Attracting psychiatrists to a rural area - 10 years on.

CONTEXT: In rural areas across Australia the recruitment and retention of adequate numbers of medical specialists, including psychiatrists, has been a long outstanding problem. Latrobe Regional Hospital (LRH) has not been exempt. Latrobe Regional Hospital provides public mental health services to a population of over 220 000 across the rural Gippsland region, with little or no access to local private psychiatrists. The equivalent of 11 full time psychiatrists are employed, the majority of whom are international medical graduates (IMGs). ISSUE: Latrobe Regional Hospital reached a major crisis in 1994, with only one psychiatrist and a large number of vacancies. This led to a focus on the recruitment and retention of psychiatrists in order to improve this essential element of the workforce. In 2006 an internal review of psychiatrist recruitment and retention over the past 10 years was undertaken to gain a better understanding of approaches that worked, those that could be improved and those that required further development and implementation. Elements of the review included aggregation of data from employment records, documented changes to the medical structure, level of professional support provided and the LRH educational program for psychiatrist IMGs. Individual interviews were also undertaken with psychiatrists who have been or are now employed by LRH. LESSONS LEARNED: Between 1994 and 2006 the number of full time equivalent psychiatrists employed by LRH increased from one to 11. Retention rates also improved from an average of 18 months to 4 years. The key elements of this success are seen as: a focus on building individual rapport with new psychiatrists at the time of their recruitment; an extensive and multifaceted orientation program, taking into account cultural background; working to meet individual and family needs, both professionally and within the wider context; a sectorised medical staff structure with both community and inpatient elements; the provision of ongoing educational support with a specific focus on preparing for Royal Australian & New Zealand College of Psychiatrists' fellowship exams. A number of additional issues were also identified that had the potential to further increase psychiatrists' work satisfaction and longer term employment. These included an increased focus on cultural adaptation and professional supervision, as well as additional linkages to city based psychiatrists and services.