Our data show different profiles between private and public cohorts, as well as by health discipline. This diversity presents challenges for health workforce planning, suggesting that differential planning at least by sector at the federal or jurisdictional level may improve effectiveness of rural retention policy initiatives. Interestingly, gender was not a significant predictor of intention to leave, but age group did predict leaving in the 20 and 60 year old age groups. The high proportion of young practitioners in the public sector is concerning, and mentoring and rural career opportunities for this age group may improve retention in the public sector . Being a significantly older group, the exodus of private practitioners may be more related to aging and retirement.
Survey items clustering as factors differed slightly between groups. For example the item on autonomy loaded more strongly to Factor 6 (Specialist Generalist) in the private group as compared with the ability to get away from work (Factor 4) in the public respondents. This difference could reflect a greater clinical autonomy in the private sector where practitioners have more control of their caseload and type of work, being limited only by their business model. There is also less bureaucracy in the private sector, permitting more flexible work practices. Autonomy and less bureaucracy in private practice settings have been associated with increased job satisfaction . This advantage may be counter balanced by a greater demand, as factor analysis suggested that the ability to get away was impeded by workload in the private group but not the public cohort.
The items in Factor 2 (Participation in Community) were diverse and the underlying concept is perhaps debatable. It is interesting that items statistically clustering in this factor reflected both the quality of relationships and altruistic motivation. It has been suggested that community is formed in a context of relationships combined with purpose , hence the choice of title for this factor. Our results point to a desire to meet community need  particularly in the public cohort where Factor 2 (Participation in Community) was the strongest predictor of retention after adjusting for age group. These findings are consistent with O’Toole et al., (2008) suggesting the importance of social relationships in rural workforce retention in allied health  and also with research in respect of rural nurses  and doctors .
Rural AH professionals with a strong motivation to ‘make a difference’ may need to be equipped with skills to be able to manage the emotional stress of being unable to meet clinical demand  by use of a thorough orientation on arrival and strong mentorship for those who are geographically isolated or new to rural practice [28, 34]. At a policy level, funding of rural mentorship programs seems likely to meet with as much success in allied health  as it has in medicine  and these programs could be extended to AH professionals in both public and private sectors.
Public health funding levels that do not enable sufficient allied health workforce to meet service expectations risk further pressure driving AH professionals out of rural practice. While use of qualified allied health assistants has potential to extend rural AH workforce capacity and partially alleviate workload pressures  this will also require negotiation of appropriate wage structures and careful regulatory policy that balances training, access and safety [37, 38]. Other strategies such as a shift to a primary health care approach may ultimately reduce clinical demand, however it is likely that CPD and appropriate policy development would be required to facilitate this shift in practice.
In this study high clinical demand increased intention to leave in both the public and private cohorts, even after adjusting for all other factors. Results of RAHW focus group research  support this finding. The inability to meet high clinical demand has been associated with emotional exhaustion in remote area nurses . Lenthall et al., (2009) suggest that this situation is “exacerbated by a low-resource environment”  but results of this study did not identify resources as a significant contributor to retention for either allied health cohort.
The broad nature of rural practice has consistently been identified as having a favourable influence on both recruitment and retention in rural practice [39, 42, 43]. Health service funding policy that rewards extended scope of practice may provide incentive to remain in rural private practice while simultaneously meeting the broad array of clinical needs in rural areas. “Rural specialist” credentialing has been suggested for rural doctors  and the concept could be extended to the allied health professions as a means of ensuring public safety with extended practice roles. Even within professional boundaries, rural AH professionals may lack confidence to cope with the role expansions required for rural practice [8, 17]. Better access to continuing professional development (CPD) may remedy this.
The role of CPD access in rural AH workforce retention has been a matter of debate in the literature. Studies using a qualitative methodology have found that lack of CPD access could trigger a decision to leave [20, 39] whereas others using survey methodology have found that CPD access improved job satisfaction but did not affect intention to leave [16, 45]. Most authors agree that CPD access is just one of many factors affecting retention [4, 7, 18, 43]. The potential of improved information technology to deliver CPD, reduce isolation and improve retention requires further research.
Because of the use of factor analysis methodology, the inability to discriminate between the CPD item and other questions on the RAHW survey was a limitation of this study. The CPD survey question loaded to F1 (Isolation) in both cohorts, but also correlated with the F7 (Management) in the public cohort. Thus it is unclear from these results whether CPD access was an influence on retention on its own, or whether it was more related to isolation or perceived management support. Improving access to CPD has been previously suggested as a retention strategy [15, 20, 46] and may be particularly effective where face to face meetings occur on a local or regional basis to simultaneously address isolation and training needs . Perceived linkage between CPD access and management support  may explain why the Isolation factor was significant in the public but not in the private group on multivariate logistic regression analysis.
Poor reliability of Factor 6 (Specialist Generalist) may have been a reflection of questionnaire design as generalist work has been previously identified as favouring job satisfaction of rural AH professionals . Similarly, the ability to look into the important role of locums  was hampered by large amounts of missing data where survey questions did not apply to the respondents’ circumstances. With several items being not applicable to private practitioners it is also likely that the questionnaire design was biased towards issues affecting the public sector. Further research is needed to clarify issues specific to the private sector in allied health.