Document Detail

A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas.
MedLine Citation:
PMID:  19530891     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The shortage of healthcare professionals in rural communities is a global problem that poses a serious challenge to equitable healthcare delivery. Both developed and developing countries report geographically skewed distributions of healthcare professionals, favouring urban and wealthy areas, despite the fact that people in rural communities experience more health related problems. This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas.
METHODS: A comprehensive search of the English literature was conducted using the National Library of Medicine's (PubMed) database and the keywords '(rural OR remote) AND (recruitment OR retention)' on 3 July 2008. In total, 1261 references were identified and screened; all primary studies that reported the outcome of an actual intervention and all relevant review articles were selected. Due to the paucity of prospective primary intervention studies, retrospective observational studies and questionnaire-driven surveys were included as well. The search was extended by scrutinizing the references of selected articles to identify additional studies that may have been missed. In total, 110 articles were included.
RESULTS: In order to provide a comprehensive overview in a clear and user-friendly fashion, the available evidence was classified into five intervention categories: Selection, Education, Coercion, Incentives and Support - and the strength of the available evidence was rated as convincing, strong, moderate, weak or absent. The main definitions used to define 'rural and/or remote' in the articles reviewed are summarized, before the evidence in support of each of the five intervention categories is reflected in detail.
CONCLUSION: We argue for the formulation of universal definitions to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.
Nathan W Wilson; Ian D Couper; Elma De Vries; Steve Reid; Therese Fish; Ben J Marais
Publication Detail:
Type:  Journal Article; Review     Date:  2009-06-12
Journal Detail:
Title:  Rural and remote health     Volume:  9     ISSN:  1445-6354     ISO Abbreviation:  Rural Remote Health     Publication Date:    2009 Apr-Jun
Date Detail:
Created Date:  2009-06-17     Completed Date:  2009-09-14     Revised Date:  2012-08-01    
Medline Journal Info:
Nlm Unique ID:  101174860     Medline TA:  Rural Remote Health     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  1060     Citation Subset:  IM    
Ukwanda Centre for Rural Health, Faculty of Health Sciences, Stellenbosch University, South Africa.
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MeSH Terms
Personnel Loyalty
Personnel Selection / organization & administration
Physicians / supply & distribution*
Rural Health Services / manpower
Rural Population*
Comment In:
Fam Med. 2009 Nov-Dec;41(10):743-4   [PMID:  19882400 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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