A retrospective study evaluating outcomes of the Allied Health Rural Generalist Training Positions in the Queensland public health system

Introduction: The purpose of the study was to evaluate the workforce outcomes and costs associated with implementing Rural Generalist Training Positions (RGTP) in Queensland public health services.

Methods: A retrospective analysis was conducted between January 2019 and October 2021. Rural and organisational retention of employees was calculated as the median time to event, either transfer to a non-rural or remote Queensland Health service or permanent separation from the organisation respectively, and the mean difference using a two-sample t-test with equal variance with statistical significance set at 0.05. Descriptive analysis was performed to evaluate education and promotion outcomes. Retention and promotion of employees in RGTPs (‘trainees’) were compared with a group of allied health professionals in standard base grade rural or remote clinical positions. A cost analysis calculated the additional cost of implementing a RGTP compared to a standard early career allied health position from the perspective of the employing health service.

Results: Forty-five (45) allied health professionals employed in a RGTP (‘trainees’) and 53 non-trainees were eligible for analysis. Participants’ professions were nutrition and dietetics, occupational therapy, pharmacy, physiotherapy, podiatry, speech pathology and social work. Compared to non-trainees, trainees were retained significantly longer in their original rural or remote location prior to relocation (mean difference 153 days, 95% CI 55 days to 252 days, p=0.003); in any Modified Monash (MM) Model category 4 to 7 (MM4 to MM7) location until moving to a MM1 to MM3 location (mean difference 172 days, 95% CI 62 days to 277 days, p=0.003) and in any MM2 to MM7 location until moving to a MM1 location (mean difference 139 days, 95% CI 11 days to 266 days, p=0.035). The trainee group had a total of 51 enrolments across two approved post-graduate rural generalist education courses, including six participants that undertook both courses. There were 22 (43.1%) course completions, 16 (31.4%) withdrawals, and 13 (25.5%) were continuing studies at the conclusion of data collection. More trainees were promoted above base grade Health Practitioner Level 3 (39%) than employees in the non-trainee group (29%). The total average annual cost for a health service to implement an early career allied health position as a RGTP was between $10,730 and $15,718, which was fully covered by organisation funding grants of a minimum $25,000 per annum.

Conclusions: Rural Generalist Training Positions (RGTPs) showed favourable outcomes for  retention, education and promotion of early career allied health professionals in rural and remote public health services compared to similar employees in standard positions. Implementation costs for a rural or remote work unit were manageable. The RGTPs provide good value for the health services through focussing training and development investment on early career allied health professionals who are retained longer in rural or remote communities.

Keywords: allied health, Australia, retention, rural generalist, training, workforce.