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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (31 May 2019) | Viewed by 16160

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Special Issue Editors

Dr. Matthew McGrail

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Guest Editor

Rural Clinical School, University of Queensland, Rockhampton, QLD 4700, Australia
Interests: rural health workforce; access to health care; health services research; GIS methodologies in health; health workforce policy/incentives; recruitment, retention and mobility

Dr. Belinda O'Sullivan

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Guest Editor

School of Rural Health, Monash University, Bendigo VIC 3550, Australia
Interests: rural health policy; public health; health systems; workforce training and development; evaluation

Special Issue Information

Dear Colleagues,

Rural communities contribute greatly to each nation’s economic outcomes, as well as their environmental and cultural diversity. A strong rural health workforce, particularly supporting public health and primary prevention, is a vital component of improving rural population health and rural communities. As such, governments and clinicians strive to support a workforce that meets the needs of rural populations, through interventions across selection, education, regulation, incentives or support. However, the rural environment introduces many health workforce and service challenges and, to date, most of the research about rural health is descriptive and localised, rather than delineating what works.

This Special Issue of IJERPH focuses on evaluative research that informs outcomes of strategies to build a rural health workforce for meeting the needs of rural populations. Submissions are welcome on topics relating to those keywords listed below. In particular, we seek evidence of interventions that demonstrate improved health workforce outcomes of training and development, increased critical mass of health workers to service particular needs, increased health worker distribution or improved health worker retention and applications of new health workforce service models to meet demand. We welcome research from all healthcare disciplines and settings.

Dr. Matthew McGrail
Dr. Belinda O'Sullivan
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Rural health workforce
Scope of practice
Access equity
Workforce training models
Models of practice
Rural policy evaluation
Workforce retention and mobility
Rural training pathways

Published Papers (5 papers)

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Research

10 pages, 268 KiB

Open AccessArticle

Rural Work and Specialty Choices of International Students Graduating from Australian Medical Schools: Implications for Policy

by Matthew R. McGrail, Belinda G. O’Sullivan and Deborah J. Russell

Int. J. Environ. Res. Public Health 2019, 16(24), 5056; https://doi.org/10.3390/ijerph16245056 - 11 Dec 2019

Cited by 6 | Viewed by 2637

Abstract

Almost 500 international students graduate from Australian medical schools annually, with around 70% commencing medical work in Australia. If these Foreign Graduates of Accredited Medical Schools (FGAMS) wish to access Medicare benefits, they must initially work in Distribution Priority Areas (mainly rural). This study describes and compares the geographic and specialty distribution of FGAMS. Participants were 18,093 doctors responding to Medicine in Australia: Balancing Employment and Life national annual surveys, 2012–2017. Multiple logistic regression models explored location and specialty outcomes for three training groups (FGAMS; other Australian-trained (domestic) medical graduates (DMGs); and overseas-trained doctors (OTDs)). Only 19% of FGAMS worked rurally, whereas 29% of Australia’s population lives rurally. FGAMS had similar odds of working rurally as DMGs (OR 0.93, 0.77–1.13) and about half the odds of OTDs (OR 0.48, 0.39–0.59). FGAMS were more likely than DMGs to work as general practitioners (GPs) (OR 1.27, 1.03–1.57), but less likely than OTDs (OR 0.74, 0.59–0.92). The distribution of FGAMS, particularly geographically, is sub-optimal for improving Australia’s national medical workforce goals of adequate rural and generalist distribution. Opportunities remain for policy makers to expand current policies and develop a more comprehensive set of levers to promote rural and GP distribution from this group. Full article

(This article belongs to the Special Issue Rural Health Workforce)

15 pages, 454 KiB

Open AccessArticle

Are Medical Graduates’ Job Choices for Rural Practice Consistent with their Initial Intentions? A Cross-Sectional Survey in Western China

by Jinlin Liu, Bin Zhu, Ning Zhang, Rongxin He and Ying Mao

Int. J. Environ. Res. Public Health 2019, 16(18), 3381; https://doi.org/10.3390/ijerph16183381 - 12 Sep 2019

Cited by 6 | Viewed by 2316

Abstract

Global concerns persist regarding the shortage and misdistribution of health workers in rural and remote areas. Medical education is an important input channel of human resources for health. This study aimed to identify the association between medical graduates’ job choices for rural practice and their initial intentions when they began to look for a job in China. Data were extracted from a cross-sectional survey among medical students in ten western provinces in China in 2013. Only medical students who were in the last year of study (i.e., medical graduates) and had found a job were included in this study. Of the 482 participants, 61.04% (293) presented an initial intention of rural practice when they began to look for a job, and 68.88% (332) made a final job choice for rural practice. However, of the 332 graduates with a final job choice of rural practice, only 213 (64.55%) had an initial intention. A univariate association was identified in which medical graduates who were more likely to make final job choices for rural practice were those having initial intentions (OR: 1.59; 95% CI: 1.08–2.36); however, after adjusting for controlled variables, it became insignificant and was reduced to a 1.31-fold increase (95% CI: 0.82–2.07). The initial intentions of medical graduates are not assurance of ultimate job outcomes, and it cannot be deduced that all medical graduates who made a final job choice for rural practice had authentic desires for rural practice. Twenty years of age or below, low-income families, majoring in non-clinical medicine, and studying in a junior medical college or below were associated with medical graduates’ final job choices for rural practice. More studies are required on how to translate medical student’s intention of rural medical practice into reality and how to retain these graduates via a job choice in rural practice in the future. Full article

(This article belongs to the Special Issue Rural Health Workforce)

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18 pages, 337 KiB

Open AccessArticle

What Are the Challenges Faced by Village Doctors in Provision of Basic Public Health Services in Shandong, China? A Qualitative Study

by Qian Wang, Yuejia Kong, Jiyao Sun, Yue Zhang, Linlin Yuan and Jian Wang

Int. J. Environ. Res. Public Health 2019, 16(14), 2519; https://doi.org/10.3390/ijerph16142519 - 15 Jul 2019

Cited by 10 | Viewed by 3433

Abstract

Background: Village doctors, as gatekeepers for the health of rural residents in China, are confronted with adversity in providing the basic public health services (BPHS), which has significantly impeded them from providing high quality BPHS. This study aimed to explore the obstacles and difficulties faced by village doctors in order to improve the quality and efficiency of BPHS provision and increase the health level of the population. Methods: In-depth interviews were employed to conduct this qualitative study. A total of 51 village doctors in four cities of Shandong Province were interviewed. The interviews were transcribed, anonymized, and imported into NVivo11.0 to facilitate management. Thematic framework analysis employing the constant comparison method was applied to the data analysis. Results: The main challenges faced by village doctors comprised the shortage, gender imbalance, and poor education of village doctors; older village doctors in some villages; low income; lack of social security; inappropriate performance assessment; inadequate professional BPHS training; heavy workload; and insufficient cooperation from rural residents, which have exacerbated the quality, efficiency, and accessibility of BPHS to some extent. Conclusions: Village doctors, as the important BPHS providers in rural Shandong, are facing a wide range of challenges. It is urgent for government officials and policy makers to consider these challenges and concentrate on improving the quality of BPHS provision by developing relevant and practical strategies. Full article

(This article belongs to the Special Issue Rural Health Workforce)

19 pages, 2053 KiB

Open AccessArticle

Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective

by Bin Zhu, Chih-Wei Hsieh and Ying Mao

Int. J. Environ. Res. Public Health 2019, 16(10), 1753; https://doi.org/10.3390/ijerph16101753 - 17 May 2019

Cited by 9 | Viewed by 3115

Abstract

Background: The maldistribution of licensed doctors is one of the major challenges faced by the Chinese health sector. However, this subject remains underexplored, as the underlying causes of licensed doctor distribution have not been fully mapped out. To fill the research void, this study theoretically modeled and empirically measured various determinants of licensed doctor distribution from both the supply and demand sides while taking the spillover effect between the adjacent geographical units into consideration. Methods: The theory of demand and supply is adopted to construct a research framework so as to explain the imbalance in the licensed doctor distribution. Both direct effects and spillover effects of the supply-side factors and demand-side factors are empirically measured with the spatial panel econometric models. Results: The health service demand was found, as expected, to be the major driving force of the licensed doctor distribution across the nation. That is, the increase in health services demands in a province could significantly help one unit attract licensed doctors from adjacent units. Unexpectedly but intriguingly, the medical education capacity showed a relatively limited effect on increasing the licensed doctor density in local units compared with its spillover effect on neighboring units. In addition, government and social health expenditures played different roles in the health labor market, the former being more effective in increasing the stock of clinicians and public health doctors, the latter doing better in attracting dentists and general practitioners. Conclusions: The results provide directions for Chinese policy makers to formulate more effective policies, including a series of measures to boost the licensed doctor stock in disadvantaged areas, such as the increase of government or social health expenditures, more quotas for medical universities, and the prevention of a brain drain of licensed doctors. Full article

(This article belongs to the Special Issue Rural Health Workforce)

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24 pages, 333 KiB

Open AccessArticle

Rural Public Health Workforce Training and Development: The Performance of an Undergraduate Internship Programme in a Rural Hospital and Healthcare Centre

by Luis Miguel Dos Santos

Int. J. Environ. Res. Public Health 2019, 16(7), 1259; https://doi.org/10.3390/ijerph16071259 - 09 Apr 2019

Cited by 17 | Viewed by 4314

Abstract

Workforce shortages in the field of public health and healthcare are significant. Due to the limitations of career opportunities and compensation, rural hospitals and healthcare centres usually have on-going career openings for all departments. As a result, university departments of public health and healthcare management, and rural hospitals and health centres may need to establish internship and training programmes for undergraduate senior-year students in order to provide opportunities and human resource opportunities for both students and public health professions. The research examined the performance, feedback, and opinions of a university-based one-year-long on-site internship training programme between a university public health and healthcare undergraduate department and a regional hospital and healthcare centre in a rural region in the United States. Individual interview data were collected from management trainees and focus group activities data were collected from hospital departmental supervisors who have completed this one-year-long on-site internship training programme. The results offered an assessment of performance and evaluation of how a one-year-long internship programme could be beneficial to hospitals and health centres in the areas of human resources, manpower management, and skill training to prospective professionals in rural and regional communities. Also, the study provided a blueprint and alternative for universities and partnered sites to redesign and improve their current internship programmes which may better fit their needs for their actual situations. Full article

(This article belongs to the Special Issue Rural Health Workforce)

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