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Insufficient rural doctors: Maslow's theory and the need for social accountability

There has been considerable debate and research on the reasons for poor representation of doctors in rural areas. Other countries have been facing this problem as well and the reasons are not very different. In a study from the University of Melbourne, Azer and colleagues reported that medical students with a rural background showed more inclination to practice in rural areas than those from urban areas. The results, though, could be viewed from the perspective of Maslow’s hierarchy of needs, which is a theory of motivation relevant in industrialised societies. While students from rural areas reported the more basic ‘safety’ needs such as the lack of schools for children and unmet spouse/partner needs as barriers to rural practice, the students from an urban background cited higher needs such as the lack of both social opportunities (social needs) and higher education (esteem needs) in rural areas. This means that as and when their current needs are realised they would automatically move up the pyramid with higher needs and this will be a continuous process. Consequently, attempts to address the shortage of rural physicians by attempting to address the needs of the medical workforce may not be quite fruitful. Establishing medical schools in rural areas and inviting overseas doctors to work in areas of need are some of the other measures taken to overcome the shortage. While the former is a rather expensive option with still-unclear outcomes, the latter has been fraught with cultural and linguistic dilemmas. However, there is one possible way of addressing the issue of insufficient rural doctors. The New South Wales Rural Resident Medical Officer Cadetship Program started in 1988 and was evaluated by Dunbabin and others. This program was developed to overcome the shortage of a junior doctor workforce in rural hospitals. The authors concluded that the program ensured that junior doctors spent two of their three postgraduate years in a rural hospital. This practice not only served to bring rural hospitals closer to mainstream teaching institutions in terms of academic and clinical work, but also ensured a continuous supply of the medical workforce in areas of need. In addition, such a program also serves as a gentle reminder to young doctors of their social responsibilities. Replication of this model across Australia might go a long way in overcoming the shortage of rural medical practitioners.