for internship. Med J Aust. 2008;189(3):166-168.
  46. Farmer J, Kenny A, McKinstry C, Huysmans RD. A scoping review of the association between rural medical education and rural practice location. Hum Resour Health. 2015;13:27. doi:10.1186/s12960-015-0017-3
  47. World Health Organization (WHO). Increasing access to health workers in remote and rural areas through improved retention: global policy recommendations. France: WHO; 2010.
  48. Rural Health West. Critical success factors for recruiting and retaining health professionals to primary health care in rural and remote locations: contemporary review of the literature. Nedlands, WA: Rural Health West; 2013.
  49. Agyei-Baffour P, Kotha SR, Johnson JC, et al. Willingness to work in rural areas and the role of intrinsic versus extrinsic professional motivations - a survey of medical students in Ghana. BMC Med Educ. 2011;11:56. doi:10.1186/1472-6920-11-56
  50. Campbell N, McAllister L, Eley D. The influence of motivation in recruitment and retention of rural and remote allied health professionals: a literature review. Rural Remote Health. 2012;12(2):1900.
  51. Dieleman M, Cuong PV, Anh LV, Martineau T. Identifying factors for job motivation of rural health workers in North Viet Nam. Hum Resour Health. 2003;1:10. doi:10.1186/1478-4491-1-10
  52. Mutale W, Ayles H, Bond V, Mwanamwenge MT, Balabanova D. Measuring health workers’ motivation in rural health facilities: baseline results from three study districts in Zambia. Hum Resour Health. 2013;11:8. doi:10.1186/1478-4491-11-8
  53. Serneels P, Montalvo JG, Pettersson G, Lievens T, Butera JD, Kidanu A. Who wants to work in a rural health post? the role of intrinsic motivation, rural background and faith-based institutions in Ethiopia and Rwanda. Bull World Health Organ. 2010;88(5):342-349. doi:10.2471/BLT.09.072728
  54. Marko Vujicic MA, Bukhuti Shengelia, Sophie Witter. Attracting doctors and medical students to rural Vietnam: insights from a discrete choice experiment. Washington DC: World Bank; 2010.
  55. Miranda J, Diez - Canseco F, Lema C, et al. Stated preferences of doctors for choosing a job in rural areas of Peru: a discrete choice experiment. PLoS One. 2012;7(12):e50567. doi:10.1371/journal.pone.0050567
  56. Smitz M-F, Witter S, Lemiere C, et al. Understanding health workers’ job preferences to improve rural retention in Timor-Leste: findings from a discrete choice experiment. PLoS One. 2016;11(11):e0165940. doi:10.1371/journal.pone.0165940
  57. Rao KD, Ryan M, Shroff Z, Vujicic M, Ramani S, Berman P. Rural clinician scarcity and job preferences of doctors and nurses in India: a discrete choice experiment. PLoS One. 2013;8(12):e82984. doi:10.1371/journal.pone.0082984
  58. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68-78. doi:10.1037/0003-066x.55.1.68
  59. Neumann O, Ritz A. Public service motivation and rational choice modelling. Public Money & Management. 2015;35(5):365-370. doi:10.1080/09540962.2015.1061179
  60. Parlier AB, Galvin SL, Thach S, Kruidenier D, Fagan EB. The road to rural primary care: a narrative review of factors that help develop, recruit, and retain rural primary care physicians. Acad Med. 2018;93(1):130-140.
  61. Lee DM, Nichols T. Physician recruitment and retention in rural and underserved areas. Int J Health Care Qual Assur. 2014;27(7):642-652. doi:10.1108/ijhcqa-04-2014-0042
  62. Viscomi M, Larkins S, Gupta TS. Recruitment and retention of general practitioners in rural Canada and Australia: a review of the literature. Can J Rural Med. 2013;18(1):13-23.
  63. Rabinowitz HK, Diamond JJ, Markham FW, Wortman JR. Medical school programs to increase the rural physician supply: A systematic review and projected impact of widespread replication. Acad Med. 2008;83(3):235-243.
  64. O’Sullivan BG, McGrail MR, Russell D, Chambers H, Major L. A review of characteristics and outcomes of Australia’s undergraduate medical education rural immersion programs. Hum Resour Health. 2018;16(1):8. doi:10.1186/s12960-018-0271-2
  65. Johnson GE, Wright FC, Foster K. The impact of rural outreach programs on medical students’ future rural intentions and working locations: a systematic review. BMC Med Educ. 2018;18(1):196. doi:10.1186/s12909-018-1287-y
  66. Pfarrwaller E, Sommer J, Chung C, et al. Impact of Interventions to Increase the Proportion of Medical Students Choosing a Primary Care Career: A Systematic Review. J Gen Intern Med. 2015;30(9):1349-1358. doi:10.1007/s11606-015-3372-9
  67. 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(2):1060.
  68. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:10.1080/1364557032000119616
  69. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-269. doi:10.7326/0003-4819-151-4-200908180-00135
  70. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation the PRISMA-ScR statement. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/m18-0850
  71. Covidence systematic review software. Melbourne, Australia: Veritas Health Innovation. https://www.covidence.org/home.  
  72. Hong QN PP, Fàbregues S, Bartlett G, et al, Inventors. Mixed Methods Appraisal Tool (MMAT), version 2018.
  73. Bearman M, Dawson P. Qualitative synthesis and systematic review in health professions education. Med Educ. 2013;47(3):252-260. doi:10.1111/medu.12092
  74. Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005;10(1):45-53. doi:10.1177/135581960501000110