Fly in Fly out Rural Hospital to Regional Medical Hub
10 October 2014 Last updated:
10 October 2014
Fly in Fly Out Rural Hospital to Regional Medical Hub
Griffith Base Hospital, Murrumbidgee Local Health District
A needs analysis was undertaken and medical workforce requirements were identified and positions created. Through engagement with medical and government bodies, an innovative multi-platform advertising campaign and remuneration incentives, clinicians with the right skill mix were attracted to the hospital.
To improve the quality of care delivered to the community of Griffith by attracting and retaining a medical workforce by offering innovative career pathways, training incentives and remuneration within policy directives.
Improved access to safe, sustainable, quality acute care at significantly lower cost than the existing unstable locum workforce required.
Project started: 2011
Sustained: The project has been implemented and is sustained as standard business.
- Attracting permanent Doctors to rural areas is difficult everywhere and Griffith Base Hospital (GBH) was no different. In 2011 close to 70% of the medical positions were vacant and filled by fly-in fly-out doctors.
- In addition to compromising continuity, quality and safety of patient care Griffith Base Hospital was spending an additional $2.5 million annually on premium medical labour costs.
- Patients saw a different face each visit, causing a lack of continuity of care and the community was demanding improved local services.
- The local hospital staff had increased administrative duties including a continual cycle of advertising/recruiting and managing Locum Doctors.
- In addition to vacancies in the Emergency Department, specialist workforce was also required in Surgery, Paediatrics, Anaesthetics and Obstetrics.
Workforce needs analysis
Through a series of consultations with local and district clinicians and managers, the team defined the medical establishment for Griffith Base Hospital. Four new specialist positions, one each in Anaesthesia, Surgery, Obstetrics & Gynaecology and Paediatrics were created after a needs analysis was undertaken.
A range of innovative strategies was used including:
- Advertising the positions on NSW Health website
- Advertising through Specialist College websites and newsletters
- Overseas advertising e.g. BMJ Careers
- Facebook advertising
- Advertising by word of mouth
- Informal medical conference advertising.
The selection process
- All suitable locum doctors were interviewed to determine if they wanted permanent jobs.
- Active follow up of NSW Health contracted recruitment agencies.
- Once a suitable candidate was identified, GBH was proactive in speaking with them, facilitating interviews, arranging the necessary paperwork and referee checks. This was often undertaken within a 24-hour period.
- Care was taken not just to match the doctor to the position but to also match the family with Griffith.
- Extensive pre-employment discussions with candidates took place to ensure the doctor and family would fit into the town.
- A number of doctors were invited to visit Griffith with their families and get togethers were organised with other medical staff.
- Local Medical Networks through existing Doctors were often used, and the Director of Medical Services personally greeted the candidates on arrival to Griffith. Suitably qualified partners were advised of vacant jobs within the health service.
- Issues arising out of the recruitment process were discussed as a priority within the Hospital Executive and where required followed up proactively with the District Executive.
- Griffith Hospital staff made themselves available to assist the new recruits with any potential problems to ensure improves retention.
- GBH has successfully recruited 15 FTE doctors including four specialists.
- 96% of the GBH Medical Workforce now permanent.
Positions filled or created
- All 10 positions within the Emergency Department have been filled.
- A resident Physician was appointed after a four year vacancy.
- A third full time Surgeon position was created and filled.
- A second consultant position in Obstetrics and Gynaecology was created
- A second Paediatrician position created and filled.
- A consultant Anaesthetist commenced in February 2013, the first consultant in the speciality to work at Griffith Health Service in a decade.
- A second consultant Anaesthetist position created and appointed.
- A Director Medical Services commenced in December 2011.
Enhanced or introduced services
- New services at Griffith Base Hospital include:
- Physician Clinics
- Additional Obstetrics and Gynaecology consultation/clinic services.
- Additional Surgical consultation/clinic services (including breast cancer services).
- Additional Paediatric consultation/clinic services.
- Specialist Anaesthesia service on a regular round the clock basis.
- A full time permanent Medical Administrator.
- A new Orthopaedic Clinic.
With the above improvements and new services, the net saving was over $1 million per annum.
Griffith Base Hospital has been able to overcome this challenge through devolved decision making, applying innovative local thinking and solutions, and a sustained proactive team effort. A similar approach with modifications according to local conditions could be applied in other regions.
The key to success with this project included:
- Innovative local thinking and strategies to attract doctors to a rural city.
- Teamwork in managing large numbers of applicants and setting tight timeframes for responses, offers and contracts.
- Career pathways and training incentives, remuneration within policy directives.
- The Medical Locum Challenge: understanding the Impact of Locum Working Arrangements on NSW Public Health System. Sydney: Agency for Clinical Innovation: 2005.
- Health and Community Services labour force 2006. Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare; 2009.
- The Rural Health Crisis. Retrieved June 15, 2013, from Doctors4the Bush: http://www.csu.edu.au/doctors/the-rural-heath-crisis.
- Skinner CA, Riordan RL, Fraser KL et al. The challenge of locum working arrangements in New South Wales public hospitals. Med J Aust 2006; 185 (5): 276-278.
- NSW Health Annual Report 2011-12. Sydney: NSW Health.
Director Medical Services
Griffith Base Hospital and MIA Rural Group
Murrumbidgee Local Health District
Phone: 0409 756 081
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