RELOCATION & RETENTION

Relocation and retention are often treated as secondary considerations within training systems, occurring after recruitment has been achieved. In reality, relocation and retention are integral parts of workforce development and impacts if recruitment efforts will result in a sustained workforce presence.

In training pathways that span over multiple years or involve moving between multiple sites, this process can be further complicated as trainees need to adjust to new environments repeatedly. Where systems support smooth transitions, maintain connections across sites, and provide consistent experiences, trainees are more likely to remain engaged with the broader network.

Relocation

Relocation is not just a movement between one place to another. Rather, it is a transition into a new environment both professionally and socially.

This can be especially difficult for trainees who are moving from one clinical context to another, moving from a metropolitan area into a region with limited social connections or infrastructure, or for those who have never relocated before. Therefore, relocation needs to involve more than just logistical arrangements, with trainees needing to be integrated into the system they are relocating into.

Participants in the study frequently reported the following factors as influencing whether a consultant would leave or stay in the community:

Housing
Childcare
Schooling
Partner employment
Community integration
Social connections

It is most commonly factors outside of the clinician's workplace that impacts retention, and considerations should be made to cater for not only the clinician but their family as well.

Retention

Retention operates over a longer timeframe than relocation, although the both are closely interlinked. An important point to note is that decisions about retention are made early in the training pathway. Trainees tend to begin making judgements about their experiences in the community and services they are working in within the first week of placement, which means that the quality of immediate experience is integral to retention.

Trainees are more likely to remain in a region if they can see a viable future there, including opportunities for progression, meaningful work, and alignment with their training goals. Where these pathways are unclear or incompatible with local service models, trainees may leave regardless of positive short-term experiences. Ensure the contract length and details of the training pathway are made clear to the trainee to allow them to make decisions appropriately.

Some steps to consider within retention include:

Consultants who train in a region often develop professional networks, community connections, and familiarity with local services that increase the likelihood of long-term retention. Health services that invest in medical students, junior doctors, registrars, and fellows create a workforce pipeline that ultimately supplies their future consultant workforce.

The likelihood of a consultant to remain in an area increases greatly when there are available opportunities to grow their career, such as the ability to take on leadership roles, lead services, and develop subspecialty interests.

Retention improved when consultants felt they were part of a broader professional community rather than practising in isolation. Some important considerations include cross-disciplinary networks, regular educational meetings, access to peer support, and communities within practice.

Trainees who feel known, supported, and connected to the system they are in are more likely to stay. They are also more likely to recommend the placement to others. This extends beyond formal supervision to include community contacts, administrative staff, and peers.

TYPES OF ORIENTATION

Orientation is more than just a once-off activity that needs to be done at the start of a trainee's placement. Findings from this study show that orientation is a critical component of trainee experience and retention, and can shape how trainees perceive the service and the community. Trainees tend to decide within the first weeks of a placement whether they feel supported, whether they can see themselves returning, and whether they would recommend the experience to others.

Different types of orientation that should be considered are listed below.

PRE-ARRIVAL

Effective orientation begins well before the trainee arrives at the placement site. Prior to the commencement of their training, trainees should receive contact details and practical information about their relocation, which can greatly reduce uncertainty about moving to their new home. Pre-arrival information may include: • Welcome information • Key contacts • Accommodation information • Rosters • Reporting arrangements • Maps / access information • Education opportunities • Local services / amenities • Childcare Where possible, trainees should have a direct point of contact who can answer questions and assist with transition into the service. The objective is to ensure that trainees arrive feeling prepared, rather than spending their first weeks trying to navigate basic logistical issues.

SITE-SPECIFIC

Multi-site training pathways should always involve orientation to each site the trainee will be working in. It can be frustrating for a trainee when differences between sites are not explained, and it should never be expected for them to "work it out" independently. Some differences can include: • Clinical workflows • Local policies • IT systems • Rostering • Escalation pathways • Education opportunities Site-specific orientation should include the following: Clinical orientation such as the scope of service that site provides and the processes that occur; Supervision orientation such as introduction to supervisors and team members, contact details for escalation pathways, and access to senior clinicians; Educational orientation such as available resources, teaching schedules, and opportunities for simulations and research, and; Practical orientation to the site facilities, parking, after-hours support, and local contacts.

COMMUNITY

Trainees also greatly benefit from being integrated into the community they will be living in. Orientation should include welcoming activities to the broader environment. This can include providing information about: • Community events • Local sports clubs • Partner and family support • Cultural orientation • Local services This is particularly important for trainees who have moved from a metropolitan area or from interstate, as they are more likely to be feeling isolated.

HEALTH SERVICE

All trainees should be formally orientated to the facility in which they will be working. This should include but not be dominated by compliance activities such as workplace health and safety. Orientation should also help trainees understand how clinical work is actually conducted within the organisation. Practical information often reported as most valuable included: • How referrals work • How to access senior support • Local workflows • After hours contacts • Key administrative contacts • Departmental expectations Trainees consistently valued information that helped them function safely and efficiently in their day-to-day role.

TRAINING PATHWAY

Alongside individual organisations, trainees should be oriented to the broader training network. Many reported that although they understood the placement itself, they knew little about how it related to the rest of their training journey. Pathway orientation should explain the overall structure of the training pathway, along with: • Expected progression • Educational opportunities • Supervisory arrangements • Key contacts • Future placement options This allows trainees to understand where they are in their journey as a whole.

EARLY FOLLOW-UP

It can be very overwhelming for trainees who are being inducted into a new placement to retain all the information provided to them. An effective system should do frequent check-ins with their trainees to allow them to voice questions and concerns. These can include: • End of week one review • One month review • Three month review Orientation should be an ongoing process of following up with the trainee rather than a single event.

WORKFORCE AGENCIES

Not every regional training hub can provide this kind of service to their trainees, whether due to funding, staffing, or other factors. There are a range of agencies across the country that can assist with this process.

CHECKLIST

There are many steps involved in ensuring your trainees are properly oriented, inducted, and encouraged to stay long-term. Provided here are downloadable checklists for different aspects of relocation and retention of trainees. Click on each one to learn more!

1. References go here, in Vancouver format.