Academic journal article Australian Health Review

Is Western Australia's Rural Surgical Workforce Going to Sustain the Future? A Quantitative and Qualitative Analysis

Academic journal article Australian Health Review

Is Western Australia's Rural Surgical Workforce Going to Sustain the Future? A Quantitative and Qualitative Analysis

Article excerpt


The provision of equitable surgical services to rural and remote populations, particularly in the light of chronic workforce shortages, has long posed a significant challenge. Data published by the Royal Australasian College of Surgeons (RACS) in 2011 suggested that Australia would be unable to meet the demand for surgical services within the next 15 years if the number of graduating surgeons was not increased significantly.1

The demand for surgical services rurally has increased in proportion with the expansion of rural communities, particularly in regional centres3 and along the west and east coasts of Australia.3,4 By 2021, the demand for surgical services is expected to increase by 36%, with 22% ofthe increase attributed to population growth2,4 and 14% to the aging population.2,4 Given that an aging population will necessitate an increased number of hospital admissions and surgical procedures,4 the burden placed on the public health system is also expected to increase by 50%.3 Decreasing insurance rates with the aging of the population is predicted to encourage the subsidisation of elective surgery in the private sector, thereby disadvantaging rural communities where there are relatively fewer private facilities.2

Research conducted in 1998 by Bruening and Maddern5 concluded that most of the rural surgical workforce was working long hours and experiencing significant difficulties, primarily because of professional isolation, heavy on-call load and limited locum cover. The aging of the workforce, the inadequate supply of new surgeons and the difficulty of recruiting and retaining surgeons in rural and remote areas4 are other important factors that continue to affect the provision of surgical services in rural and remote communities.

Since the publication of the paper by Bruening and Maddern,5 there has been no further research published examining the specific distribution of active rural surgeons, their practice skill set, career stage, work-life balance (measured by on-call commitments) and the availability of surgical training opportunities in rural and remote Australian communities. On that basis, the present aim of the present study was to analyse the distribution and workforce practices of rural resident surgeons in Western Australia (WA) to provide data to predict the future landscape of rural surgical practice.


All research was completed under ethics approval from The University of Western Australia (approval RA/4/1/519). The study dataset included all WA rural and remote hospitals offering surgical services as defined by the WA Country Health Services website, Western Australian Health Department. Of the 89 health services listed, 20 were listed as offering surgical services (see table 1 for the list). All 20 were contacted (http://, accessed 18 July 2013).

Surgeon data

The collection of data was conducted in 2013 by a 10-min telephone interview with hospital staff members who had knowledge of theatre lists at each site. The survey questions were developed with input from a practicing rural surgeon with the assistance of the Section of Rural Surgery at the RACS. The 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.

Population data

Data from the 2006 Australian Census (Australian Bureau of Statistics (ABS) website:; accessed 18 July 2013) was integrated into the Excel v.14.3.2 (Microsoft, Redmond, WA, USA) database of questionnaire responses to allow the determination of population density; defining geographic boundaries of census data as well as health regions were also collected from the ABS website (( nsf/home/quickstats?opendocument&navpos=220; accessed 18 July 2013). …

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