Health Practitioner Motivations in Choosing the Very Remote Indigenous Community Workplace: Developing a Scale to Describe and Measure Them and their Relationship to Total Length of Stay.

Author: Michael Tyrrell

Tyrrell, Michael, 2017 Health Practitioner Motivations in Choosing the Very Remote Indigenous Community Workplace: Developing a Scale to Describe and Measure Them and their Relationship to Total Length of Stay., Flinders University, School of Medicine

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The aim of this study was to establish the nature of health practitioner motivations that influence the decision to seek work in the very remote Indigenous community, and to establish their potential for predicting substantial retention there. To achieve this, the developing of a set of practitioner work motivation subscales was required and described. The study’s rationale was founded on the maldistribution of health practitioners across Australia and the high costs, in various terms, associated with high turnover and low retention rates of very remote Indigenous community practitioners.

The literature review found much work addressing recruitment and retention of health practitioners in rural, remote and very remote contexts, but little specifically focussed on measuring health practitioner motivations, or on their nature and influence. The power of incentives to attract and hold practitioners in the more remote locations received some attention. Conclusions across studies were difficult to make because of the variety of remoteness classifications and descriptors used, including the poorly defined use of the term “rural”.

Theory predicted that work motivations can be validly and reliably described and measured via self report; that some of these measures will correlate with choice of workplace location and some with retention in the chosen job. It was hypothesised that the practitioner who chooses the very remote Indigenous community job will report some motivations that are very specific to that decision, a subset of which will be useful in predicting substantial length of stay (retention) in such work.

A total of 547 health practitioners from five ARIA+ levels of remoteness in Australia responded to the 140 item Health Practitioners Motivation Survey, which was compiled for the project. Using principal component analysis, 14 motivation components were identified which described the predominant motivations that influence health practitioners’ workplace choice decisions. Eight subscales provided measures relating to variables associated with very remote work experience and specifically, for three years’ very remote Indigenous (VRI) community work experience. These eight subscales provided the basis for a Very Remote Health Practitioner Motivation (VRHPM) subscale set, now ready for further development. Four of these subscales were used in a model to estimate the likelihood of a practitioner having more than three years’ very remote Indigenous community work experience, compared with no such experience.

Early impetus for this study came from the “Three Ms” motivational construct, which predicts that the practitioner who chooses and stays for a substantial time in the underserved and isolated workplace, would need to be a “Missionary, a Mercenary or a Misfit” to do so. This assertion was not supported by this study, with respect to the very remote Indigenous community workplace.

The VRHPM subscale set and the predictive model will, when further developed, be useful in various human resource applications with regard to the very remote workplace. These are discussed in detail, as are the limitations and policy implications from the findings.

Keywords: work motivations, very remote, health practitioner, Indigenous community.

Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Medicine
Supervisor: Prof Tim Carey (in USA Aug17-mid18);A/principal Prof J Wakerman NT Medical