’s Rural Generalist Pathway What it was, is and must become Introduction Background

The Queensland Rural Generalist Pathway (QRGP) represents a state government workforce strategy conceived and managed by Queensland Health The QRGP was established in response to the Roma Agreement which to address medical workforce shortages in rural communities. It provides a supported career pathway for junior doctors to train committed to develop and sustain an integrated service and training in rural and remote medicine, combining evidence and policy to achieve professional recognition, credentialing and industrial program to form a career pathway supplying the Rural Generalist recognition. The QRGP’s supported, fast-tracked program to a vocationally registered career in Rural Generalist Medicine workforce that the bush needs. provides: flexibility; minimises geographic re-location; supports the interface with other training providers and colleges; and offers ongoing engagement with Queensland Health throughout training. The QRGP aligns scholarship return-of- The program is founded on four key transformational pillars service obligations with career progression, provides high quality training, recognised portable qualifications and near- characterised by: specialist remuneration. The Pathway forms part of the pipeline to rural practice, harmonising with other rural initiatives including incentives, the ever-increasing focus on rural training and the rising number of students and junior doctors. »» recognition of rural generalist medicine as a unique medical discipline in its own right »» practice value for its true worth »» a supply line/pathway to vocational practice Operation of the pathway »» responsiveness to workforce redesign. Rural Generalist Graduates Advanced skills training A geographically dispersed team of A Rural Generalist is defined administrators, educators and clinicians manage Principle House Officer as a rural medical practitioner Vocational training who is credentialed to serve in: the Pathway. The Rural Generalist Pathway Prevocational training Registrar PGY 3 team provide training and career advice, Senior Medical Officer Hospital and community-based Intern (Provisional Fellow) advocate on behalf of trainees and assist with primary medical practice; and Junior House Officer ... fast tracking to rural the coordination of placement into training PGY 1 and 2 procedural practice Medical Officer with positions. A major strength of the Pathway is Right to Private Practice Hospital-based secondary medical practice, without the additional support Trainees receive through ... marketing and promoting Anaesthetics | Emergency supervision by a medical a supportive career from Medicine ... creating innovative and the provision of additional educational activities specialist in at least one medical school to rural Indigenous Health affordable workforce models including preparatory workshops and personal and professional specialist medical discipline generalist practice Internal Medicine | Mental Health and opportunities to meet (commonly, but not limited career planning through the Vocational Indicative Planning process. Obstetrics and Gynaecology community needs Paediatrics | Surgery to anaesthetics, emergency medicine, obstetrics and gynaecology); and

Hospital and community-based Rural Generalist training ATTRITION RISK TO: public health practice METRO or REGIONAL GENERAL PRACTICE METRO HOSPITAL | SPECIALTY | NON-CLINICAL PRACTICE position locations 32 4 Prevocational training hospitals 1. Bundaberg Figure 1: Operation of the Queensland Rural Generalist Pathway. Source: Queensland Health. 2. Caboolture 3. 4. Ipswich 35 5. Logan 6. Mackay 7. Nambour 8. Redcliffe 9. Rockhampton Key findings 10. Toowoomba 11. Townsville

13 Rural vocational placement locations From an initial intake of 30 trainees in 2007, the pathway has matured with total enrolment currently at 218. Entry is competitive and over- 1. Atherton 24 2. Ayr subscribed, with a cohort of 57 commencing training in 2015 across 11 prevocational training hospitals. A total of 121 trainees are currently 3. 23 3 4. 1 3 completing or have completed vocational training in rural practice, providing invaluable medical support to rural facilities. 19 5. Beaudesert 33 6. Biloela 7. Bowen 8. Charleville 20 26 As the Pathway evolves through increased training positions, emphasis is now being placed on improving and refining 9. Charters Towers 11 10. Cherbourg processes including the engagement of trainees; increasing training capacity (in particular, Advanced Skills Training posts); 2 11. Childers 9 7 12. Cloncurry and matching Rural Generalist graduates with workforce requirements and community needs. The maturity of the QRGP 25 12 27 13. Cooktown 14. Cunnamulla has coincided with a marked decrease in the number of critical medical vacancies (as outlined in Table 1), which in the 6 15. Dalby 16. Emerald past, if not filled, may have resulted in the closure of services. It is evident that critical vacancies have now stabilised and 17. Gladstone 18. Goondiwindi proactive management practices can be applied including a focus on targeted recruitment and retention strategies through 19. Innisfail 20. Ingham 22 21. Kingaroy improved workforce planning. 16 9 22. Longreach 17 23. 8 24. Mossman QRGP summary | 2014 25. Mt Isa 31 Queensland Health medical vacancies | 2010-12 1 26. Palm Island 11 27. Proserpine 28. Roma PGY1 | 46 6 29. St George Vacancies 2010 2011 2012 28 10 21 30. Stanthorpe 7 31. Theodore 15 2 8 32. 750 194 34 PGY2 | 38 10 33. Tully 14 29 4 5 5 34. Warwick Critical level 1 18 34 35. - -74.13% -84.48% 30 PGY3 | 39 * Please note these positions are Figure 2: Queensland Rural Generalist training position locations. Source: Queensland Health. indicative only and are based on 1109 1004 481 historial data Critical level 2 PGY4 | 30 - -9.47% -52.09% PGY5 | 34 568 1674 1277 Further information Critical level 3 194.71% -23.72% PGY6+ | 31 For further information, please contact the Rural Generalist Pathway team: Total 2427 2872 1792 Fellows | 34 t. 1800 680 291 Table 1: Queensland Health medical vacancies. Source: Queensland Health. Figure 3: Queensland Rural Generalist Pathway summary 2014. Source: Queensland Health. e. [email protected] w. http://www.health.qld.gov.au/ruralgeneralist Conclusion

The Queensland Rural Generalist Pathway has been recognised by all stakeholders as an effective and sustainable training pathway that is providing a solution to the rural medical workforce challenges faced in Queensland. The long term success of the pathway will hinge on its ability to flexibly adapt to the changing needs of the rural workforce and maintain high quality training with these adaptations. Future refinement aims to moderate the program to fit with the individual workforce planning requirements of the respective rural Hospital and Health Services of Queensland.

Great state. Great opportunity.