Training Health Professionals in the Rural Health Career Pipeline: A Complex Health System requiring Strategic Systems Based Research

Background: In the 21st Century, health professionals require five core competencies including: the ability to deliver patient-centred care; the capacity to work in partnership (with patients, health professionals and communities); to implement quality improvement in the workplace; to use information and communication technology and to adopt a public health perspective. The rural career pipeline is a term defined from medicine which can be applied to all health professionals. It refers to a systems based approach to recruitment and retention of health professionals. Ideally, we need to train enough health professionals to meet the needs of the population in the required time and have distributed equitably across the population to meet need. Objective: This paper aims to describe contemporary issues in health workforce recruitment and retention with particular emphasis to the rural health workforce where shortages are more profound. The importance of multidisciplinary systems based approaches to training and education and research is described. Discussion: The career pipeline is a complex system with many inputs and outputs and long lead time to produce new clinicians. Recruitment and retention are different complementary processes in this system. Traditional quantitative approaches to rural heath workforce research are increasing being augmented by qualitative methods to answer complex questions about career decision making in the health professional population. Mapping the health systems to consider rate limiting steps in the existing system is a useful framework for the future directions of systems based health system research. Drivers of future workforce demands will include ageing population, patient demand and improved health technology. Disruptive technologies can change this system. The influence of changing work practices including team based care, work substitution and the increasing focus on clinical governance and patient safety in health care will be discussed as potential influences on the future health workforce supply and demand.