Every AI conversation happening in health right now seems to start from the same place: how do we get more people using this. Boards ask it. Conference sessions build their whole agenda around it. I’ve even been asked to speak about it to Allied Health professionals. Which got me thinking: what do our professions actually need to hand off, so there’s room left for the work only it can do?

Two kinds of work

Some of what allied health, scientific and technical professionals do is built on accumulated competence: assessment, clinical reasoning, the judgement that comes from years of pattern recognition and relationship with the people in front of us. Some of it is built on task execution: documentation, scheduling, first-draft correspondence, repetitive data entry. A physiotherapist ‘losing’ an hour to progress notes. A dietitian redrafting the same explanatory letter for the fourth patient this week. Artificial intelligence sits comfortably in that second ‘task execution’ category. Most of the anxiety I hear, and most of the rollouts I’ve watched not land well, come from treating AI as though it can do the first.

Function-Led Delivery, one of the three components in my Rural Health Equity Framework™, offers a useful lens here. It asks services to organise around what a community actually needs a profession to do, rather than around the familiar shape a role has always taken. Applied to AI, the same test holds. Handing a task over is worth doing when it creates room for the parts of the role that genuinely require a person, judgement, relationship, the reading of a room no model can manage. It stops being worth doing when the task itself needs that same judgement to do safely.

The lawns

During my mother’s decline, I started handing over things I’d always done myself. The lawns. The housework. The small, physical, repeatable tasks that had simply been mine to manage for as long as I was a ‘grown up’ with my own home. I didn’t do it because I’d stopped caring about the house. I did it because every hour someone else spent mowing was an hour I could spend sitting with her, actually present, doing the one thing nobody else could do in my place.

Delegating the lawns didn’t take anything away from what I gave my mother. It’s what made room for it. Plenty of people could have mowed those lawns. Only I could sit with her the way I did.

I think about that difference every time someone asks whether AI is coming for their job. My lawns needed mowing whether the person doing it was me, someone I paid, or eventually a robotic mower that doesn’t care either way. What mattered was what I did with the hours that freed up.

An honest audit

This is where Function-Led Delivery earns its place, not as an abstract principle but as a genuinely practical sorting tool. When a profession decides what to hand off, human or otherwise, the test isn’t whether a task feels beneath someone’s qualification. It’s whether holding onto it is stopping them from doing what only they can do.

That’s a harder audit than it sounds. Documentation feels like part of the job because it’s always been part of the job, not because it needs fifteen years of clinical judgement to produce. First-draft letters, appointment scheduling, routine data entry: an honest look at these is overdue in most of the professions I work alongside, not because the work is unimportant, but because nobody has built the headroom to ask whether it needs to sit where it currently sits.

Handing something over, even something nobody particularly enjoys, can feel like giving up territory. I’d rather measure it by what the room it creates gets used for. In my case, that room went to my mother. In AHST practice, it should go to the assessment, the relationship, the clinical reasoning that no one else in the system can do in a clinician’s place.

Ngā mihi,

Jane

Next week, the harder side of this question: what happens to the people whose expertise gets delegated out from under them, and who gets to decide.

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

Kia ora e te whānau,

I have a piece of paper I have used more times than I can count. A blank page. A circle in the middle. Lines and words spidering out from there. Nothing more sophisticated than that. I was reminded of it as I was going through workshop material preparing for my next few months of events, and it has got me through more than one year I am not sure I would have got through otherwise.

Here is how it works, roughly. You write your desired future state in the centre of the page. Not a task, a state. What does it actually look like when this is working? Then you branch outward from that centre, mapping the components you would need to get there. Connections, sub-elements, whatever shape makes sense to you. There is no wrong way to draw it.

I have watched people draw it as neat branching trees. I have watched people draw it as tangled webs that look more like weather systems. Or lists, doodles, landscapes.

It feels like a particularly important exercise at the moment because of what I am hearing in my networks, at cafes, and in client meetings.

Workplaces have more work in them than people to do it, so only the urgent gets touched and the important waits, sometimes indefinitely. People have tried to protect a bit of quiet by closing email, only to find the people who need something from them simply relocate their messaging. They catch you in the corridor. They message you on Teams and then, when that goes unanswered for twenty minutes, text to ask if you’ve seen the message. There is no quiet space left that has not been found.

Underneath that, I am hearing something that sounds less like busyness and more like powerlessness. Not enough say in the decisions that shape the work. Not enough autonomy in how the day actually goes. And now, sitting on top of all of it, AI. Even for the people who aren’t really using it themselves, their colleagues have, and the outputs from those colleagues are creating a tsunami of work for everyone else.

If that is what the week feels like, when exactly are you meant to work out what you are actually trying to build?

This is where I think the map earns its place. Not as one more task to add to the pile, but as the one thing on the page that is not reactive. Everything else on your list this week was put there by someone else’s urgency. The map is the only thing you put there yourself.

It will not clear your inbox and it will not make the noise stop finding you. What it does is give you something to check yourself against when you do get a rare, unclaimed moment. It can hang over your desk (or be your computer desktop) reminding you of what’s most important and what actions you can take to move towards the centre, when you can.

I built my first version of this map nine years ago, when I was leading Allied Health on the West Coast and could not work out how to recruit or keep the people we needed. I did not have the research yet. I did not have the networks I have now. What I had was a fairly desperate need to know what I was actually working toward, because “fix recruitment” was too big and too vague to act on. So I put the future I wanted in the centre of a page: more people wanting to work for us than we had roles for. Then I worked backwards from there. That mindmap became the beginning of the research that has shaped much of what I do now.

But the part I still use, all these years later, is not the recruitment answer it eventually gave me. It is the map itself. Whenever I feel untethered, off track, or unexpectedly handed a bit of time that is actually mine, I go back to it. I look at the branches and remind myself there is always something I could do, for one of them. Maybe right now, or not this week. Either way, I know where I stand in relation to where I said I wanted to go.

That is the whole use of it, really. Not a productivity system. Just your own touchstone, your most meaningful to-do list, when so many of the other to-do’s aren’t really yours at all.

If your work life is feeling like the ones I’ve been hearing about, I would try it. One page, one circle, ten minutes. You do not need a workshop to do this, and you do not need it to be tidy. If you want a hand, I’m here to help.

Where would your central circle take you, if you drew it today?

Ngā mihi,

Jane

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

On 30 July, the Government confirmed $6 million to expand the National Rural Recruitment and Locum Support Service. For more than 20 years the service has recruited and locum-supported general practitioners, and nurse practitioners into some of the country’s hardest-to-staff rural communities. From 1 July, for the first time, it also covers registered nurses and allied health professionals.

That $6 million funds a scope change: allied health now sits inside the same national recruitment and locum infrastructure as medicine, for the first time in this country’s rural workforce policy.

I want to think through what that could mean, so that we use this opportunity well.

What locum support is actually for

Rural allied health vacancies rarely resolve as one clean event. A physiotherapy position in a small hospital sits unfilled for eighteen months, someone starts, they leave after a year, the gap reopens. A speech-language therapist covers three rural towns from one regional base and isn’t backfilled when they take leave because there’s no one to hand over to.

Locum support isn’t a consolation prize for roles nobody wants permanently. It’s what makes those permanent roles survivable, and what keeps services running while a rural generalist pathway matures enough to produce more permanent AHPs than it loses each year. Locum cover across rural hospitals, community teams and primary care means people don’t go without physiotherapy, occupational therapy, dietetics or pharmacist input for months at a time while a service waits for the right permanent hire.

Cover is not the same as practice

Medicine has run a locum culture in rural Aotearoa for decades. Allied health hasn’t, not at this scale, not with dedicated national infrastructure behind it. So the question for our profession is whether we’re ready to do this well, because goodness knows we deserve the investment.

Doing it well means recognising that a locum placement isn’t a smaller version of a permanent one, and it definitely isn’t the same thing as “providing cover” in the sense of parachuting a city colleague into a gap for six weeks. My doctoral research named geographical narcissism as one of the core barriers rural AHPs face: the unconscious assumption that urban practice is the real thing and rural practice is a lesser version of it. That assumption doesn’t switch off because someone is only there short-term. If anything, a short placement gives it more room to operate unchecked, because there’s less time for the community to correct it.

Each month I sit with the multidisciplinary cohort coming through Aotearoa’s first rural generalist entry pathway, physios, nurses, midwives, OTs and dietitians working across primary care, rural hospitals and NGOs nationwide. What we are exploring is that rural competence isn’t just clinical scope stretched wider. It’s knowing the referral pathways, the transport realities, who else is on the ground, what the community has already tried. A locum AHP who treats a placement as clinical hours in an unfamiliar location isn’t delivering locum services. They’re providing cover.

The difference is whether Fit, the alignment between person, place and purpose that determines whether rural practice actually works, is something we design deliberately into short placements, or something we assume will show up on its own. That’s exactly what Rural-First Design, the first component of the Rural Health Equity Framework, asks of us: start from what the place and the people already have, rather than adapting a model built somewhere else and dropping it in for six weeks.

What our medical colleagues already know

This is where our GP and rural hospital colleagues have something to teach us. Allied health doesn’t need to work this out from scratch. Hauora Taiwhenua’s NZMedJobs and NZLocums already run structured orientation for incoming clinicians, a dedicated rural hospitals locum service, and two decades of relationships with the practices that host them. Locum doctors arrive into infrastructure built specifically to make short-term practice work: information about the place, introductions to the team, a sense of joining something rather than filling a hole in it.

Allied health locums need the equivalent, built for our scopes of practice rather than retrofitted from a medical model. What does a locum physiotherapist need to know about a rural community before their first clinic that a GP orientation pack won’t cover? What does reciprocal, tuakana-teina handover look like when the outgoing permanent AHP and the incoming locum might only overlap for a single day? Those are design questions our sector gets to answer now, while the service is still being built around us rather than for us.

One thing worth watching

Australia’s NDIS-funded allied health boom is a useful, if imperfect, comparison. Occupational therapy alone grew 171% over a decade largely on NDIS referrals, draining public health systems of staff as they pivoted to private NDIS driven work. And as that funding has tightened through 2026, practices built entirely around it are discovering they have no other way to reach patients. That’s a different funding mechanism to a locum service, but the underlying question travels: is this new infrastructure designed to strengthen permanent rural AH roles by making them more sustainable, or could locum work become an easier, better-paid alternative that draws people away from the permanent positions rural communities actually need filled long-term?

That’s not something I’ve seen answered yet. Better to ask now, while the service is new, than after the pattern has already set.

Genuinely new ground

Allied health has never had national locum infrastructure like this in rural New Zealand before. We are perfectly placed to do the thinking before unhelpful habits kick in.

What could rural allied health locum work make possible, for services and for our profession, if we design the orientation, the relationships and the workforce strategy around it deliberately, rather than default to treating it as an extension of the medical model, or assuming the communities will cover that off themselves?

Ngā mihi,

Jane

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

Also, in case you don’t know, I co-chair Hauora Taiwhenua’s Scientific, Technical and Allied Health chapter

A colleague of mine ended up in hospital unexpectedly last week. Not where they wanted to be, and not where any of us want our colleagues to be. They work in health, so they know exactly what good care requires, and exactly how stretched our services are on the front line right now.

When I saw them after discharge, I said the thing you say. I hope they looked after you.

Their answer stopped me. “It restored my faith in the health system”, they said

The staff were excellent. The care was exactly what it should be. In a system everyone agrees is under strain, in the aftermath of a budget that’s already shaping up to be tough, with an election four months out and every party sharpening its health lines, someone still walked out of a hospital bed with more faith in the system than they went in with.

Why is that?

When the money gets tight, people step in

Front line staff don’t choose to step away when resources are stretched. They step in. I regularly hear some version of the same story, from nurses, from allied health colleagues, from GPs: less time, less capacity, less certainty about what the next budget holds, and somehow the same standard of care still gets delivered, one patient at a time.

It would be easy to suggest that the system working. And yet, clearly it isn’t. It’s people working inside a system that’s been built to make them absorb the shortfall.

Every budget round, decisions get made a long way from the ward, the clinic, the home visit. Funding gets allocated, reallocated, contested, and the further you are from where those decisions get made, the less likely the quick wins ever reach you. It’s the same dynamic my doctoral research surfaced in rural allied health: geographical narcissism, the reflex to treat distance from the centre as a lesser problem, or someone else’s problem, rather than a design feature of how resources get shared out. Rural communities feel it hardest and earliest, but the pattern isn’t only rural. It’s what happens whenever the gap between resource allocation and service delivery widens, and someone has to stand in that gap and keep showing up anyway.

That’s where I think leadership actually lives right now. Not in a title. In the space between what the system provides and what patients need, held up by people who refuse to let it collapse in on itself.

Outsourcing is fine. Until it isn’t

Every other week brings the same conversation about handing pieces of the health system to private providers. Sometimes that makes sense - I’ve been in situations where it’s been the only way to get services to communities. Often what gets offered up is the straightforward work, the predictable work, the work with a margin in it, and what’s left for the public system is everything harder, more complex, and less certain.

Outsourcing is fine, until it isn’t. Until the hard cases still need somewhere to go, and that somewhere is a public system already carrying more than its share, still expected to deliver the standard of care my colleague experienced.

Hope isn’t a strategy, except when it’s all we’ve got

Health has never been optional for the people who need it, whatever a funding round or an election decides about how it gets paid for. Easy to say. Much harder to hold onto when you’re the one short-staffed on a Tuesday afternoon, or your nearest health provider is a 3 hour drive away.

We’ve come through worse than this. Every time, it’s been the same combination that got us through: people willing to lead, at every level, and hope stubborn enough to survive the gap between what’s promised and what’s delivered.

Regardless of what this election decides, regardless of what central government does with the next budget, the people on the front line will still be there for their patients. My colleague is proof it still shows up as care good enough to restore someone’s faith, even now.

This is also the start of something I want to keep exploring here: how our budget architecture itself is built to set services against each other, and what agency looks like once we can see that design clearly. More on that soon.

Where have you seen hope and leadership hold the line this year, in your own team or your own care?

Ngā mihi,

Jane

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

This year, I have the privilege of facilitating the pilot cohort working through the Supported Entry to Rural Practice programme, or SERP as we’ve started calling it, the first rural generalist entry pathway this country has tried. Physios, nurses, midwives, OTs, dietitians and others, scattered across primary care, rural hospitals and NGOs from one end of the motu to the other. We meet monthly across a twelve-month programme built around five modules, two months apiece. Module one alone covers workforce roles, demographics, access, and the health profile of rural communities, in enough depth that two months feels about right.

Te Whatu Ora developed the programme by learning from Services for Australian Rural and Remote Allied Health (SARRAH), who helped build the Australian Rural Generalist Programme that James Cook University now runs. So SERP is grounded in a model with runs across the Tasman, though it’s also, honestly, being built on the smell of an oily rag, which is a very rural health thing to do well.

What the cohort is actually learning

The module works through Levesque, Harris and Russell’s access model, separating what services and systems make accessible from what populations and individuals are actually able to reach, afford, and feel safe using. It sets out the numbers: around 16% of New Zealanders live rurally, and between 20 and 25% of the rural population identify as Māori, with Māori life expectancy sitting seven to eight years below non-Māori. And it says, plainly, that these gaps are not about individual behaviour. They are the product of a system.

Watching a room of physios and midwives and OTs work through that together, disciplines that don’t always get taught alongside each other, let alone taught to see the same structural cause behind the same set of outcomes, is genuinely something. It’s the kind of shared language rural teams need and historically haven’t been supported to develop.

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So could this learning be helpful to others?

Rural-first design only holds if it starts where the decisions actually get made, not just where the care gets delivered. Reciprocal development has to run in both directions. This cohort is doing real work adapting to rural realities over a carefully paced twelve months. And watching them learn makes me wonder who else might benefit from this?

So here’s my challenge, watching this pilot unfold in real time. If this module alone is worth two months of a clinician’s professional development to build this understanding properly, what would it take to ask the same of the people deciding funding, policy, and workforce settings for the communities this cohort will serve? Not a briefing paper skimmed once. The same pace, the same information and quizzes that makes you sit with the wrong answer before it tells you why it’s wrong.

What could be possible if policy makers, funders, and regulators did this course too?

Ngā mihi,

Jane

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

A friend told me about a conversation she’d had recently. Not really her conversation; she was on the periphery of it. A woman she knows had finally worked up the courage to ask her GP for help with what she suspected was perimenopause. The GP was kind, but honest that this wasn’t his area of confidence, and referred the woman on to a gynaecologist.

So far, so good. This is the system working as it should.

Then, in the specialist’s room, while they were still working through her symptoms and trying to understand whether perimenopause was the right frame, the gynaecologist offered something like this: perhaps she just needed to accept that this was ageing.

One sentence. A shrug, really, dressed up as clinical wisdom.

The woman’s response was to decide she’d manage it herself from here. Dr Google, and her own resourcefulness, over a health system that had just told her, through one of its most senior representatives, that her lived experience wasn’t worth investigating further.

What actually happened here

There’s an obvious thread to pull in that story, about older clinicians (often men) who remain under-curious about perimenopause despite it affecting roughly half the population at some point in their working lives. That thread is real and it matters. But it’s not the one that’s been sitting with me.

What’s been sitting with me is this: one interaction, with one person, in one appointment, was enough to end this woman’s engagement with the entire system. Not the GP, who’d been thoughtful and honest about their own limits. Not “the health system” as some abstract entity. One specialist, in one room, on one afternoon.

We know from service design and trust literature that people don’t experience systems, they experience representatives of systems. A patient doesn’t interact with “primary care,” they interact with the receptionist who booked them in three weeks later than they’d hoped, and the nurse who took their bloods, and the doctor who did or didn’t look up from the screen. Trust in the system is built or eroded transaction by transaction, and it only takes one poor transaction, especially with someone perceived as an authority, to undo a dozen good ones.

This is exactly what I keep encountering in rural health, just with geography standing in for gender and specialty.

The rural version of the same story

A locum flies into a rural town for six weeks. Doesn’t know the whānau, doesn’t know the history, doesn’t know that this particular patient has been managing a chronic condition well for years with an approach that doesn’t match the textbook. The locum, working from limited information and understandable caution, overrides that approach. The patient’s confidence in “the doctors” (all of them, forever) takes a hit that no amount of good ongoing care from their usual, absent, GP can easily repair.

Or the version I hear even more often: a rural clinician or patient raises a concern about the standard of care available locally, and someone in a city, with more resource and more options at their fingertips, responds with a version of “well, that’s probably about the best you can expect out there.” Not malicious. Often meant kindly, even. But it does the same work as the gynaecologist’s comment about ageing. It tells the person in front of them that their dissatisfaction isn’t a signal worth acting on, it’s just the cost of where they live.

Malin Fors calls this geographical narcissism, the largely unconscious assumption that what happens in the centre is the standard, and what happens at the periphery is a lesser version of it, worthy of sympathy rather than genuine investigation. It shows up as “that’s rural for you,” the same way “that’s just ageing” showed up in the gynaecologist’s office. Both are ways of closing a conversation that the person on the other side of it desperately wanted kept open.

Why one bad representative costs more than it should

Here’s the part I think is worth sitting with. The system doesn’t get to average out its interactions. A patient who has four good experiences and one dismissive one doesn’t walk away rating the system at 80 percent. They walk away deciding whether they can trust it at all, and that decision tends to get made on the worst data point, not the mean.

For rural communities, this compounds. If your only touchpoint with a specialty is an infrequent locum, or a single unhelpful phone call to a city-based service, you don’t have four other good interactions sitting in the ledger to balance it out. You have the one interaction, and it becomes the whole story you tell yourself, and others, about whether the system is for you.

This is why continuity and relationship matter so much more in rural contexts than workforce planning documents tend to credit. It’s not a nice-to-have. It’s what allows a community to accumulate enough good experiences that one dismissive one doesn’t tip the whole balance.

Where this sits in the framework

This is Rural-First Design in miniature. A system designed around urban assumptions treats each clinical interaction as a discrete, interchangeable unit, this locum, that specialist, doesn’t matter, they’re all delivering the same evidence-based care. A system designed rural-first has to reckon with the fact that trust is cumulative and fragile, and that the person delivering care is never actually interchangeable from the patient’s side of the desk.

It also points to something in Reciprocal Development. The locum who flies in for six weeks and flies out again isn’t positioned to develop the local knowledge that would let them extend trust instead of overriding it. That’s not really the locum’s failing, it’s a structural one. Nobody has built in the reciprocity, the two-way exchange of knowledge, that would let a visiting or unfamiliar clinician earn the standing to say “I think we should try something different” rather than simply asserting it.

I don’t have a tidy fix for the gynaecologist’s shrug, or the specialist’s “that’s about as good as it gets out there.” But I think naming the pattern matters. Both are small moments where someone with more power in the room closed down a conversation instead of staying curious in it. And both cost the system something far larger than the five minutes it took to say them.

What’s a moment, in your own experience of the health system, rural or otherwise, where one interaction changed how much you trusted the whole thing?

Ngā mihi,

Jane

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

A line manager messaged me recently, looking at a shortlist for a rural role. Not one applicant had grown up rurally. Not one had trained rurally. She asked me, half joking and half not, whether she should just keep advertising and hope someone with the “right background” eventually applied.

On the other side of that same conversation sits someone scrolling that same job ad. Born and raised in the city, trained in the city, never lived anywhere with a population under fifty thousand. Wondering if they’d even be considered. Wondering if applying is a waste of everyone’s time.

Both of them are working from the same assumption: that fit is something you either have or you don’t, baked in before you ever show up.

I wrote about Fit in depth back in March, including what it actually is and why it turned out to be the thread running through everything else in my doctoral research. If you haven’t read that one, it’s worth starting there. What I want to get into today is narrower: what this means for the specific moment a manager is staring at a shortlist, or a would-be applicant is staring at a job ad, each privately convinced the other person has already been picked.

There’s a body of evidence, much of it strong, showing that people born rurally are more likely to work rurally. Brown and colleagues (2017) found rural-born health professionals were 2.35 times more likely than their urban-born counterparts to end up working in rural settings. It’s a real effect, and it’s part of why rural pipeline programmes target rural rangatahi for health training.

But the same evidence shows urban training substantially reduces the likelihood that a rurally born person returns home. And a good number of the participants in my research who were thriving rurally hadn’t grown up rural at all. For them, the decision to work rurally was specific. A particular town. A particular community. Not “rural” as a category, but a place that mattered to them for reasons of their own.

One of my participants hadn’t set foot in a rural community before her first job out of training. She’d taken the role because of a partner’s work, expecting to stay two years and move on. Five years later she was still there, embedded in the community, coaching the local netball team, and unable to picture herself anywhere else. Nothing about her background predicted that outcome. What changed it was what happened once she arrived: the welcome she got, the trust she built, the sense that her work mattered to people she knew by name.

This is where I think the framing of “right background” does real damage, on both sides. For the manager, it turns recruitment into a waiting game for a demographic that may never arrive, when the more reliable lever is building the conditions, the welcome, the networks, the sense of mattering, that let fit develop in anyone willing to try. For the person applying, it turns a genuine interest in rural practice into self-disqualification before they’ve even had the conversation.

This sits squarely inside what I call Rural-First Design in my Rural Health Equity Framework™: building from what a rural community and role actually need, rather than retrofitting urban assumptions about who belongs there. A rural-first approach to recruitment doesn’t ask “does this person match the profile of someone who stays rural.” It asks “what would make this place somewhere this person, whoever they are, could come to feel they fit.” That’s a question about systems and welcome, not about birthplace.

So if you’re the manager looking at a shortlist with no rural-born names on it, the absence isn’t the problem you think it is. And if you’re the person wondering whether you’re “allowed” to apply because your life so far has been entirely urban, I’d ask you to sit with the difference between what you are and what you might come to feel, and let that guide you rather than your CV.

What would it take for your team, or your application, to be judged on the second kind of fit rather than the first?

Ngā mihi,

Jane

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

Reference:
Brown, L., Smith, T., Wakely, L., Little, A., Wolfgang, R., & Burrows, J. (2017). Preparing graduates to meet the allied health workforce needs in rural Australia: Short-term outcomes from a longitudinal study. Education Sciences, 7(2), 64. https://doi.org/10.3390/educsci7020064

Last week I wrote about my keynote at the Education Operations Group for the Tairāwhiti and Te Tai o Poutini Rural Interprofessional Education programmes, and promised I’d come back to something I road-tested with that same room. Here it is.

Midway through the session, I handed them a stack of cards. Each card carried a single statement, the kind of bias and assumption that shows up across workplaces, health, education, and beyond: things like rural placements are a lesser training experience or senior clinicians know what students need better than students do.

Almost nobody recognised themselves in the cards. What I watched instead, again and again, was the room arguing the opposite. Rural placements are actually the better training experience. Students know what they need better than senior clinicians do. The leap was instant, confident, and went straight past the middle ground into the reverse certainty.

Don’t get me wrong, when I asked some curious questions, they agreed these statements are out there. They just jumped straight to defending rural spaces.

That reflex is the thing I want to talk about today. I’ve got a working name for it, and I want to test it out loud here before I get too attached to it, because it isn’t bias in the way we usually mean it.

Beyond geographical narcissism

Malin Fors gave us geographical narcissism years ago: the largely unconscious habit of treating metropolitan knowledge as the standard and everywhere else as a variation on it. It’s done real work in rural health thinking, mine included. But the cards I’d made to hand out came from a pattern I’d already been noticing, in places that weren’t just about geography. Medicine correcting nursing. Senior clinicians correcting graduates. This year’s curriculum correcting last decade’s lived experience. That’s what I built the exercise to test.

So while I was putting the workshop together, I went looking for whether anyone had named the pattern underneath all of these, the thing geography, hierarchy, time, and seniority all seem to be doing the same job for. A literature search in June turned up nothing that synthesised it. Plenty of work on each axis separately. Nothing holding them together as one mechanism.

It feels like positional certainty: an unexamined confidence that your perspective is correct, derived from your position rather than your proximity to the realities being described.

It shows up on at least four axes. Geographical, where urban becomes the standard and rural the deviation, that’s Fors’ territory. Inter-professional hierarchy, or positional power, where one profession’s knowledge sets the baseline and others are read against it, that’s Gareth Rees’ territory. Temporal, where confidence in current practice rests on your training environment, the time and place you trained in, rather than your grounding in what that place or service actually looks like now. And academic or positional authority, where seniority and institutional standing get treated as proof of accuracy, regardless of how close that seniority actually sits to the ground.

The further out you are on any of those spokes, the more certain you tend to feel, and the less proximity you actually have to the thing you’re certain about.

It reminds me a bit of my constant battle in my garden, twitch popping up everywhere. I clear my garden beds methodically, thoroughly, feeling pretty chuffed when it’s clear. But the root system isn’t mine alone. It’s running under the fence, and you can’t see that part, because it belongs to next door’s yard. Positional certainty works the same way. The confidence is real and the work might even be good. It’s the boundary that’s the problem, not the effort.

📷 My actual garden 🙄

What this adds

Giving it a new name doesn’t dismantle it on its own. But once I had a name, and saw how these four separate pieces worked together, it felt so much more useful. Where before I’d felt I was jumping from trying to shine a light on one problem then another, now I see it’s the same behaviour showing up in different outfits.

Positional Certainty isn’t a replacement for geographical narcissism, professional hierarchy dismissiveness, or any of the specific barriers I’ve named before in this work. It’s the mechanism running underneath them, the same root system, different parts of the fence. I’m building this out properly, slowly. Testing it out loud, to see who else has been thinking about this. Looking at ways of mapping where any of us sit on those four spokes, because I think most of us are more confident in at least one of them than our proximity earns us. Myself included. That’s the uncomfortable part of naming a concept like this: you don’t get to stand outside it and point.

Where do you notice yourself leaping to the opposite certainty fastest? I’d genuinely like to know, it’ll shape what the self-assessment version of this looks like.

Ngā mihi

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

I was invited to speak to the Education Operations Group for the Tairāwhiti and Te Tai o Poutini Rural Interprofessional Education programmes last week. While I expected the conversation to centre on future workforce strategy (and it did), it was how differently each part of the room was framing it that really caught my attention.

The people managing the funding were naming fragility. The placement coordinators were naming capacity. The university representatives were naming student reluctance. Three real problems, all pointing at the same gap in the pipeline, but not yet held together as a single systemic question.

Which got me thinking, if we know that early rural exposure shapes career decisions, why is the pre-graduate rural pipeline still running primarily on goodwill, spare capacity, and the commitment of a relatively small group of educators?

The evidence is not the problem

The literature on this is strong and has been for some time. Exposing health students to rural practice early increases the likelihood they will choose rural careers. Growing up rural, or having meaningful rural experience during training, is one of the most reliable predictors of rural workforce intention. This isn’t a contested finding. It’s about as settled as rural health research gets.

And it’s not just about career decisions. Early rural exposure shapes clinical reasoning. Students who experience rural practice learn to work with complexity and uncertainty in ways that specialist urban placements often don’t require. They work across scope. They collaborate out of necessity. They develop a kind of professional flexibility that rural communities need, and that health systems increasingly say they want.

The pre-graduate period is also when professional identity forms. Who a student understands themselves to be as a clinician, what kind of work they imagine doing, in what kind of setting, with what kind of community, is being shaped during training, not after it. If rural never appears in that picture, it’s much harder to introduce it later.

I wrote last year about what rural generalism needs to look like as a post-graduate pathway, and the professional governance that has to accompany it. This piece is the earlier part of that argument. Before we can build a rural generalist workforce, we need students who have genuinely encountered rural practice and had the chance to form something more than a passing acquaintance with it.

What’s actually happening

The Tairāwhiti and Te Tai o Poutini IPE programmes are doing something remarkably impactful. Sixteen health disciplines. Two rural sites. Students from across the health sciences programmes of eleven tertiary education providers placed together in communities that need them, learning interprofessionally in a way that most of our health profession training struggles to offer.

Fifteen years of this. That’s not nothing. That’s accumulated evidence that it can be done, that students value it, and that communities benefit from it.

But it reaches a fraction of the students who could benefit. It is not universally funded. It is not structurally protected. It depends on the ongoing commitment of placement providers, the capacity of small rural communities to absorb students, and the continued goodwill of educators who are already stretched. The medical equivalent, the Rural Immersion Programme, has comparatively more resourcing and throughput. The gap between those two realities is not accidental.

And then there is the student reluctance question. Some students arrive at a rural placement pre-convinced it will be less than what they’d get in a city. Less complex. Less supervised. Less career-relevant. Those assumptions are worth examining, and I’ll come back to them in a piece I’m working on about what I’m calling positional certainty, the unexamined confidence that your perspective is correct derived from your position rather than your proximity to the realities being described. For now, the point is that reluctance is real, it has sources, and it doesn’t disappear on its own.

Experience versus identity

Here’s a distinction that came into focus for me during the keynote, in the question I put to the room.

Are students leaving rural placements with a rural experience? Or are they leaving with a rural professional identity?

The difference matters more than it might seem.

An experience is something that happened to you. It goes on the CV. It might be remembered fondly. It doesn’t necessarily change how you see yourself as a clinician or what you imagine your future practice looking like.

An identity is something you carry forward. It shapes decisions. It makes rural feel not just interesting but possible, even desirable, when the time comes to choose where to work.

So what creates the conditions for the second rather than the first? My instinct, backed by what my research shows about what matters to rural AHPs, is that it’s a lot to do with connection and belonging. Students who feel like they belong in a rural setting, who are welcomed into the community, who see their contribution valued, who experience what it feels like to be the person with the right skills in the right place, are the ones who leave with something that sticks.

That’s a design challenge for placement providers, for universities, and for the programmes that connect them. It’s not just about getting students there. It’s about what happens when they arrive, and what they carry when they leave.

Who isn’t getting there

The room also drilled down into a harder question. Not just how do we get students to rural placements, but how do we make it genuinely possible for the students who face the most barriers to getting there.

The student who is a parent. Who has a disability. Who can’t afford to stop working, or to pay for accommodation somewhere unfamiliar. Who has never seen themselves reflected in rural health, because rural health has historically reflected a fairly narrow slice of who health professionals can be.

If the students who go rural continue to be predominantly those who were already inclined toward it, already connected to rural, already without the caring responsibilities or financial constraints that make travel hard, then we are quietly reproducing the same workforce we already have. One that doesn’t reflect the communities it serves.

Making rural placement truly possible for all students isn’t just an equity argument, though it is that. It’s a workforce design argument. The diversity of students who experience rural today is directly connected to the diversity of the rural workforce in ten years’ time.

What this asks of us

This isn’t a problem that sits with one part of the system. Funding bodies need to treat pre-graduate rural exposure as infrastructure, not as a nice-to-have. Universities need to ask honestly whether their support structures make rural placement genuinely possible for students with caring responsibilities, disabilities, or financial constraints. Placement providers and rural communities need recognition and resourcing for the work they do in hosting and supporting students. And the profession needs to get clearer about what we’re trying to achieve, not just rural experience, but rural identity formation; and design accordingly.

The IPE programme in Tairāwhiti and Te Tai o Poutini is upstream work. What flows from it, over fifteen years, is a small but real cohort of health professionals who know what rural practice feels like from the inside. That matters.

The question is whether we’re prepared to take that upstream work seriously enough to protect it, resource it, and extend it to the students who need it most.

Ngā mihi

Next time I’ll be writing about positional certainty, the concept I road-tested with the IPE group, and what it means for how we make decisions about rural education and workforce. If you have thoughts on what’s in this piece, I’d love to hear them in the comments.

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

Every year, we watch the same performance. Ministers emerge from the Beehive. Numbers are announced. Health gets quite a big slice. The primary sector gets a smaller one. Housing and community somewhere in between. At some point in the commentary, someone expresses surprise or disappointment that allied health didn’t feature, that rural communities missed out again, that primary care funding flatlined.

This year was no different.

I wasn’t going to write about the budget. It had left me feeling pretty flat. But the more I thought about it, the more I realised there is a different way to think about it. And it starts by considering this.

The system isn’t broken. It’s doing exactly what it was designed to do.

A few weeks ago, I had the privilege of leading a workshop of clinicians working across different ministries who were trying to figure out how to work better together. Good people. Genuinely motivated. Frustrated by how hard it felt.

One of the things I shared with them was this: the New Zealand parliamentary and government system is architecturally built for competition.

It was actually designed that way.

Each ministry holds a budget line. Each budget line is protected. At the highest level of government, in the rooms where Budgets are actually written, ministers and their officials are taught, structurally and culturally, to compete for the size of their slice. Health vs industry vs education. The pie is finite. The competition is real.

Budget day is the moment when that architecture is most visible. The numbers published aren’t just the figures of what goes where, they’re a blueprint. And the blueprint says: compete.

Is it any wonder that’s how it feels in our teams?

When a physiotherapist and a nurse argue about scope of practice, they’re not just having a professional disagreement. They’re enacting the logic of the system they’re embedded in. When a DHB (now Health NZ) regional office hoards data rather than sharing it with a PHO, that’s not organisational dysfunction. It’s the architecture operating as intended, just at a smaller scale. When allied health funding gets cut to protect the medical budget, or rural services get defunded to protect urban centres, the same competitive logic is playing out.

The budget room doesn’t stay in Wellington. It travels. Down through ministries, into health systems, into teams, into the relationships between us.

None of this is inevitable. That’s the important bit.

Structural conditions aren’t destiny. They’re patterns we can learn to see. And once we can see them, we have a choice; not an easy one to be sure, but a real one, about how we want to act.

The clinicians I was working with didn’t need me to fix the structural competition baked into the NZ government system. That’s not something any of us can do in an afternoon. But naming it changed how they looked at what happens between them. Because when you understand that the friction you feel isn’t personal, isn’t inevitable, and isn’t a result of the bad intentions of your colleagues, you can stop fighting the wrong battle.

You can choose to be the person in the room who acts differently. Who shares rather than hoards. Who collaborates across the budget line. Who models, at whatever scale you have, the system you actually want to work in.

This might sound naïve. I’d argue it’s actually strategic.

Geographical narcissism, the unconscious assumption that what matters most happens in cities, is baked into this architecture too. Rural communities aren’t missing out on budget day by accident. Their absence from the blueprint isn’t oversight. It’s a predictable outcome of a system that has never been designed with them as the centre.

Which means that rural health leaders, allied health professionals, PHO teams working in under-resourced communities, they are already practising something the system isn’t designed to support. They are already choosing, every day, to act differently within a structure that doesn’t reward them for it.

And that is leadership.

I’m not going to pretend Budget 2026 was good news for rural allied health. It wasn’t. There was no discernible increase in primary care funding. No meaningful investment in the AHP workforce. The pharmacy pre-announcements aside, allied health was largely invisible in the conversation.

But I’ve stopped being surprised by that. Not because I’ve given up; I promise you I haven’t, but because I understand the architecture better now. The budget reflects the design. And the design needs to change at a level that a single budget line never will.

In the meantime, the most powerful thing I know how to do is name the structure clearly, and work with the people inside it who are already choosing to act differently.

That’s what this mahi is about.

What structure do you keep bumping into that nobody seems willing to name?

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

There’s something quietly moving about seeing ideas you’ve been part of fighting for land in a formal document, signed and endorsed and sent out into the world. The Aotearoa New Zealand Declaration on Rural Health 2026 is that kind of document for me. A product of years of collective mahi by Hauora Taiwhenua, by rural practitioners and researchers and community advocates, by the extraordinary gathering that was the 21st WONCA World Rural Health Conference in Wellington, and a genuine reflection of what rural communities in Aotearoa actually need.

It’s a formal consensus document, grounded in the presentations and discussions across the six conference subthemes, and signed by the chairs of Hauora Taiwhenua Rural Health Network, the WONCA Working Party on Rural Practice, and Te Rōpū Ārahi. It received ministerial endorsement from the Associate Minister of Health on behalf of the Minister. It sits in the lineage of the Bengaluru, Ubuntu and Limerick Declarations, international commitments with real intent behind them.

The Declaration speaks plainly about what’s broken. Rural communities, particularly rural Māori, experience compounding inequities shaped by rurality, deprivation, and the enduring impacts of colonisation. It names geographical narcissism; the unconscious assumption that urban centres are where the real decisions, the real expertise, and the real health care happen, as a driver of policy failure. And it calls for rural proofing; the deliberate inclusion of rural perspectives and evidence at every level of health policy, funding, service design and implementation.

The Declaration covers six subthemes. Workforce. Research. Equity. Innovation. Digital health. And Rural Generalism.

RuralFest 2026

Just one month after Rural WONCA, the Hauora Taiwhenua delegation headed to Parliament for RuralFest, an annual event now in its twelfth year, where representatives from across the rural health and primary sector come together to put rural communities’ concerns directly to politicians. This year we were joined by delegates from rural PHOs, Rural Women New Zealand, Rural Support Trust, and Federated Farmers. We met first as a delegation to agree our approach, then briefed officials from Manatū Hauora and Te Whatu Ora, before spending time with the governing parties before lunch and opposition parties after.

The Declaration became our framework for the day. Each delegation member was asked to pitch two or three points from it, make the case for why those points mattered most, and then the group voted to prioritise the order we’d present them to politicians, knowing we wouldn’t get through everything.

I was ‘volunteered’ to pitch points 3.6 and 3.7.

The case I made (and the badge I wore)

In the spirit of maintaining appropriate professional gravitas, I flipped my name badge over before my pitch and wrote “Vote Workforce” on the back in green marker. I wore it through the whole thing. I may have made a few comments about how the earlier pitches had helpfully built my case, and encouraged my colleagues to deploy all five of their votes wisely.

But here’s what I actually argued.

Point 3.6 calls for all health profession regulatory bodies to collect workforce data using the Geographic Classification for Health; for each practitioner’s primary workplace and usual place of residence, as part of Annual Practising Certificate renewal.

Point 3.7 calls for a comprehensive, sustainably resourced Rural Health Workforce Plan, informed by that GCH-analysed data (such as the workforce data in 3.6), enabling rurally led initiatives across attraction, education, recruitment, training, and retention.

These two points are the foundation. You cannot build a rural health workforce plan on data you don’t have. Right now, we don’t know with any precision where our health practitioners actually are, particularly across the AHST professions. We don’t know how many physiotherapists live and work in genuinely rural communities, how many speech-language therapists are covering geographic areas that would make an urban planner’s eyes water, or how many sonographers are working alone in settings designed for teams. Without that data, workforce planning is guesswork dressed up as strategy.

I made the point to our politicians plainly: if you want to advocate for rural communities in the health system, you need the numbers to back you up. GCH-coded workforce data gives you that. It makes the invisible visible. And it gives rural communities the right to say ‘here’s what we have, here’s what we need, and here’s the gap you’re responsible for closing.’

I also forgot to introduce myself before I started talking, which we were supposed to do. Credentials and all that. We’ll call it enthusiasm.

What comes next

The Declaration exists. It has ministerial endorsement. It was heard by politicians across the spectrum. That matters, and I don’t want to diminish it.

But a document becomes a declaration only when the actions follow. The gap between policy intent and rural reality is exactly what the Declaration names as the core problem. The test of this one will be whether the calls to action; on data, on workforce planning, on rural generalism pathways, on funding, move from the page into the systems that shape people’s lives.

For those of us in AHST, I think our job is to keep pointing back to this document. To use it in conversations with leaders, with regulators, with education providers. To say: this is what was agreed, in our name, at a world conference, with ministerial endorsement. Now what are you doing about it?

The whakataukī that opens the Declaration reminds us that this is collective work. No single basket is enough. I think the AHST basket has been left off the table for too long.

It’s time to put it down firmly, and let people see what’s in it.

The Aotearoa New Zealand Declaration on Rural Health 2026 was developed as a consensus output of the 21st WONCA World Rural Health Conference, held at Tākina, Wellington in April 2026. It is available through Hauora Taiwhenua Rural Health Network.

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

Life’s really thrown the curveballs since returning from the WONCA World Rural Health Conference last month, so my apologies for the lack of posts til now. It’s actually taken a bit to warm my brain up to write in this format again, so I thought I’d start with a recap of the conference.

Research & Education Day

We say it every year, and this year is no different. The Hauora Taiwhenua Research & Education pre-conference workshop is an absolute highlight. So good in fact, that I failed to take any photos! With an international contingent thanks to WONCA’s pull, we had delegates from Australia, Canada, Alaska, Africa and Europe joining with many familiar and new faces from around the motu. Developing a rural pedagogy (led by Kyle Eggleton), lightening talks, some fun networking and an expert panel discussing how to increase the research capacity in rural places. A big thanks to Sue Crengle, Jane Taafaki, Virginia Dickson-Swift, Rachel Milte, Suzie Harte, and Kyle (again!) for taking the time to consider some Australian research (link) as a jumping off point and offer some really important insights into what it might take. The day, masterfully MCd by Dr Jesse Whitehead gave everyone the opportunity to build and renew connections as we headed into a big 4 days.

Networking (my favourite part of conferences!)

In preparation for writing this week’s article, I went back to look at last year’s and noticed how much joy I’d taken from the human connections, and this year delivered that even more so. There were colleagues from across the word, and close to home that being in person with was such a gift. People to meet who I only knew by their LinkedIn profile, or their academic writing. So many hugs, exclamations of delight and straight into rich and interesting conversations. Here’s just a few of the photos I remembered to have taken.

The best people (IMHO)

We hosted a lunchtime meet-up for people from the various Scientific, Technical and Allied Health professions and had a great turnout from home and abroad. Rural generalism was one topic of conversation, as was exploring whether there is (or should be) a place in WONCA’s Rural Special Interest Group structure in the future. I’m looking forward to seeing where both conversations go, and staying in touch with everyone.

Rural Generalism

As you’d imagine, Rural Generalism was an important topic for discussion over the conference and the plenary panel created a really useful meeting place of the various professions, ideas and experiences. It was really gratifying to see Ali Dymmott representing the Allied Health voice on the panel, and to field the excitement across all of the professional groups following her announcement that we hope to explore an Australasian College for Allied Health Rural Generalism in the near future. If you’re interested in allied health rural generalism, I’d highly recommend you following Ali’s work, as the leading academic internationally in this field (link to profile).

Workshops, Presentations and Making Plans

The conference gave me the opportunity to speak about a small component of my doctoral research that I think warrants further exploration - the way that being in service to a rural community, through volunteering, playing sport and so forth helps to knit AHPs into those communities in ways that seem to making staying more valuable than just their professional role (I touched on this within the context of my research themes here).

And I had the privilege of co-facilitating a workshop with Dr Veronika Rasic and Dr Anna Moran, where we encouraged delegates to look and think more broadly when linking their primary care patients with other rural community services and supports.

I also really enjoyed supporting Dr Lynne Clay present our recent modified Delphi study on establishing research priorities for Rural Health in Aotearoa. You can read more about that in our article here.

And there were plenty of opportunities to connect with our colleagues from SARRAH (Services for Australian Remote and Rural Allied Health), including introducing them to some of the Hauora Taiwhenua operational team, and to surface possibilities for collaboration in all sorts of directions.

The Main Event

Of course, this was all in the context of some deeply inspirational and informative plenary presentations from Dr Diana and Mark Kopua, Sir Collin Tukuitonga, Dr Hinemoa Elder and Sir Ashley Bloomfield. I’m still processing the challenges and opportunities they laid down for us all.

It was also heartening to hear Prof. David McCormack build on the message I shared at Aotearoa’s Digital Health Week last November about building health innovation from the edges in. More great examples of rural innovation that aren’t just a solution for rural settings.

Plus of course the joy filled performances of various cultural groups, including the iconic Pātea Māori Club.

The 21st WONCA World Rural Health Conference here in Te Whanganui-a-Tara was a once in a very long time adventure that I am so grateful to have been able to be part of. And the ripples will likely continue out into rural health service delivery, research and connection for a long time yet.

Ngā mihi nui ki a koutou, to everyone who contributed to an outstanding event!

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

This week, I watched astronauts float through a spacecraft 450,000 kilometres from Earth and wave at Canadian schoolchildren in real time.

The audio was crisp. The video was seamless. The wonder in those kids’ voices was crystal clear.

I watched this from a conference venue where, hours earlier, a rural clinician had described something rather different: loading a Starlink kit into their car before driving out to see patients, because the road they travel has no cellular coverage. No wifi. Just kilometres of silence where connection should be.

Same week. Same planet. Vastly different realities.

Image Credit: NASA

I’m at the WONCA World Rural Health Conference this week, a gathering of clinicians, researchers, community leaders and advocates from around the world who spend their working lives, and often their personal lives, trying to close gaps that the rest of the health system has quietly decided to live with.

The conversations here are rich, and hard, and hopeful in the way that only people who haven’t given up can be hopeful.

But they keep returning to a question that sits underneath almost everything: who do we decide matters enough to invest in?

The Artemis II mission is genuinely extraordinary. Four astronauts, the first crewed lunar trajectory in more than fifty years, a feat of engineering and international collaboration that deserves every bit of attention it has received. I am not here to diminish it.

But I find myself sitting with the contrast.

Space is attractive to spend money on. It has heroes and countdown clocks. It has flags, and children watching in classrooms with their mouths open. It produces images that make the front page; a capsule breaking the surface of the Pacific, four people alive and safe who were just, impossibly, near the moon. There is spectacle. There is narrative. There is a moment when the world holds its breath and then exhales together.

Rural health infrastructure has none of that. There is no countdown when a cellular tower goes up in a remote valley. No live feed when a nurse practitioner finally gets a reliable connection to consult with a specialist in the city. No moment of collective wonder when a whānau in a rural community receives the same standard of care as one who lives ten minutes from a hospital.

And so the funding follows the feeling. We invest where the story is easy to tell.

That’s not a technology problem. It’s not even simply a policy problem. It’s a question of what we have decided is worth caring about, and what we’ve allowed to remain invisible.

Geographical narcissism - the quiet assumption that innovation flows from cities outward, that urban is the default and rural is the exception, shows up everywhere once you start looking for it.

It shows up in research that treats rural populations as a difficult subgroup rather than a distinct context.

It shows up in health system design that asks rural communities to receive what urban centres have decided to offer.

It shows up in the funding decisions, the infrastructure investments, the planning assumptions that treat distance as a problem to be tolerated rather than a challenge to be solved.

And it shows up, somehow, in a world where we can stream live video from lunar orbit but still shrug at dead zones on rural roads where clinicians are trying to care for people.

Here’s what I keep thinking about: the Artemis programme succeeded, in part, because failure was not considered acceptable. The question was never whether to solve the communications problem, it was only how.

What would rural health look like if we applied that same assumption?

Not “how do we make do with what’s there?” but “what needs to exist, and how do we build it?”

Not “rural communities should expect a different standard” but “the standard applies everywhere, and we work until it does.”

The clinicians I’ve been sitting alongside this week aren’t asking for the moon. They’re asking for reliable connection. For infrastructure that treats their communities as worth investing in. For health systems that are designed with rural people, not delivered at them.

That’s not an unreasonable ask. We just haven’t decided it matters enough yet.

Part of the mahi ahead; for advocates, researchers, and decision-makers, is learning to make the unglamorous story compelling. To find the equivalent of that live feed, that capsule breaking the surface, that child’s voice full of wonder. Because the story is there. It just doesn’t come with a rocket.

📸Image Credit: NASA/Bill Ingalls

Artemis II splashed down safely this week. The astronauts are home.

And somewhere, a rural clinician is checking their Starlink kit is charged before tomorrow’s rounds.

Both of those things are true at once. The question is what we decide to do with that.

This post was written during the WONCA World Rural Health Conference, where I’ve had the privilege of being in conversation with practitioners, researchers and advocates working at the frontlines of rural health equity. Their mahi deserves far more than a shrug.

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

Maybe it belongs to the rural health professional who wanted to come, but there was no one to cover their clinic. Maybe it belongs to the colleague whose funding application didn’t get across the line, or the practitioner whose country is at war and for whom the world has narrowed to what is immediately survivable. Maybe it belongs to the urban health leader who looked at the programme, couldn’t find themselves in it, and moved on.

Those absences are not to be overlooked. They are the point.

This week, hundreds of health professionals, researchers, indigenous leaders, students, and community advocates will gather in Te Whanganui-a-Tara Wellington for the 21st WONCA World Rural Health Conference. For five days, from 9 to 13 April, Tākina Wellington Convention and Exhibition Centre will be home to what I expect will be one of the most significant rural health gatherings I will ever attend.

And yes, before you ask: no chocolate. WONCA is the World Organisation of Family Doctors, not a golden ticket competition. Though given what rural health professionals manage to conjure from limited resources, perhaps Willy Wonka’s particular genius for making magic is not so far from the mark.

What is WONCA, and why does it matter?

WONCA is the global body for family medicine and primary care. Its rural working party meets every two years to share research, build relationships, and strengthen the global rural health community. This is the 21st time the conference has been held.

It is the first time it has been held in Aotearoa. And because of that, the first time it’s had a truly interprofessional feel. That matters more than it might seem. Conferences shape what counts as knowledge. Who hosts shapes whose knowledge is centred. Hosting this conference is an act of reorientation.

Whānau Ora: the kaupapa at the centre

The theme chosen is Whānau Ora: Integrating Mātauranga Māori indigenous knowledge with rural health for a thriving future. The whakataukī (proverb) guiding the conference is:

Nāku te rourou nāu te rourou, ka ora ai te iwi. | With your basket and my basket, the people will thrive.

This is not decoration. It is not a conference theme in the way a colour palette is a theme. It is a framework for how knowledge should move, how relationships should be built, and what health is actually for.

Mātauranga Māori (Māori knowledge systems) are not supplementary to rural health science. In Aotearoa, they are foundational. The health disparities that rural communities face, particularly rural Māori communities, cannot be understood, let alone addressed, without understanding the systems that created them and the knowledge systems that have sustained communities through them.

That this kaupapa sits at the centre of a global conference, held here, in Aotearoa, for the first time, matters. It is an opportunity to reposition not just what we talk about, but how we talk about it, and whose voice carries authority in the room.

I am a member of Hauora Taiwhenua, the organisation hosting this conference. I have also been part of the scientific committee and the subcommittee overseeing the publication of conference abstracts, which will appear in the Rural and Remote Health journal. So this is not just a conference I am attending. It is, in a small way, a conference I have helped to call into being.

The scene: Tākina, Wellington, five days

Tākina sits at the heart of a compact, walkable city that will spend this week reimagining itself as a global rural health hub. There is something quietly pleasing about that. Wellington is not a rural place, but it is a good host for rural people. It knows how to bring people together.

The pre-conference events begin on Thursday 9 April, including a welcome reception and the Hauora Taiwhenua Research and Education Day, which I am co-hosting. The main conference runs from Friday 10 through to Monday 13 April. Over those five days there will be keynotes, panel discussions, concurrent sessions, workshops, posters, and the kind of over coffee conversations that are often more transformative than anything on the programme.

What I will be doing, with some remarkable people

On Thursday, I am co-hosting the Hauora Taiwhenua Research and Education Day. One of my favourite parts will be the game of Human Bingo, a networking activity designed to get people out of their default clusters and into genuine conversation with strangers who are about to become colleagues. I am also hosting a panel on building research capacity in rural areas, anchored by a recently published paper that maps the distribution of PhD-qualified professionals across levels of remoteness in Australia. The findings are confronting: 85% of PhD-qualified people are concentrated in cities, with income falling and precarity rising as remoteness increases. The panel brings together six researchers and leaders from Aotearoa and Australia to ask what that means and what to do about it.

On Saturday, I am presenting a strand of my doctoral research on what I call being In Service: the way that volunteering and community contribution knit rural health professionals to the places they live and work. The idea that giving more might be part of what makes staying sustainable runs counter to a lot of workforce thinking. But it is what rural practitioners themselves say.

Before that, I am co-facilitating a workshop with Dr Anna Moran, an entrepreneur and physiotherapist from rural Australia, and Dr Veronika Rasic, a GP from rural Wales. Our workshop, “Beyond the Referral: Seeing the Whole Person to Strengthen Rural Care, Workforce and Community Outcomes,” challenges participants to think past conventional referral pathways when supporting rural patients where traditional services are unavailable or weeks away. We’ll use the ICF (International Classification of Functioning) framework to structure a genuinely holistic look at patient need, and to find creative, community-based solutions together. The three of us have never been in the same room before. That itself feels like a conference gift.

I am also on the chairing and judging teams for concurrent sessions throughout the week, and will chair the Scientific, Technical and Allied Health chapter hui at Sunday lunch.

The people I cannot wait to find

Two research papers I have been involved in will be presented at the conference: the New Zealand rural health research priorities study, and a paper on Dr Cath Cosgrave’s Attract Connect Stay model as it has been implemented across Australia and Aotearoa. Getting to be in the same room as those co-authors, in person, after all the shared mahi across screens and time zones, is something I have looked forward to for a long time.

I am also deeply looking forward to hearing from Cath Maloney and Ali Dymmott from SARRAH, Services for Australian Rural and Remote Allied Health. Cath will be presenting on the possibility of an Allied Health College of Rural Generalism. Ali will appear on a plenary panel on rural generalism and present her own research during the conference. Australia is further along in this kaupapa than we are in Aotearoa, and I intend to learn everything I can.

And then there are the LinkedIn people. You know who you are. The ones who make me think harder, push back when I need it, cheer when I don’t expect it. The people I have been in genuine intellectual relationship with for months or years without ever having shared a room. I cannot wait to meet face to face, share a hug (with mutual consent, of course), and simply bask in the togetherness that only in-person gatherings can offer.

The empty chairs

I want to return to where I started.

There are people who will not be at this conference because the world has made it impossible. The rural health professional who could not be spared. The researcher whose funding didn’t come through. The colleague whose country is at war. The practitioner from a community that has never had the luxury of sending someone away for four days, because there is no one to hold the place together while they are gone.

And there are people who will not be there because they looked at a rural health conference and concluded it had nothing for them.

To the first group: your absence is not invisible. The whakataukī says the people will thrive when all the baskets come together. When some baskets never make it to the table, we are all diminished by what we do not get to know.

To the second group: I want to gently invite you to reconsider. Rural health systems are not a lesser version of urban health systems. They are places where generalism, creativity, community connection, and necessity have been producing solutions that urban systems are only beginning to recognise they need. There will be nothing at this conference that is only relevant to rural places. There will be a great deal that urban systems should urgently learn from.

Your basket, through me

There is an online attendance option. If you cannot be in Wellington this week but want to be part of what is happening, visit www.ruralwonca2026.com for details.

And if you cannot attend at all, I want to make you an offer.

Tell me what you would ask if you could be in the room. Is there a session you want me to attend on your behalf? A question you would put to a plenary panel? A person you would like me to find, knowing I will tell them about your work?

Leave a comment below. I will carry your basket with mine.

Nāku te rourou nāu te rourou, ka ora ai te iwi. | With your basket and my basket, the people will thrive.

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

I was reading over the earliest posts that I wrote here on Substack, looking for inspiration in a week that’s felt pretty heavy. And I realised that when I wrote about my DHSc research themes Connection & Belonging, Safe & Supported Practice and Creating Roles People Want to Come For, I never wrote one about the concept of Fit, woven throughout those themes.

There was a pattern I heard over and over again in my DHSc research with rural Allied Health Professionals across Aotearoa.

A talented clinician joins a rural team. They have the right qualifications. They seem enthusiastic. The role looks good on paper, the incentives are in place. And then, within a year or two, they’re gone.

Sometimes they could name why. More often, they couldn’t. They just knew something wasn’t working.

It was this concept in my research that I called Fit.

More than a checklist

When workforce researchers and health managers talk about “fit” in rural health, they usually mean have a checklist in mind. Were you born rurally? Did you train rurally? Do you have rural connections? The assumption is that someone who ticks these boxes will be a better long-term prospect for a rural community.

There’s evidence for this. Rurally born health professionals are statistically more likely to work rurally. Rural training placements increase the likelihood of rural employment after graduation. These patterns are real and they matter for pipeline planning.

But across the 18 rural Allied Health Professionals I interviewed for my doctoral research, I found something more.

Fit is something you feel, not just something you are.

What Fit actually looks like

One participant put it simply: “I’m thankful to be here. It’s good to know you’re where you’re supposed to be.”

Another described their rural role as “it’s like my dream job” — not because rural work is inherently easier or more comfortable (it isn’t), but because the role allowed them to use their skills in ways that felt fulfilling, their values were aligned with the place and the mahi, and they could envisage their future from where they were standing.

A third participant, whose parents had been rural schoolteachers, didn’t identify as rural at all. They’d grown up, gone to university in the city, built a career. But when they moved to a rural role, something clicked. “Being a public servant in a rural area feels very familiar,” they said. They hadn’t expected to feel it. But they did.

Fit isn’t about where you were born or what’s on your CV. It’s an inner sense of being in the right relationship with your purpose, your place, and the people around you.

When Fit is lost

The flip side is just as telling. One participant reflected on a conversation with a former colleague who had left a hospital role. She asked: would you come back?

The response was immediate. The colleague said no, absolutely not — the place didn’t fit who she was. No long list of grievances. No ‘navel gazing’. Just a clear felt sense that this was not her place anymore, and that was enough.

This is what makes Fit so significant for retention. When it’s present, people stay even when things are hard. They carry the weight of workload pressures, the isolation, the professional complexity of rural generalist practice, because the overall sense of belonging in that place outweighs the difficult parts.

When it’s gone, all the incentives in the world won’t bring it back.

Fit runs through everything

This is where Fit gets interesting from a research perspective. It doesn’t sit alongside the other themes I identified — Sense of Connection and Belonging, Safe and Supported Practice, and Creating Roles People Want to Come For. It runs through all of them.

You can feel Fit within your team, within your professional support structures, and within the role itself. But there is also a broader sense of Fit that encompasses all of this; a felt sense of being in the right space, at the right time, for the right reasons.

And here’s the finding that most surprised me: having an overall sense of Fit appeared to outweigh the more particular ideas in each individual theme. People who had a strong overall sense of Fit could manage a lack of fit in one specific area. But when the overall sense was gone, the specifics didn’t carry much weight.

What this means in practice

If Fit is primarily something people feel rather than something they inherently are, this changes how we should be thinking about rural health workforce strategy.

The checklist approach to identifying “rural types” will always leave capable people out, including those who haven’t yet had the chance to discover that rural practice might be exactly right for them. Rural training placements work not because they identify people who are already rural, but because they create the conditions for people to find their Fit.

Recruitment conversations need to go beyond qualifications and logistics. The questions that matter are about values, about what someone finds meaningful, about what kind of relationship they want with a community.

Retention strategies that focus only on incentives and conditions are addressing the wrong problem. A salary supplement doesn’t replace a felt sense of belonging.

And when a good clinician leaves a rural role without being able to fully articulate why, that’s worth paying attention to. Fit is hard to measure. That doesn’t mean it isn’t real.

The thread underneath

As I mentioned at the start of this post, Fit is the fourth concept or theme that came out of my doctoral research, and it might be the most significant, because it’s the thread that weaves through all three.

It’s also the one I find most hopeful. If Fit is something people feel rather than something fixed about who they are, then it’s something we can create the conditions for. That shifts the question from “how do we find the right person?” to “how do we build the kind of place where the right person can feel at home?”

And that, I think, is where rural health workforce strategy gets genuinely interesting.

Kia pai tō wiki,

Jane

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

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What happens when you do something that feels a bit wrong, even when everyone else seems to be doing it?

You notice it first as a small discomfort. A kind of low-grade friction between what you’re doing and who you think you are. It’s not dramatic enough to stop you, but it doesn’t go away either.

That’s where I found myself a few weeks ago, running a tiny experiment I’m now calling off.

Let me back up.

When people start paying for your writing, something unexpected happens. It doesn’t feel like a transaction. It feels like a form of trust. Like someone is saying: your thinking matters enough that I’ll put money towards it continuing.

That’s genuinely energising. Weird and wonderful and a little bit humbling. And it created a responsibility I hadn’t anticipated. If people are paying for a subscription, surely I should give them something extra? Something that justifies the spend?

So I did what many Substack writers do. I put a handful of posts behind the paywall.

Image: Maël BALLAND

And then I sat with the icky feeling for a few weeks and waited to see what happened.

Here’s what the data said:

Subscription rates didn’t really change. Not free subscriptions, not paid ones. The paywall had no impact (that I could see).

And here’s what my gut said “This is at odds with who you are”

One of my core values is Connection. And a significant part of what connection means to me is being of service. The idea that the thinking I do, the research I’ve spent years building, the frameworks that have helped me make sense of rural health inequity, should only be available to people who can afford a subscription? That sits uncomfortably close to exactly the kind of access barrier I spend my professional life arguing against.

So I’m releasing those three articles to everyone, while I’m taking a holiday break.

And while I’m away I’m looking for a better experiment.

Curiosity is the other value that sits alongside Connection for me. I’m genuinely interested in what makes this kind of writing worthwhile, what creates actual connection rather than just content, and how a Substack like this one can sustain itself without building walls.

I don’t have the answer yet. But I’m on the lookout for a small, low-stakes experiment that’s actually aligned with what I believe, rather than imported wholesale from what everyone else in this space seems to be doing.

If you’ve seen something interesting in this space, or if you have a thought about what that might look like, I’d genuinely love to hear from you. Drop a comment or reply to this email.

That’s the thing about running experiments. The ones that don’t work tell you something too.

Ngā mihi nui ki a koutou

Kia ora, ko Jane tēnei | I’m Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

Recently I posted on LinkedIn about one of the findings from my doctoral research that I keep coming back to: the way professional development funding in our health system works as a proxy for professional worth. Nurses have dedicated pathways. Doctors have fully funded specialist training. Rural allied health professionals (AHPs) get told to sit through the same generic nursing designed e-learning. Again. For the third year running.

I could see from the response that this resonated. The pattern was familiar. One of the comments led to a conversation that I haven’t been able to stop thinking about since, which ended with the reflection.

“The unions who negotiate the MECAs would be a good place to start.”

My first instinct was: yes. Absolutely yes. Unions exist precisely to hold employers to account on conditions of work, and professional development funding is a condition of work. The Multi-Employer Collective Agreements (MECAs) that govern health employment in Aotearoa shape what health workers can expect in terms of leave, pay, and learning support. If equitable professional development isn’t in those agreements, it’s not enforceable. Simple as that.

But then a second thought arrived, quieter and a bit more uncomfortable.

By the time the senior doctors have negotiated, then the junior doctors, then the nurses and midwives, there’s often very little left in the pot for the Allied Health, Scientific and Technical professions. Not because of conspiracy; that’s just the current order of the queue.

And here’s the uncomfortable truth underneath that: this is a zero-sum game. Professional development funding is a finite resource, and a bigger slice for one group does mean a smaller slice for another. So the real question isn’t whether we can magically grow the pie. It’s whether there’s a way to help the professions who currently do well out of the current arrangement see that a more equitable distribution would make the whole system work better (even if it doesn’t feel that they are doing well from where they’re sitting).

The Logic of Siloed Advocacy

Let me be clear: I am pro-union. Always have been. I’ve been a member with every salaried role I’ve held. The gains that nursing and medical workforces have made (the dedicated pathways, the funded placements, the rural specialist pipelines) were won through decades of organised, persistent advocacy. That mahi deserves enormous respect.

But here’s the thing my research keeps surfacing: the professions that have done best under the current system are the ones with the loudest, best-organised, most politically connected voices. And those voices have, largely, been advocating for themselves.

Which makes sense. That is what unions and professional bodies are designed to do.

The problem is that when every profession advocates separately, the health system becomes a competition rather than a collaboration. Professional development funding gets allocated to whichever group has the most negotiating leverage that year. And the 30% of our health workforce who are Allied Health, Scientific and Technical (AHST) professionals (the physiotherapists, occupational therapists, speech-language therapists, dietitians, podiatrists, social workers, and forty-plus others) tend to lose that competition. Quietly. Repeatedly.

We end up with a system where, as one participant in my research put it, the only way to get funding for your own specialist training is to frame it as freeing up a doctor to do more surgery.

That’s not professional development equity. That’s professional development by proxy.

An Unlikely Political Analogy

I’ve been thinking about the work of Natalia Albert, who researches, writes and speaks about the “relationship between policy and our competing views between groups in New Zealand”. One of her recently shared (very helpful to me!) insights, which she applies to political candidates and parties, is that under MMP and similar models, you can be on your own ticket and still need to understand how you’ll work with everyone else. You don’t win by pretending the other parties don’t exist. You win by being clear about your own position and by being able to articulate how you’ll work across difference toward shared outcomes.

I keep thinking: what would it look like if health professions took that approach?

Right now, we behave a bit like parties under a first-past-the-post system, each trying to capture as much of the limited resources as possible, treating gains for others as potential losses for ourselves. The MECA negotiations reflect this. Professional development funding is fought for profession by profession, body by body, employer by employer.

But what if we thought about this differently? What if nursing, midwifery, AHP unions, and medical associations started asking: what would equitable professional development for the whole workforce look like, and what would it take for all of us to advocate for that together? Not out of altruism (let’s be honest, that’s a hard sell at a negotiating table) but because a workforce where every profession is well-supported, well-trained, and well-retained is a less pressured, more sustainable place to work for everyone.

What the Research Tells Us

My doctoral research with eighteen rural AHPs revealed something that I think is important to name clearly: the participants in my study were not primarily angry at their nursing or medical colleagues. They understood that their colleagues were also navigating a system with limited resources and competing demands, and often feeling underappreciated themselves.

What they were angry about (quietly, persistently, in ways that ultimately drove some of them out of rural practice) was a system design that treated professions unequally. Training developed as nursing training, mandated for everyone. Professional development policies written without AHPs in mind. Organisational cultures that saw AHP learning as discretionary and medical learning as essential.

This isn’t a problem that any single profession created. And it’s not a problem that any single profession can solve.

The existing literature backs this up. The medical and nursing workforces have made gains through working in partnership with professional associations, unions, health boards, training institutions, and government; a coalition approach, even within a single profession. The question I find myself sitting with is: what would it look like to take that coalition approach across professions?

The Case for Collective Advocacy

Here’s what I think is possible, and I want to be careful here, because I don’t want to paper over real tensions with optimism.

There are genuine power differentials between health professions. There are historical hierarchies that have served some groups at the expense of others. There are real resource constraints, and equitable distribution of limited funding does mean some professions would need to give something up. I’m not pretending otherwise.

But I do think there is a genuinely shared interest that hasn’t been fully leveraged.

When rural AHPs can’t access clinically significant professional development, they leave rural practice. When they leave, rural communities lose access to the breadth of care that keeps people well, functioning, and out of hospital. The doctors and nurses who remain in those communities then carry a heavier burden. The system becomes more fragile, not more efficient.

Equitable professional development for AHPs isn’t just good for AHPs. It’s good for rural communities. It’s good for the whole health workforce. It’s good for the system.

If we could make that case collectively (nurses, doctors, and AHPs together) it becomes much harder for health organisations and policymakers to dismiss it as special pleading from a marginalised group.

Every voice at the table makes everyone stronger. That’s not a platitude. It’s a workforce strategy.

So What Might This Look Like?

I don’t have a fully formed answer, and honestly, I think the answer needs to come from the professions themselves, through exactly the kind of conversation the comment on my LinkedIn post pointed toward.

But some starting points I keep returning to:

MECA negotiations that include whole-of-workforce principles. I’ll be upfront, I’ve never sat at a negotiating table, so I hold this suggestion lightly. But what if unions negotiated not just for their members’ professional development, but for professional development equity across all workforce groups? What if that became a standard clause, not “radiology gets X” but “all clinical professions have access to equivalent funding, adjusted for rural loading”?

Professional bodies and colleges building cross-professional coalitions. The Medical Association, the Nursing Council, the various Allied Health Scientific & Technical Professional associations; what would it look like for these bodies to develop a shared position on professional development equity and take it to government together?

Health organisations being held accountable to whole-of-workforce standards. Not just “we have a professional development policy” but “we can demonstrate that our investment in learning is equitable across all professions, and here’s the data that shows the benefits we’re realising.”

Rural loading applied consistently. If it’s accepted that rural practitioners face higher costs to access training (travel, accommodation, locum cover) then that loading should apply regardless of profession. The rural physiotherapist faces exactly the same geographic barriers as the rural nurse.

The Deeper Question

The comment on my post was about unions and MECAs, and that is a genuinely important lever. I hope this piece has honoured that insight, while also expanding it a little.

Because I think the deeper question isn’t just who we advocate to. It’s how we advocate, and whether we’re willing to advocate for something bigger than our own profession’s immediate interests.

I absolutely want us to work together. And I want us to be honest about why we haven’t been working together until now, because understanding that is the only way to make sure we don’t recreate the same barriers under a new arrangement.

The health professions that have been most marginalised (AHPs, rural practitioners, the professions with fewer members and quieter voices) don’t need charity from their more powerful colleagues. They need genuine partnership. They need the professions that have had a seat at the table to actively make room, not because it’s the nice thing to do, but because health genuinely works better when everyone is there.

In politics, you can win a seat on your own. But under MMP, you govern together, or you don’t govern at all.

Maybe it’s time health professions started thinking the same way.

Ngā mihi nui ki a koutou

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

Alicia McKay shared a post this week that I haven’t been able to stop thinking about.

She took her daughter to the GP. The nurse practitioner introduced an AI notetaking tool using a “funny little kiddie voice” - meet Heidi, my little helper. A second screen displayed previous patient consultations. When Alicia raised privacy concerns, she was reassured that the session was “unidentifiable” as long as nobody said a name or date of birth.

When she asked where the data was stored, the practitioner paused. “Yes, it’s a good question. We don’t know.”

I jumped into the comments. Practitioners are supposed to gain consent every time they use a tool like this. Someone pushed back - are they though? Is that actually required? The thread was so rich, with people’s experiences. Turns out, it depends who you ask.

You can read Alicia’s original post and the conversation it sparked here

That uncertainty in the comments told me something important. And it wasn’t about the technology.

The problem isn’t Heidi

AI scribes like Heidi are just one part of a much larger picture. Across our health system, technology is being used at every level - some of it sitting right in the room with patients, some of it running quietly in the background, nowhere near a clinical encounter.

It helps me to think about it in four quadrants.

On one axis: whether the tool is used directly with patients or sits further back in the system - think radiologists using AI-assisted image review, or laboratory scientists working with predictive analytics. On the other axis: whether a tool is essentially contained (it stores and transmits information, but doesn’t interpret or generate) versus inferential (it actively reasons, connects to external systems, generates output, learns).

What this grid helps me think about is how the consent and transparency obligation don’t disappear as you move further from the patient. They transform. In the direct/inferential quadrant, the practitioner needs to be able to explain what the tool does and invite a genuine response - in the moment, under time pressure, possibly with a child in the room. In the indirect/inferential quadrant, somebody still had to decide whether patients know their scan was read by an algorithm. Who made that call? Do the staff interacting directly with the patient know what to say if asked?

Whose job is it to prepare them?

Here’s the question I keep coming back to. Not “did the nurse practitioner do the right thing?” but “who prepared her to?”

Was she uncomfortable using Heidi and hoping to ease past it? Nervous that a patient might say no and unsure how to manage that? Unclear on how the tool actually worked, or what “unidentifiable” really meant in practice? Possibly all three.

We are rolling out inferential tools across our health system, and in many cases, practitioners are sourcing their own, while assuming that the people using them have the literacy to use them safely, explain them clearly, and navigate consent with confidence. We assume they know which tools connect to the internet and which don’t. We assume they understand what it means for data to be “stored offshore.” We assume they can field a question from a patient they weren’t expecting.

Where did that capability come from? Was it taught? Or assumed?

The health workforce is being asked to have an increasingly complex conversation with patients on behalf of systems and vendors they may not fully understand themselves. That is a significant ask. And it falls hardest on the practitioner in the room, the one with thirty seconds before the next patient, the one whose name is on the notes.

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Same failure, different era

Here’s the thing. When Alicia left that appointment, she needed to update their address. The receptionist wasn’t logged in on that computer. It was “sort of tricky.” So she handed over a post-it note and went out the back.

They waited. She didn’t come back. They left their address on a sticky note at an unmanned front desk.

No AI involved. No inferential tools, no data sovereignty questions, no algorithms. Just an address on a piece of paper, left where anyone could see it.

The same practice. The same day. The same assumption - that the person in the role would know how to handle the situation safely, without anyone having specifically prepared them to do so.

That’s not a technology problem. It never was.

Ngā mihi nui, Jane

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

When the Language Reveals the Power

Notice the language we use about rural health development:

“Building capacity” in rural areas. “Upskilling” rural practitioners. Urban experts travelling rural to “teach.” Professional development “delivered” to rural communities. Research done ON rural populations.

This language speaks volumes.

It positions urban as expert and rural as perpetually needing help. It assumes knowledge flows one direction. It frames rural as deficit rather than different.

During COVID lockdowns, I watched this play out in real time. Our rural practitioners were innovating rapidly - finding creative solutions to maintain care for their communities when usual systems collapsed. We were problem-solving, adapting, doing what rural health professionals have always done.

And then our urban colleagues stepped in to “govern” what we were doing. Calling halts to activity without being prepared to understand the consequences. The automatic assumption that innovation needed oversight from the centre, that rural couldn’t be trusted to problem-solve.

It’s like an urban power monopoly; this assumption that cities know best and rural needs capacity building.

What Reciprocal Development Actually Means

Reciprocal Development is the third component of my Rural Health Equity Framework. It dismantles urban power monopoly and builds toward something fundamentally different: tuakana-teina relationships.

For my international readers: tuakana-teina is a learning relationship from te ao Māori (the Māori world). Tuakana (older or more experienced) and teina (younger or less experienced) work together, but the relationship is reciprocal. Both teach, both learn. The roles shift depending on context and expertise. It’s not hierarchical mentorship, it’s mutual support where everyone has mana (authority, prestige, integrity).

In health systems, this means:

• Rural and urban practitioners as equals with different expertise

• Bidirectional innovation exchange

• Co-designed professional development

• Research as partnership, not extraction

• Urban learning FROM rural, not just teaching TO rural

The barrier being dismantled: One-way knowledge transfer that assumes expertise only flows from cities outward.

The inclusive alternative: Mutual teaching and learning where both rural and urban bring expertise the other needs.

Telehealth: When Rural Innovation Gets Claimed by Cities

Rural practitioners pioneered telehealth long before COVID made it mainstream.

Out of necessity, rural health professionals figured out:

• How to build therapeutic relationships remotely

• Which assessments work virtually and which don’t

• How to manage technology failures mid-consultation

• Community engagement strategies for digital health

• Supporting whānau through screens when you can’t be there in person

We’d been doing this for years. Refining it. Getting good at it.

When COVID hit, suddenly everyone needed these skills. Urban services scrambled to pivot to virtual care. Telehealth went from “making do with distance” to “innovative digital transformation.”

But here’s the question: did urban systems position rural practitioners as the experts? Did they ask us to teach them what we’d learned?

Or did they develop their own telehealth protocols in urban centres and “roll them out” to rural areas - to the very practitioners who’d been doing it successfully for years?

The innovations that rural practitioners develop out of necessity get repackaged as urban innovation. The expertise we build gets overlooked, then “taught” back to us through urban-designed professional development.

This is urban power monopoly in action.

The “Capacity Building” Problem

Through my doctoral research with 18 rural Allied Health professionals, I found something telling about how professional development operates.

Participants described professional development designed around urban models of learning towards specialism and sub-specialism that appears to dominate the thinking of those training and regulating professions, an attitude that participants found unsupportive.

One participant captured it perfectly: “I like the variety in rural, so that keeps my head engaged. It means I know a little about a lot, instead of a lot about a little.”

But this breadth of expertise isn’t recognised as advanced practice. It’s positioned as generalist work, lesser than specialisation. The sophisticated clinical reasoning required to work across the lifespan, across conditions, across professional boundaries? Not valued in professional development frameworks designed around urban specialist models.

Another participant expressed their frustration: “if I wanted to progress in terms of my career I would need to leave [this town], definitely.”

Because growth pathways follow urban templates. Specialty nursing pathways. Sub-specialisation. Depth over breadth. The very opposite of what makes rural practice work.

The assumption is that rural practitioners need “capacity building”, that we lack something urban practitioners have. But what if we’ve developed expertise that urban practitioners lack? What if breadth of practice, adaptability, and working across traditional boundaries are sophisticated capabilities that urban systems need to learn?

Reciprocal Development asks: who’s building whose capacity?

What My Research Revealed About Urban Narcissism

Through my doctoral work, I identified a pattern my participants described as the perception rural AHPs appeared to hold was that their urban counterparts believed them to be less skilled or capable, or that they were working in an environment where their skills were being wasted.

This urban thinking is often labelled geographical narcissism - a concept from Swedish researcher Malin Fors. It “geographically locates expertise in the urban centres or big cities and ‘often unconsciously devalues rural knowledge, conventions and subjectivity.’”

The impact on rural practitioners is profound:

• The combination of professional hierarchy AND geographical bias creates issues of self-worth

• Participants felt their expertise wasn’t recognised

• Professional development didn’t value what they’d actually developed

• Growth pathways required leaving rural practice

• No endorsement of rural scope as extended or specialist practice

Participants also told me that they saw protected time and funding dedicated to the ongoing professional development of nursing and medical colleagues that did not seem to be available to them. A privileging of some professions over others, or so it seemed.

This isn’t just about Allied Health versus other professions. It’s about how we systematically devalue rural expertise through old ways of “capacity building” that assumes the centre knows best.

How Reciprocal Development Creates the Rural Equity Zone

When we shift to Reciprocal Development, we enable the other framework components to work effectively.

It builds on Rural-First Design because you can’t learn from rural innovations if you haven’t designed from rural contexts first. Rural-first design reveals what rural practitioners have already figured out that urban systems need to know.

It builds on Function-Led Delivery because you can’t have mutual learning if you’re locked into hierarchical professional structures where only certain professions “teach” and others “learn.”

In the Rural Equity Zone - where all three components overlap - Reciprocal Development ensures:

• Rural practitioners are recognised as experts and teachers

• Innovations flow bidirectionally (not just urban → rural)

• Professional development is co-designed WITH rural practitioners

• Research is partnership, not extraction

• Urban systems actively learn from rural solutions

• “Every voice matters” becomes operational, not aspirational

What This Means for You

If you’re responsible for professional development:

• How many of your programmes were designed BY rural practitioners?

• Do you position rural practitioners as teachers for every learner, or just the rural ones?

• Does your curriculum value breadth of practice or only depth and specialisation?

• When rural practitioners develop innovative approaches, do you scale them or reinvent them from urban centres?

If you’re responsible for research:

• Are rural practitioners co-investigators or data sources?

• When you study rural health, who gets authorship?

• Do you position small rural data sets as “insufficient” or as revealing patterns large datasets miss?

• Does your research extract knowledge from rural or create knowledge with rural?

If you’re a health system leader:

• When did you last learn FROM a rural practitioner rather than teach TO them?

• Which rural innovations have you scaled to urban contexts?

• Does your language reveal one-way assumptions? (”capacity building,” “upskilling rural”)

• Do your professional pathways require rural practitioners to leave rural practice to progress?

This is uncomfortable for urban-based systems because it requires acknowledging that the centre doesn’t have all the answers. It means recognising that rural practitioners aren’t perpetually behind - they’re often ahead, having already figured out solutions urban areas desperately need.

True reciprocal development means urban systems position themselves as learners, not just teachers.

This completes the Rural Health Equity Framework series. All three components - Rural-First Design, Function-Led Delivery, and Reciprocal Development - work together to create the Rural Equity Zone where sustainable, equitable rural healthcare actually thrives.

What examples of one-way “capacity building” have you experienced - or what genuine reciprocal learning partnerships have you seen work? I’d love to hear what resonates.

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

REFERENCES:

Baker, L., & Hess, S. (2019). Countering geographical narcissism. Augur, 7 June 2019. https://augur.buzz/countering-geographical-narcissism-4aaa4e5cd8f

George, J. E. (2023). Understanding the complexities of recruitment and retention of Allied Health Professionals in rural health settings [Doctoral thesis, Auckland University of Technology]. Tuwhera. http://hdl.handle.net/10292/16511

Rolleston, A., Cassim, S., Kidd, J., Lawrenson, R., Keenan, R., & Hokowhitu, B. (2021). Enhancing well-being and social connectedness for Māori elders through a peer education (tuakana-teina) programme: A cross-sectional baseline study. Frontiers in Public Health, 9, 775545. https://doi.org/10.3389/fpubh.2021.775545

When Form Trumps Function

In rural health, we have a problem with professional gatekeeping.

Not the dramatic kind - no one’s standing at the door turning people away. It’s subtler than that. It’s the quiet assumption that certain work “belongs” to certain professions, regardless of whether that serves the community’s needs.

It’s nurse specialist roles that inadvertently block Allied Health professionals from practicing at their trained scope. It’s GPs refusing collaborative practice claiming they “don’t have time to supervise” professions that don’t legally require supervision. It’s city-based therapists telling rural parents their child won’t get quality care from rural colleagues.

This is what I call prioritising form over function.

Form is the form of the profession that people associate with healthcare. The media, members of the public, health system administrators, politicians - they all talk about nurses and doctors routinely. There are often barriers to delivering health services differently, because the professions delivering the service don’t have the same form as what people are used to. If it’s not a GP, it won’t be as good.

Function is the service delivery itself - what the community actually needs.

In urban settings with workforce density, you can afford to maintain strict professional boundaries. There are enough of each profession to cover their scope. But in rural areas? Professional gatekeeping becomes a barrier to access.

Recent workforce planning research has exposed exactly this problem. Rees, Willis and Scotter’s 2025 analysis in Health Policy argues that traditional workforce planning uses linear forecasting - essentially extrapolating from what we currently have. They advocate instead for normative backcasting: starting with what communities actually need and working backwards to design workforce solutions. Sound familiar? That’s function-led delivery versus profession-led delivery. When we design from professional form (what we currently have, what’s familiar), we perpetuate existing hierarchies. When we design from community function (what’s actually needed), we create sustainable solutions.

Image generated in Google Gemini

The Evidence of Gatekeeping

Dymmott and colleagues’ 2024 study of the Allied Health Rural Generalist Pathway in Australia found that rural allied health professionals need “broad skills and knowledge to provide vital services to local communities” and must manage “wide ranging and complex health conditions over vast geographical areas.”But here’s where it gets interesting: their research also revealed that “unlike medical training, allied health post-grad training is variable and not directly related to career advancement.” There’s often an “absence of incentives or recognition of learning” that impacts motivation.This creates a perfect storm for professional gatekeeping.When Allied Health professionals lack clear career progression pathways, larger professions step in to fill perceived gaps by creating specialist roles. Well-intentioned. Seemingly practical. But it perpetuates the exact problem it’s trying to solve.

Through my doctoral research with 18 rural Allied Health professionals, I found that professional boundaries designed for urban contexts actively hindered their ability to serve their communities. Participants described being capable of delivering interventions but blocked by professional hierarchy. They spoke of urban-based professionals questioning their competence simply because rural practice looked different from urban norms. The system assumes professional form equals quality, when function is what actually matters.

When Good Intentions Create Unintended Barriers

Let me tell you about a pattern I’ve seen repeatedly in rural health services.

A rural hospital identifies a need for respiratory assessment and management. There’s work there - patients with COPD, asthma, post-surgical respiratory complications. Important work. Clinical work. Work that needs doing.

But there’s not enough respiratory work for a full-time physiotherapy role. Maybe 0.3 FTE worth. Not enough to recruit a physiotherapist to relocate rurally.

The form-led response? Develop a post-graduate trained nursing respiratory specialist role.

Seems sensible, right? Nursing has the workforce numbers. They’re already there. Train them up in respiratory assessment, diagnosis, and management. It offers an added advantage of creating a career pathway into senior nursing, strengthening retention. Problem solved.

But look at what just happened:

• Community still has no physiotherapist (for ANY physiotherapy needs - not just respiratory)

• Nursing is now doing work outside their undergraduate scope, requiring expensive post-graduate training

• No pathway for physiotherapy expertise to establish in the community

• The nursing specialist had to train for work physiotherapists do at entry level

• When a physiotherapist eventually does want to work rurally, there’s no viable role because nursing has absorbed the work

The function-led alternative looks completely different.

Instead of defaulting to the largest profession, strategically identify ALL physiotherapy-scope work across the service. The respiratory assessments, yes. But also the mobility work, falls prevention, rehabilitation, pre-operative assessments, post-surgical recovery, musculoskeletal clinics.

Bundle it together. Suddenly you have 0.8-1.0 FTE of physiotherapy work - a viable role worth relocating for.

Now:

• Community gets access to physiotherapy expertise

• Physiotherapist works at their undergraduate scope (no expensive post-grad training needed)

• Nursing can focus on nursing-scope work

• The role is sustainable because it’s built on actual community function

• Allied Health workforce becomes viable in rural areas

The sacrifice? Nursing gives up the “interesting” respiratory specialist work.

The gain? Everyone works at their trained scope, community gets better care, more workforce groups become sustainable.

Image generated in Google Gemini

This strategic workforce design connects directly to what Rees and colleagues call normative backcasting. Instead of extrapolating from what we currently have (nursing is here, so expand nursing scope), we start with what the community needs (physiotherapy expertise) and work backwards to create sustainable roles.

Another Version of the Same Pattern

I’ve also heard city-based Allied Health professionals tell parents of children with disabilities that if they want high-quality therapeutic input, they’re unlikely to get it from the public hospital therapists in their rural area.

City therapists. Undermining rural therapists. To families.

This combines professional hierarchy with geographical narcissism - the assumption that rural practitioners are somehow less competent, less current, less capable. It positions the city therapist as saviour and rural colleagues as inadequate.

The damage this does is profound. It undermines rural practitioners’ relationships with families. It suggests families should accept second-tier care or relocate. It positions rural practice as inferior rather than differently skilled.

This Isn’t Unique to Any Profession

Let me be clear: This isn’t unique to any profession. I’ve seen medicine gatekeep collaborative practice, nursing inadvertently gatekeep Allied Health work through specialist roles, and Allied Health professionals from cities questioning the competence of their rural colleagues.

This is a systemic pattern across all health professions - and it’s particularly damaging in rural contexts where workforce limitations mean we simply cannot afford professional silos.

What Function-Led Delivery Actually Means

Function-Led Delivery means designing services based on what communities need, not on professional hierarchy or traditional boundaries.

Think about how we currently design rural health services:

Form-led thinking asks: “Which profession traditionally does this work?”

Function-led thinking asks: “What functions need to be performed, and who’s trained to perform them?”

The difference is profound.

When services are designed around professional form:

• Work gets allocated based on professional tradition, not training or community need

• Professions develop specialist roles to claim territory

• Smaller professions can’t establish viable rural roles because larger professions have absorbed their work

• “Oversight” becomes a gatekeeping mechanism even when not legally required

• Professional hierarchy determines access more than community need

When services are designed around community function:

• Work gets allocated based on who’s actually trained to do it

• Roles are designed to create sustainable positions for needed expertise

• Larger professions strategically share work to enable smaller professions to establish viable roles

• Collaboration serves the community, not professional territory

• What matters is delivering the function, not protecting the form

Function-Led Delivery Isn’t About Everyone Doing Everything

Let me be clear: Function-Led Delivery isn’t about everyone doing everything, or abandoning professional boundaries entirely.

It’s about strategically designing roles based on what the community needs, then distributing work to create viable positions for the right expertise.

This requires:

• Letting go of professional territorialism

• Larger professions being willing to give work to smaller professions

• Thinking community function over professional form

• Accepting that “interesting” doesn’t always equal “appropriate”

• All of the health professions working together (Allied Health are already bundled together anyway - we can’t afford silos)

Sometimes this means a larger profession deliberately gives work back to a smaller profession to create a sustainable role. Yes, it might mean giving up something interesting. But it means the community gets the right expertise, and rural roles become viable enough to attract that expertise.

How Function-Led Delivery Creates the Rural Equity Zone

When we shift to Function-Led Delivery, we enable the other framework components to work effectively.

It builds on Rural-First Design because once you’ve designed from rural contexts, you can see what functions are actually needed - not just what professional forms you’re used to seeing.

It enables Reciprocal Development because you can’t have tuakana-teina relationships (mutual learning and support) if you’re locked into rigid professional hierarchies where only certain professions are “allowed” to learn certain things.

In the Rural Equity Zone - where all three components overlap - Function-Led Delivery ensures:

• Every profession is valued (not just familiar professional forms)

• Services meet actual community needs rather than professional convenience

• Rural practitioners can work at their full scope

• Professional expertise is strategically distributed to create viable roles

• Collaboration serves communities, not professional territory

What This Means for You

If you’re responsible for rural health workforce, ask yourself:

• Are you designing roles around professional form (traditional boundaries) or community function (what’s actually needed)?

• When creating specialist roles, have you considered whether that work is already within another profession’s undergraduate scope?

• Are larger professions in your service absorbing work that could create viable roles for smaller professions who are also needed in your community?

• Do your service models assume professional hierarchy designed for urban workforce density?

• Are you protecting professional territory or serving community needs?

Function-Led Delivery challenges us to put community function ahead of professional form. It’s uncomfortable. It requires professions to give up territory. It asks larger professions to make sacrifices so smaller professions can establish sustainable rural roles.

But it’s how we build health services where every profession is valued and every community gets access.

Next week: Reciprocal Development and why the assumption that urban knows best undermines rural health equity

What examples of professional gatekeeping have you seen in rural practice? Share in the comments - I’d love to hear what resonates.

Kia ora, ko Jane tēnei | I'm Jane 👋🏼

🧩I bring health together - helping rural health system leaders build inclusive recruitment and retention strategies that acknowledge barriers while actively dismantling them so every profession has a voice at the table
🧩 I talk about #ruralhealth #alliedhealth #equity #socialjustice because #HealthWorksBetterTogether

🧩 Want more like this but bite sized? Check out my LinkedIn content https://www.linkedin.com/in/janegeorgenz/

REFERENCES:

Dymmott, A., George, S., Campbell, N., & Brebner, C. (2024). Sustaining our rural allied health workforce: experiences and impacts of the allied health rural generalist pathway. BMC Health Services Research, 24, 749. https://doi.org/10.1186/s12913-024-11207-5

Rees, G. H., Willis, G., & Scotter, C. (2025). Health workforce planning should be strategy or policy-driven: From linear forecasts to normative futures. Health Policy, 161, 105440. https://doi.org/10.1016/j.healthpol.2025.105440