Recruitment and Selection of Doctors - Assignment Example

Recruitment and Selection of Doctors - Top End Medical Care EXECUTIVE SUMMARY Recruitment and retaining of skilled doctors has been a constant problem and area of worry for healthcare units in Queensland, Australia. The paper has researched this subject with a view to improve the fill rate of qualified doctors for Top End Medical Care – TEMC in Queensland, Australia. The external factors that were found showed that experienced doctors were unwilling to work in remote areas due to reasons such as lack of learning and career development opportunities; absence of good infrastructure and hospitals and lower wages. The paper has examined the various issues and recommended three options that would help TEMC to increase recruitment and retaining of skilled doctors. The options include: obtaining sufficient funds and paying adequate wages; creating a network of skilled doctors who would be sent on rotation to remote areas; creating a robust IT infrastructure with video conferencing that would help experienced doctors in urban areas to diagnose patients in remote areas and guide fresh recruits to provide better treatment. It is expected that if the recommendations are adopted, then there would be more experienced consultation available for patients in remote areas. Table of Contents 1. Introduction 2 2. Discussion of the Problem 3 3. Recommendation 8 4. Conclusion 9 References 9 1. Introduction Doctors and trained physicians are the life support entities of any healthcare system and this is more so in remote and rural areas that have few hospitals and health care units. Gorman (2009) reports that many regions of Queensland and New Zealand have 70% of required doctors. The author has reported that these regions also have a high level of dependency on foreign born doctors and about 42% of the doctors in these regions are of foreign origin. While this factor should not be an issue since foreign born doctors are also competent, the disturbing fact is that it is difficult to attract and retain doctors in the rural areas of Queensland. Fowler (1997) comments that while fresh doctors and interns do join rural practice, it is meant to fulfill certain requirements to obtain a medical degree. The author has estimated that since 2005, about 182 to 681 doctors per annum have left the rural practice and migrated to bigger cities with better career prospects. Better career prospects in cities, changing priorities, poor rural living conditions and lack of skill development can frustrate even the most ardent and medical practitioner who would then quit the rural posting. This behavior and trend among doctors has become very severe and lives of children, pregnant women, aboriginal people and the elderly are at stake. This paper examines the case of Top End Medical Care hospital – TEMC in far North Queensland, Australia that is facing problems in recruitment of doctors. The paper would examine the external environmental and organizational issues that effect TEMC RSP efforts and recommends a set of procedures to follow for recruiting, selecting and placing specialist doctors. 2. Discussion of the Problem The issue of shortage of trained doctors is not only limited Queensland but according to Pradhan (June 2010), attracting and retaining doctors in rural areas is a problem faced throughout the world, right from USA to Nepal and remote villages of poor African nations. This chapter discusses various issues involved in the recruitment of doctors in Queensland. 2.1. External environmental and organizational issues at TEMC and their impact on RSP Hays (June 2008) mentions some important societal changes that have impacted even the medical fraternity. Doctors have their priorities and after some years of experience, they would prefer to practice in a big city with their own consultancy and being attached to a hospital. A Cardiologist would earn many times more in a city such as Perth than in a remote rural place in the Australian outback. There are also other pressures such as pressure from the spouse and children, desire to learn more skills and be exposed to new medical technology, changing life style with a need to be among peers and enjoy the good things of life and so on. Taylor (2006) points out that the work of recruiting skilled doctors and healthcare specialists is more complicated than it seems. Many rural villages do not have even the basic houses, hospitals and doctors are supposed to be Bush Doctors who travel in a Jeep and provide general practice. Not many of the new breed of doctors are attracted by this image and hence when advertisements appear for doctors in remote posting, very few apply and fewer still join after selection. Schubert (12 June 2010) has been scathing is his criticism of government policies and attitudes towards rural doctors. According to the author, there is very poor management and poorer budgeting with very little available in the form of amenities. Salary and wages are not only less but wages are paid once in three months and thus it becomes hard for doctors to survive. Also the poor quality of hospitals, lack of OR facilities and rudimentary infrastructure can frustrate even the best doctors. The author has said that more experienced doctors will come to rural areas of Queensland if they are assured that they would get proper training, if they know that they will be mentored and supervised properly, if they get proper funding, if the on call duties are not very heavy and if they can have holidays as and when they want. Shankar (14 September 2010) is of the opinion that doctors leave rural practice not just because of only money but due to other lifestyle related issues such as lack of growth opportunities, lack of learning and training and absence of medical infrastructure. AMSA (2010) has indicated the tentative tuition fees to earn a MBBS degree at Bond University, Queensland as 262,566 AUD. There are other expenses such as hostel, food, living and further PG specialization and the overall costs can very well go up to more than 500,000 AUD. It is natural that students should be expected to look forward to recovering the expenses and there is nothing wrong ethically in this attitude. White (11 April 2007) conducted field research among 429 medical practitioners to find out the main barriers for rural practice in Queensland. According to reports of the study, 94% of the respondents strongly agree that lack of continuing medical education is the main inhibitor in rural and remote practice. 93% also agree that lack of CME reduces professional isolation and 80% strongly agreed that they were less likely to remain in the medical practice in rural areas if they did not have access to CME. Duration of remote and rural practice was also important and while the time spent in rural practice ranged from 44 years to 0.5 years, more elderly doctors were in the group that had spent a minimum median of 12.1 years in rural practice. The inference drawn here is that continued medical education was very important for doctors and that younger doctors preferred to move out of the area after a minimum time spent. Reed (2008) reports that among the factors that influence the decision to work in rural areas are the presence of professional support from senior specialists; availability of experienced mentors and further skills up gradation; proper on call arrangements and locum relief; local provision of services and nearness to a large regional medical centre and more important, a message given to undergraduate medical students that working in rural areas is important for a doctors career. 2.2. Advantages and disadvantages of realistic improvement options As far back in the early 1970’s, Champion (1970) had written about the unwillingness of doctors and the problems of recruitment of skill doctors in rural areas. As a pattern, doctors with some years of experience preferred to set up practice in areas with a population of at least 100,000 people. In areas with smaller population, private hospitals tended to be smaller and offered consultancy services, referring patients to more expensive and better arranged hospitals in urban areas. The only clinics were owned by government and community agencies and these had immense problems of recruiting skilled doctors. Lian (February 2007) uses the social theory constructs to suggest that doctors in rural areas are a part of the local community and doctors are not just performing a job but saving lives tending to the health and well being of people. Any attempts at recruitment should aim to bring the doctor into the community as a valued member and this increase the retention of doctors who are involved at the community level. Based on the observations from the previous sections and paragraphs, TEMC has to find ways and means to attract and retain skilled doctors. Some important facts that have to be noted are that: more experienced doctors are more likely to have a family. Medicine works in tiers, with better doctors wanting more resources, having more responsibility, and wanting more senior support; because with less resources and doctors there is an increased likelihood of mistakes and therefore legal problems. Remoteness of regions means that there is a Poorer work/life balance; Low community services for doctors with families; Gen X/Y prefer to work in cities; Low quality hospitals in rural areas and that Less doctors means higher stress and responsibility. The following options can be considered for recruitment: Offer better wages and facilities for doctors. Adopt the 'Working and personal/family' environment as suggested by RHW (February 2009). Adopt the Midwest Brokerage Model or the Wiluna Model practiced in Wiluna village that is located East of Perth and at the gateway of Gunbarrel Highway. Other models are Mid West Aero Medical Group model. Increased use of IT applications and the Internet to increase access of medical knowledge and learning for doctors While some of the options would be more appropriate at the government and council level, the options can be considered even for TEMC. Next section elaborates on these options. 2.3. Procedures for TEMC to follow when recruiting Options presented in the previous section 2.2. are discussed here. 1. Better wages and facilities: TEMC should consider offering some or all of the following facilities at the time of recruitment. These are: free Accommodation and work related travel with company car or Jeep; create a lifestyle that suits the doctors and promote the community, town and also the hospital. Other facilities are focus on creating a work and life balance; provide for holidays and days off; provide training and gym facilities; provide paid meal breaks and outpost visits to remote clinics. 2. Working and personal/family' environment: In this model, the hospital and community takes care of not only the doctor but also the wife and children. This may involve offering employment to the wife, providing for childcare facility and so on. 3. Adopt the Midwest Brokerage Model: In this model, there is a need to establish a coordination centre that would have a pool of skilled doctors. Since TEMC and other smaller clinics would have problems in recruiting expensive and skilled doctors, the health care centers along with government clinics would hire skilled doctors. These skilled doctors would have a monthly tour of duty wherein each month, a few doctors would traverse the area either in airplanes or by car and visit remote rural areas and at designated centers. TEMC can be proposed as centre where the skilled doctors would visit as often as needed. Once such doctors start visiting TEMC and other areas, lesser experienced doctors would also join up. 4. Increased use of IT applications: Broadband Internet is easily available in almost all areas of Australia. There are available a number of software applications with video conferencing that allows doctors in remote areas such as TEMC to chat live on the video with experts in large cities. When such facilities are made available, TEMC can make arrangements with skilled doctors in far off cities such as Melbourne and Perth and they can examine patients virtually through online video and offer diagnosis and treatment. Lesser skilled doctors and even fresh recruits can be made to interface between patients and far off doctors. This reduces the need for skilled doctors to be available physically in places such as TEMC hospitals. 3. Recommendation Based on the discussions from the previous sections, the following recommendations are made: Obtain adequate funding from government bodies and other possible sources. Finance is the key to any further actions. A rough budget can be drafted based on requirements of doctors and infrastructure. Create a network of skilled doctors from urban areas. These can be approached through face book and personal contacts. The issues and opportunities should be explained to the doctors and aspects of continued learning, personal interaction through video conferencing with expert doctors and the chance to make a difference in the lives of rural people should be highlighted. Packages and wages offered facilities available, etc should be explained transparently and all attempts to misinform potential recruits should be avoided. These doctors can be shared through TEMC and other healthcare agencies. Invest in high end and robust IT applications: With the cost of IT solutions coming down everyday, obtaining powerful and robust IT systems that offer video conferencing and that connect to medical databases should be affordable. 4. Conclusion The paper has discussed the recruitment and retaining problems of skilled doctors in rural areas of Queensland where TEMC operates. Various factors that act as barriers for recruitment of skilled doctors have been examined. Among the reasons are: lack of peer association; isolation from other specialist; lack of continued learning and education; low level of infrastructure and facilities and lower wages in rural areas. A set of options and recommendations have been proposed and these can be considered by TEMC and local healthcare councils. References AMSA, 2010. Bond University: 6 Year MBBS Degree course. [Online] Australian Medical Students Association. Available at http://www.amsa.org.au/content/queensland [Accessed 21 September 2010] Champion, D, J., September, 1971. Physician Behavior in Southern Appalachia: Some Recruitment Factors. Journal of Health and Social Behavior, 12(3), pp. 245-252 Fowler, B., 1997. The professional development of newly graduated medical interns. Cairns Base Hospital and QMEC, The University of Queensland, Queensland, Australia, pp. 1-7 Gorman, D, F., 2009. On solutions to the shortage of doctors in Australia and New Zealand. The Medical Journal of Australia, 190(3), pp. 152-156 Hays, R, B., 28 June 2008. Why Doctors leave rural practice. Australian Journal of Rural Health, 5(4), pp. 198-203 Lian, O, S., February 2007. Rural Doctors on a Global Stage: Do Local Communities Make a Difference. Social Theory & Health, 5, pp. 88-102 Pradhan, S, K., June 2010. Retaining doctors in rural and remote areas. Journal of Community Medicine, 6(1), pp. 4-8 Reed, G., 2008. Training and Retaining More Rural Doctors for South Africa. MEDICC Review, 10(1), pp. 49-51 RHW, February 2009. Towards a National Primary Health Care Strategy: Discussion Paper from the Australian Government. Western Australian Centre for Remote and Rural Medicine Limited, Health Department, Government of Australia. Schubert, S., 12 June 2010. No incentives for rural doctors in budget. [Online] North Queensland Register. Available at http://nqr.farmonline.com.au/news/state/agribusiness-and-general/general/no-incentives-for-rural-doctors-in-budget/1856133.aspx [Accessed 21 September 2010] Shankar, P, S., 14 September 2010. Attracting and retaining doctors in rural Nepal. Rural and Remote Health, 10: 1420, pp. 1-7 Taylor, J., 2006. Community participation in organizing rural general practice: Is it sustainable? Australian Journal of Rural Health, 14, pp. 144-147 White, C, D., 11 April 2007. Making a difference: education and training retains and supports rural and remote doctors in Queensland. [Online] Rural and Remote Health. Available at http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=700 [Accessed 21 September 2010] Read More