The Defence Health Services Directorate contains many historical artefacts, but none
more interesting than the series of portraits of the leaders of our health delivery teams
from their beginnings: Directors-General of individual Services, Heads (however
styled) of the combined Services Directorates, and Surgeons-General (Regular and
Reserve). A striking feature of these portraits is that the great majority of officers
depicted wear decorations or campaign ribbons attesting to their operational service.
Major General Sir Neville Howse’s Boer War Victoria Cross is the earliest, and Air
Vice Marshal Tony Austin’s Australian Active Service Medal (East Timor) the most
recent. Between them, those portrayed wear ribbons earned in World War I, World
War II, Korea, the Malayan Emergency/Indonesian Confrontation, Vietnam, Somalia,
Rwanda, both Gulf Wars, Timor L’Este, Bougainville and the Solomons. From
earliest days, our leaders have undertaken frontline service; indeed, this experience
undoubtedly has better fitted them for their eventual leadership roles.
Equally, the ranks of our future health services leaders are filled by medical,
nursing, environmental health and enlisted staff who have undertaken operational or
humanitarian deployments, often repeatedly and in numerous theatres. Our Reservists
are no less well represented, with several having undertaken 10 or more periods of
continuous full-time service in deployed health care facilities overseas. Defence
health staff have not been so operationally engaged since Australia’s withdrawal from
Vietnam more than 35 years ago. Currently serving or recently resigned health service
members have as much operational service as any group in the Australian Defence
Forces. Their pride in service and sense of mission accomplishment are palpable, and
reflected in the reorganisation of units and War Establishment postings of Reservists.
But all is not well, as the rate of resignations from the Permanent Forces remains
unacceptably high, particularly for medical staff. Recruitment rates remain
satisfactory, but where are our O4 and O5 officers, those who have completed one or
two overseas deployments and gained hard-won experience and expertise? Despite
Defence’s attempts to provide better and more satisfying career structures for
professional health staff, together with improved pay and conditions, it struggles to
retain experienced health staff — those ideally qualified to lead and mentor at unit
levels — beyond completion of their periods of return-of-service obligations.
Defence is simply unable to offer competitive packages in the market for professionals’ skills:
witness recent resignations by several experienced, well reported and potential starlevel
officers who immediately returned to work for Defence, as civilians, for better
pay and with security of tenure in desired locations. In these cases, at least Defence
has retained the expertise and experience of these former officers, but at what cost in
preparedness?
Thirty-four years ago, I responded to a survey designed to determine the factors that
led Defence medical staff to resign or continue serving, and 23 years ago I coauthored
a similar single-Service study of the same topic. Both resulting reports failed
to effect much change in Defence Health Services’ culture or the demographic of the
staff who serve there, mostly all too briefly. That is, the drivers of health staff
behaviour have not changed, nor has the problem of achieving optimal levels of
retention.
But other relevant factors have changed, and Defence may profitably exploit them.
In particular, these include increasing feminisation of the health workforce (especially
the medical component); greater interest in work–life balance throughout society,
including among Defence health care providers; Higher Education Contribution
Scheme debts incurred for university study; the rise of postgraduate medical degrees;
the often overwhelming civilian demand for services; and the
accelerating exit of Baby Boomer generation professionals from
full-time work, an attractive potential recruiting pool for lateral
recruitment endeavours.
While Defence cannot now survive without its civilian health
staff, “uniforms” are still preferable.
Group Captain Peter Wilkins
Editor, ADF Health
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