There are well-documented, enduring difficulties attracting and retaining allied health professionals to rural and remote areas. The Allied Health Rural Generalist Pathway—in development since 2013, commencing in Queensland, Western Australia and the Northern Territory, and now nationally recognised—aims to address some of the challenges associated with allied health workforce shortages in rural and remote communities.
I spoke with two representatives from Allied Health Professions’ Office of Queensland (AHPOQ) about the Allied Health Rural Generalist Pathway: Ilsa Nielsen and Liza-Jane McBride. Liza-Jane McBride is Chief Allied Health Officer for Queensland and Ilsa Nielsen is the Principal Workforce Officer who leads the leads the rural and remote portfolio for Allied Health Professions’ Office of Queensland).
Welcome, Liza-Jane and Ilsa. Let’s start by hearing more about your roles in AHPOQ.
Liza-Jane: I’m the Chief Allied Health Officer of Queensland, and my role is responsible for providing high level strategic leadership to ensure Queensland has an appropriate skilled allied health workforce to meet the current and future needs of consumers. I lead the Allied Health Professions Office of Queensland, or AHPOQ as it’s sometimes called, which sits within the Department of Health in Queensland. The office is a multidisciplinary team that leads, influences and facilitates legislation and policy change—health service delivery and reform, allied health education, workforce development and redesign, and research and service improvements. And Ilsa is a member of the team and leads our rural and remote portfolio.
Ilsa: I’m the Principal Workforce Officer in the Allied Health Professions’ Office and lead the rural and remote strategies.
We hear a lot about rural generalism, mostly in relation to the medical workforce. People don’t seem to have as good an idea about what ‘rural generalism’ is as it relates to allied health. Could you tell us a little bit more about what you mean by rural generalism in the allied health context?
Liza-Jane: A rural generalist practitioner of any profession possesses a broad range of skills and capabilities within their own profession, which usually includes the ability to provide services in multiple clinical areas across the age range and continuum of care. Usually, in addition to a broad clinical scope, a rural generalist will have a range of skills that, although not unique in rural practice, are very important.
These are things like: professional capabilities, such as collaborative and interprofessional practice; high level of organisational and system level awareness; cultural capability and responsiveness, including the ability to partner with community; operational skills like resource management; service evaluation and planning—and important personal qualities for working rurally such as resilience, flexibility and problem solving.
Rural generalists practice under the regulatory instruments of their own profession and the policies of their employer. Although we talk about the Allied Health Rural Generalist Pathway and rural generalism in relation to allied health professions, it’s really important to understand that we’re referring to a rural generalist speech pathologist or a rural generalist pharmacist. The term ‘rural generalist’ for any of the health professions—including allied health—should not be confused with a generic health worker, which is a worker without a primary health professional degree; in Australia, we don’t actually have that worker type and it’s certainly not an outcome of the rural generalist pathway.
Ilsa, you’ve been involved in the rural generalist model from the beginning. Could you mind tell us how it came about?
Ilsa: Work on the concept of rural generalism in allied health and the Allied Health Rural Generalist Pathway commenced with a project in 2013. That project was a collaboration between the Allied Health Professions’ Office of Queensland, and the then Greater Northern Australia Regional Training Network, the Northern Territory Department of Health and Top End Health Service, and Western Australia Country Health Service. The Services for Australian Rural and Remote Allied Health or SARRAH, which is our national peak body that represents rural and remote allied health professionals, was also involved in that first stage of the project.
The project undertook a detailed analysis of the clinical practice requirements of five rural and remote allied health teams. One was a community-controlled health service here in North Queensland, three public health services in the Northern Territory, and one public health service in Western Australia. Those teams differed in terms of their profession makeup, but all of them provided all or part of their services in rural and remote communities. The project undertook a detailed clinical task analysis of each profession within the team, and also examined opportunities for delegation of tasks to allied health assistants and sharing of tasks between professions.
The outcomes are published on the AHPOQ website. Those outcomes included detailed task mapping for six professions, together with similar projects that were being done in Queensland Health around the same time, the findings formed the basis of the development of an allied health rural generalist education framework, which we started working on in 2015. That education framework, which is also published on the AHPOQ website, describes the clinical operational and professional requirements for rural generalist practitioners; the framework now covers nine professions—dietetics and nutrition, occupational therapy, medical imaging, pharmacy, podiatry, physiotherapy, psychology, social work and speech pathology.
The education framework has guided the development of training programs for early career practitioners in rural generalist training roles and supported our development to the Allied Health Rural Generalist Pathway.
Let’s talk about rewards and recognition: one of the challenges that we see in allied health is professional hierarchies, typically associated with increasing specialisation in the clinical field. But a rural generalist has to possess a breadth of skills and that’s extremely valuable in rural and remote settings. What do you see are the barriers and opportunities for building the profile and recognition of the value of generalist roles and rural generalist practice in the health system?
Liza-Jane: Specialisation and sub-specialisation has been an increasing trend in the health workforce recently, and for many practitioners, specialisation is often associated with the idea of career progression and development of expertise.
This is a real challenge for rural and remote services that require highly capable clinicians with a wide breadth of skills and capability. The concept of rural generalist practice in relation to the allied health professions is relatively new, and although we’ve had very skilled rural and remote allied health professionals in the health system for many decades, defining the practice area as rural generalist and giving it that label is much more recent.
In part, the development of the concept has been a direct response to the growth of the sub-specialisation—we’ve needed a way to explore the practice requirements and the career development that has not been linked primarily to gaining expertise in a narrow area of clinical practice. So “rural generalist” describes a broad scope of practice requirements, but it does not preclude an individual from possessing advanced skills in one or more areas within this broad scope.
We sometimes call these special skills rather than specialist skills, and it’s a term that we’ve borrowed from our medical rural generalist colleagues—it is really important to note that generalist does not mean basic, so a rural generalist practitioner can be a novice, or an expert; rural generalist really designates the area in the scope of practice, not the expertise of the individual. There is increasing recognition of rural generalist practice and its value to the health system and to rural communities, and we have work to do to promote rural generalist practice to allied health students and practitioners as a valuable career choice.
The Allied Health Rural Generalist Pathway is one way that we’re doing this but there are also opportunities for building students’ interest in understanding rural practice through extended placement opportunities, and enabling more training and longer periods of training in rural and remote areas. Queensland Health is trialling a rural immersion placement program, and similar programs are available in other areas of the country.
Incentivising and enabling training for allied health students who are interested in a rural generalist career presents a great opportunity for the health and higher education systems. I think it’s important to recognise that unlike medicine, allied health rural generalist career paths and training programs have relatively limited financial benefits for the individual, particularly in the non-government setting. Renumeration or payment rates of funding providers are not linked to qualifications or experience in rural generalist practice, so the value to the individual or their employer is a bit less tangible than it is for medicine. This is a real key challenge and opportunity for building real generalist career pathways and improving workforce sustainability.
In addition to profiling these rural generalist roles, what we really need is organisational structures and clear career pathways for allied health professionals into things like clinical leadership, service management, education or research that keep these rural generalist clinicians engaged, and see their rural or remote service as a good long-term career option with opportunities available as they grow professionally.
You mentioned the rural generalist training pathway—I understand that was first developed in 2014. Can you tell us a little bit more about how that’s evolved and what it’s looking like now?
Ilsa: The Allied Health Rural Generalist Pathway is an integrated workforce, education and training and service strategy that supports rural and remote health services to build capability and the sustainability of their allied health services.
Firstly, the workforce component to the Allied Health Rural Generalist Pathway is implemented within the human resource, industrial and other employment structures relevant to rural and remote services. The early career component of the rural generalist pathway—which is approximately the first three to four years of an individual’s practice career—includes redesign of an existing clinical role into a designated rural generalist training position within the rural and remote service. The training position will deliver clinical services similar to all other rural and remote roles, but it also has some special components that support the development of an early career practitioner. These components are designated development time of approximately four hours per week; supervision from a profession-specific supervisor, which for new graduates we recommend to be co-located with the rural generalist trainee. Another component is a development plan, including formal training in rural generalist practice, and involvement in a service development project in their local team.
The second component of the Allied Health Rural Generalist Pathway is education and training. An early career rural generalist trainee completes funded postgraduate training and rural generalist practice that is tailored to the individual’s profession and their service setting. James Cook University in Queensland delivers a two-level rural generalist program that is the main training option for rural generalist trainees. The level one program includes short online modules on a range of clinical and non-clinical topics that are relevant to new graduates. Practitioners who’ve completed the level one program and those with two years or more experience when they enter the rural generalist training position, complete the level two program which is a graduate diploma in rural generalist practice. In addition to their postgraduate training, rural generalist trainees will work with their profession-specific supervisor and manager to develop and complete a range of workplace-based training activities that apply the content from the university course to their local setting. Trainees will also commonly do other development activities during the rural generalist pathway, such as clinical placements in other services, professional development courses and attending conferences.
The third component of the Allied Health Rural Generalist Pathway is service and service development. All rural generalist trainees are involved in a project in their workplace which aims to produce service improvements that benefit their clients and their community. The projects for new graduates tend to be fairly modest in scope, but more experienced trainees will lead more complex projects that maybe redesign or develop new services. The service development projects allow trainees to apply the content from their formal study, and also produce tangible outcomes for their health service. Allied health professionals completing the early career stage of the rural generalist pathway will have a wide range of skills that are valuable in rural and remote and any service setting. Although not necessarily guaranteed, we see many of our Queensland Health rural generalist trainees successfully secure senior roles within their team and even move on to complete advanced training. The pathway provides access to more extensive development opportunities than are generally available in similar roles within metropolitan settings, and with a greater level of investment in the trainees’ training and development than they would see in similar roles within urban centres.
The positions attract highly motivated early career allied health professionals who really want to kickstart their career in rural and remote practice, and those who are focused on accelerating their development and career progression.
In Queensland Health, the Allied Health Rural Generalist Pathway also includes a senior or experienced practitioner stage—this is called the Rural Generalist Leadership Development Program. This program supports allied health professionals who are beyond the early career stage who wish to develop their capabilities in clinical leadership, health professional education or health services management. Participants in that program complete postgraduate qualifications in one of those focus areas. They engage with other emerging allied health, rural and remote leaders through a group based mentoring program, and they lead a service or workforce development project in their local service. So that’s a snapshot of the Allied Health Rural Generalist Pathway.
Can you talk a little bit more about the uptake? Who’s using it and where it’s being used and perhaps the impact on communities, services and clinicians?
Ilsa: There are rural generalist trainees in the Northern Territory within the public health system and also in South Australia. New South Wales has had rural generalist trainees in the past as has Tasmania, and Western Australia. More recently, we’ve seen the implementation of the rural generalist pathway within the primary care and private sector, which is supported by funding from the Commonwealth Government through a program administered by SARRAH.
Currently, Queensland Health has about 40 positions across nine professions and 10 health services state-wide. In the initial five-year trial between 2014 and 2018, we had a smaller number of positions we were trialling and building the pathway at that point. In that initial trial period, though, we had successful recruitment to 95% of the rural generalist training positions, which is a good outcome for rural and remote services. The funding model in that period was for temporary positions, mostly of about two years’ duration. The retention of individual trainees during that trial phase was good at 91% during the training period, and even though the positions at that time were temporary roles, the short-term retention in rural, regional and remote areas six months after separation from their training role was still 72%. So that showed positive outcomes and allowed us to progress in 2019 to embedding the rural generalist pathway within Queensland Health, within our rural and remote services.
The Allied Health Rural Generalist Pathway implementation from 2019 through to 2021 is currently being evaluated through an external evaluation, managed by Griffith University. The outcomes of that won’t be published until the end of this year, but the preliminary findings indicate that there is a retention advantage for rural generalist training roles compared to just regular early career clinical positions in rural and remote areas. There was an evaluation done in South Australia of their rural generalist training positions, which was published earlier this year, and they found a similar retention advantage.
Beyond those workforce metrics in terms of the impact of the rural generalist pathway, the workforce development and project components of the pathway have also provided benefits for rural and remote communities. Some projects that have been developed by local teams, by rural generalist trainees working in their local teams, include a physiotherapy telehealth service that was developed to support remote facilities, which saved nearly 3,000 kilometres in client travel over a 12-month period.
In another service in a remote area, a new dietetics telehealth service saved the health service over $15,000 in travel costs and redirected clinician time back into patient care. In another example, a pharmacist trainee’s research study that she undertook as part of the Allied Health Rural Generalist Pathway, investigated local barriers to post-discharge home medication reviews, and provided recommendations to improve medication management between the hospital, community pharmacists and GPs in the community. So that’s a bit of a snapshot, but I’ll hand it over to Liza-Jane, to speak to the broader implementation.
Liza-Jane: Queensland Health led the early stage of the development of the pathway. From the very beginning, we were working with our partners in the community control sector, and the non-government sectors to inform the requirements of the rural generalists, so it’s definitely not just a public sector pathway.
The implementation of the rural generalist pathway into private and non-government sectors commenced in 2019, with a trial that was funded by the Commonwealth Government, and coordinated by SARRAH. The trial was funded as part of the 2021 Commonwealth budget, and SARRAH is implementing that through to 2024. The scheme is called The Allied Health Rural Generalist Education and Training Scheme (TAHRGETS). It’s available to organizations in primary care, disability, aged care or non-government sectors wishing to implement a training position.
I think the expansion of the rural generalist pathway into these sectors is a really important step for further development of a rural generalist workforce that is capable of working in a range of settings. The adoption of the TAHRGETS model and training framework (of that) used in the public sector is critical, and what we’re likely to see is progressive development of the training and the pathway over the next couple of years to tailor it better to each sector. But the common pathway and structure in the training standards is really what’s going to enable that workforce flexibility over time.
It’s a huge achievement from starting in Far North Queensland, the Northern Territory and bits of WA to getting a national program—just those recruitment and retention outcomes in rural areas alone are fantastic given the challenges recruiting and retaining staff in that that sector. Is there anything else that you’d like to add?
Liza-Jane: Thanks, Susan. I think it’s a wonderful opportunity for both individuals and employers to consider—certainly in Queensland we’re continuing to look at how we can grow and strengthen the program. We really have seen some of the benefits that Ilsa spoke about in terms of both benefits for the individual and us as an employer within Queensland Health, but also more importantly for the communities that these allied health rural generalists are serving.
If a new graduate wanted to get onto the Allied Health Rural Generalist Pathway, how would they go about finding it?
Ilsa: Within Queensland Health, the rural generalist training positions are advertised just like all of our positions through the Smart Jobs website. If an allied health professional is in another state, then there are certainly rural generalist training positions within the [Northern] Territory and in South Australia.
The TAHRGETS program, which is run within the private and non-government sector—the positions are advertised through normal processes, through Seek and other job sites, for example. Most rural generalist training positions will be specifically labelled that way: a speech pathologist rural generalist trainee or rural generalist training position. A search through job sites for rural generalist training roles is probably the best way to go.
Liza, Jane and Ilsa, thank you very much for your time and for explaining allied health rural generalism.
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