Research Letter

'Surfing the coastal wave' – a new way to consider workforce distribution


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Jenny May
1 AM B.Med PhD FACRRM FRACGP , Director University of Newcastle, Department of Rural Health * ORCID logo

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Matthew R McGrail
2 PhD, Senior Research Fellow ORCID logo

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Judi Walker
3 PhD, Principal Co-Investigator Hazelwood Long Term Health Study


*Prof Jenny May


1 Department of Rural Health, University of Newcastle, 114-148 Johnston St, Tamworth, NSW 2340, Australia

2, 3 Monash University School of Rural Health, Northways Rd, Churchill, Vic. 3842, Australia


27 August 2018 Volume 18 Issue 3


RECEIVED: 27 January 2018

REVISED: 18 April 2018

ACCEPTED: 22 April 2018


May J, McGrail MR, Walker J.  'Surfing the coastal wave' – a new way to consider workforce distribution. Rural and Remote Health 2018; 18: 4753.



A low risk ethics application was lodged with Monash University Human Research Ethics Committee (HREC) and approval granted on 25 May 2011 (CF11/207-20011000666). A process of mutual recognition was undertaken with University of Newcastle (the researcher’s employer) HREC (Approval: H-2011-0209 on 26 June 2011).

This work is licensed under a Creative Commons Attribution 4.0 International Licence

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Surfing the coastal wave - a new way to consider workforce distribution

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Over the past 30 years, there has been significant investment and policy focus to redistribute the workforce in rural and regional areas, with robust evidence that rural origin, rural intention and positive rural exposure are factors in improved recruitment and retention. Higher turnover and poorer retention are seen in smaller rural towns and remote locations1,2, with the rural background effect noted to diminish in areas of inhospitable climate3. Whilst some work has focused on rural ‘amenity’4,5, differing rural contexts (such as inland compared to coastal locations) appear important to location decision processes5.

A recent study (2011–2012) of specialists and general practitioners (GPs) working in regional centres (population 25–100 000) aimed to identify the importance of various factors including location attractiveness in recruitment and retention using a survey and semi-structured interviews. It was conducted in two inland and two coastal locations in the Australian state of New South Wales, with 128 participants (37.5% response rate).

Our quantitative results (Table 1) confirm that recruitment and retention in these regional centres is multifactorial. Environmental attributes such as the beach, and professional factors such as work variety and workplace culture, had high rankings for GPs and specialists resident in coastal locations. In contrast, their inland counterparts had significantly lower values for location factors but similarly high values for professional factors. One clinician noted:

… the coast, it was a big part of my family. My father was a lifesaver. … Yeah, and beach is a big part of what we do with the kids, a huge part. … and I don’t even understand why anybody would want to live away from the coast. To me, it’s Australia.

Whilst acknowledging the limitations of the low response rate, the propensity for the coast highlighted different location drivers for GPs and specialists in inland and coastal regional centres. This key finding of the focused career planning of some doctors to move and stay in coastal locations and their lack of consideration of job opportunities in inland areas is cause for reflection. Thus, the available medical workforce interested in residing and working in inland regional centres is potentially a subset of the total number of practitioners in the job market. The ‘trumping’ of many other factors by location suggests the need for an approach to recruitment and retention that differs between coastal and inland locations.

With the advent of the Modified Monash Model classification system6 used in allocating medical workforce incentives, there is improved discrimination capacity to look at rural centres with differing population sizes and characteristics, such as coastal location2. Further attention to this different way of conceptualising ‘rural’ may assist not only in targeting incentives to the areas with the greatest need, but also inform health and other professional groups of the locational decision processes that may be in play, including the differing profiles of those prepared to work in inland and coastal locations.

Table 1:  Retention rankings by location and clinician (highest rankings only)


1 Russell DJ, Humphreys JS, McGrail MR, Cameron WI, Williams PJ. The value of survival analyses for evidence-based rural medical workforce planning. Human Resources for Health 2013; 11(1): 1. DOI link, PMid:24330603
2 McGrail MR, Humphreys JS. Geographical mobility of general practitioners in rural Australia. Medical Journal of Australia 2015; 203(2): 92-97. DOI link, PMid:26175249
3 Jones M, Humphreys JS, McGrail MR. Why does a rural background make medical students more likely to intend to work in rural areas and how consistent is the effect? A study of the rural background effect. Australian Journal of Rural Health 2012; 20(1): 29-34. DOI link, PMid:22250874
4 McGrail M, Humphreys J, Joyce C, Scott A, Kalb G. Rural amenity and medical workforce shortage: is there a relationship? Geographical Research 2011; 49(2): 192-202. DOI link
5 McGrail M, Wingrove P, Petterson S, Humphreys J, Russell D, Bazemore A. Measuring the attractiveness of rural communities in accounting for differences of rural primary care workforce supply. Rural and Remote Health 2017; 17: 3925. Available: web link (Accessed 16 August 2018). DOI link, PMid:28460530
6 Department of Health. Modified Monash Model. Available: web link (Accessed 16 August 2018).

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