Opportunities and challenges of FIFO and DIDO healthcare services in rural and remote Australia

Objective: Most rural and remote regions face chronic health workforce shortages. Strategies designed to redress this problem include Fly-In Fly-Out (FIFO) and Drive-In Drive-Out (DIDO) health services. The aim of this paper is to examine the opportunities and challenges involved in these forms of service delivery. Design: Detailed review of recent literature relating to FIFO and DIDO services in rural & remote Australia. Results: FIFO and DIDO have obvious short-term benefits for rural Australians seeking health care services in terms of increasing equity and accessibility to services and reducing the need to travel long distances. However, there are significant long-term disadvantages such as the potential for burnout among FIFO and DIDO health professionals who travel long distances and work long hours, often without adequate peer support or supervision. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary health care system in small rural communities.Conclusions: Given the potential negative consequences for both health professionals and rural Australians, this paper cautions against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary health care services in rural and remote communities.