Improving Health Workforce Retention in Remote Australia: A Best-Worst Scaling Study

Background: Many Australian remote primary health care (PHC) services are characterised by persistent workforce shortages and suboptimal staff retention, with patients experiencing low care continuity, culturally unsafe care, and consequently poorer health outcomes. This study aims to quantify preferences for remote PHC staff for different workforce retention initiatives. Methods: A Best-Worst Scaling (BWS) survey was administered (online and face-to-face) to staff working in remote Australian PHC services. Responses were analysed using conditional logit modelling and latent class analysis to determine differences in respondents’ preferences. Results: 228 respondents completed the survey. The majority worked in an Aboriginal or Torres Strait Islander Community Controlled Health Service (ATSICCHS) (71.1%). Overall, the most preferred retention initiatives were provision of a retention bonus; additional annual leave and flexible time-off; support for training, higher education or research; strengthened professional support networks and wellbeing engagement; and higher salary. Preference scores differed significantly by First Nations status. First Nations staff preferred increasing First Nations leadership, ensuring more on-Country training for First Nations staff; increasing opportunities for promotion or advancement; celebrating staff achievements; and increased employment for local First Nations community members. Non-Indigenous PHC staff preferred higher financial incentives such as retention bonuses and higher salary, Latent class analysis identified two groups who differed in their retention initiative preferences. Group 1 respondents had significantly higher preferences for First Nations leadership and significantly lower preferences for financial incentives such as retention bonuses; higher salary; cost of living subsidies; and annual leave and flexible time off. Conclusions: Retaining staff in remote PHC is complex. Once essential safety and housing requirements are addressed, retention initiatives should be packaged and tailored to diverse staff preferences. Findings can inform context-specific retention initiatives by remote PHC services seeking to stabilise their workforce.