Two years ago, ACRRM Fellow Dr James Doube and dentist Dr Cindy Dennis made a deliberate decision to stabilise healthcare delivery on Kangaroo Island.
At the time, the clinic had one full-time doctor. Kangaroo Island Medical Clinic (KIMC) had one clear objective: reduce reliance on short-term locum staffing and build a sustainable Rural Generalist workforce.
Today, it has grown to a base of 5 Rural Generalists working as part of a multidisciplinary team.
That shift represents more than local expansion. It demonstrates what workforce reform looks like when investment extends beyond training numbers to the systems that make long-term retention possible.
Across rural Australia, expanded training pathways have strengthened the Rural Generalist pipeline. Yet workforce instability persists where reform focuses primarily on recruitment. In many communities, the financial and service burden of high-cost locum dependence remains a recurring feature of the system.
Like many remote services, KIMC previously relied heavily on locums to maintain coverage across general practice, hospital care and aged care. While essential, this model carries significant direct costs — agency fees, travel, accommodation and repeated onboarding — alongside less visible impacts, including disrupted continuity, reduced preventive care and inefficiencies across services.
For Business Manager Tanya Biddell, the consequences were ongoing.
“Every time you rely on short-term workforce, there’s a cost,” she says. “Not just in dollars, but in disruption — to patients, to staff, and to the community.”
Rather than continuing to absorb reactive expenditure, KIMC redirected effort toward structural retention strategies designed to stabilise the workforce and create greater cost predictability.
One of the most significant initiatives was the establishment of a childcare service in a community with limited existing options. The service now supports four families and was supported by the ACRRM Community Grants Fund through the Department of Health and Ageing Australian General Practice Training pathway.
“If you want healthcare workers to build a life here, their families need support too,” Cindy says. “Childcare isn’t an extra — it’s essential infrastructure.”
The economic rationale is clear. In a modern Rural Generalist workforce, dual-career households are common. Without reliable childcare, retention becomes fragile. Fragile retention leads to recruitment cycles, which in turn drive renewed locum reliance. Investment in childcare strengthens workforce stability and reduces churn.
Travel access has also been addressed as a practical retention lever. Working with charity Angel Flight, clinicians and specialists can travel by air at times to maximise service delivery on the island and local doctors can access mainland training. Improved connectivity reduces professional isolation — a recognised contributor to rural attrition — while strengthening local capability and reducing avoidable patient transfers.
KIMC has also embedded a structured Rural Generalist training pathway within the practice, providing supervision, education and mentorship in a remote setting. By integrating training with long-term career opportunity, the clinic is supporting workforce sustainability.
Retention extends beyond clinical support. A “local connector” role assists new clinicians and their families with housing, schooling and community engagement— practical measures that evidence increasingly identifies as central to long-term rural workforce outcomes.
The broader economic implications extend beyond the clinic. Stable Rural Generalist services underpin hospital functionality, emergency response capability, aged care support and specialist outreach. Reliable healthcare also supports community confidence, local employment stability and regional economic resilience.
Kangaroo Island illustrates an important policy lesson: where funding models prioritise retention alongside recruitment, reliance on reactive locum expenditure diminishes and continuity of care strengthens.
In rural and remote Australia, Rural Generalist reform is not simply about training more doctors. It is about investing in the infrastructure that keeps them.
And when that investment is made strategically, the returns are measured not only in workforce stability — but in stronger communities and more sustainable health systems.
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