Is Western Australia's rural surgical workforce going to sustain the future? A quantitative and qualitative analysis.

Objective Despite public interest in the rural workforce, there are few published data on the geographical distribution of Australia's rural surgeons, their practice skill set, career stage or work-life balance (on-call burden). Similarly, there has not been a peer-reviewed skills audit of rural training opportunities for surgical trainees. The present study undertook this baseline assessment for Western Australia (WA), which has some of the most remote practice areas in Australia. Methods Hospital staff from all WA Country Health Service hospitals with surgical service (20 of 89 rural health services) were contacted by telephone. A total of 18 of 20 provided complete data. The study questionnaire explored hospital and practice locations of practicing rural surgeons, on-call rosters, career stage, practice skill set and the availability of surgical training positions. Data were tabulated in excel and geographic information system geocoded. Descriptive statistics were calculated in Excel. Results Of the seven health regions for rural Western Australia, two (28.6%) were served by resident surgeons at a ratio consistent with Royal Australasian College of Surgeons (RACS) guidelines. General surgery was offered in 16 (89%) hospitals. In total, 16 (89%) hospitals were served by fly-in, fly-out (FIFO) surgical services. Two hospitals with resident surgeons did not use FIFO services, but all hospitals without resident surgeons were served by FIFO surgical specialists. The majority of resident surgeons (62.5%) and FIFO surgeons (43.2%) were perceived to be mid-career by hospital staff members. Three hospitals (16.7%) offered all eight of the identified surgical skill sets, but 16 (89%) offered general surgery. Conclusions Relatively few resident rural surgeons are servicing large areas of WA, assisted by the widespread provision of FIFO surgical services. The present audit demonstrates strength in general surgical skills throughout regional WA, and augers well for the training of general surgeons. What is known about the topic? A paper published in 1998 suggested that Australia's rural surgeons were soon to reach retirement age. However, there have been no published peer-reviewed papers on Australia's surgical workforce since then. More recent workforce statistics released from the RACS suggest that the rural workforce is in crisis. What does this paper add? This paper provides up-to-date whole-of-state information for WA, showing where surgical services are being provided and by whom, giving a precise geographical spread of the workforce. It shows the skill set and on-call rosters of these practitioners. What are the implications for practitioners? The present study provides geographical workforce data, which is important to health planners, the general public and surgeons considering where to practice. In particular, these data are relevant to trainees considering their rural training options.