Assessing the Mediating Role of Internal Migration in Bushfire‐Related Changes in the Distribution of Australia's Medical Practitioners
Xin Lin, Ross Bailie, Peter Radchenko, Geoffrey Morgan, Anirban Chakraborti, K. Shuvo BakarABSTRACT
Background
Climate‐driven bushfires increasingly shape community health needs and challenge medical workforce capacity in Australia. Although population mobility can influence practitioner availability, it is unclear whether bushfires indirectly affect medical practitioner workforce distribution by prompting internal migration. Understanding these dynamics is critical for informing climate‐resilient health‐workforce policies.
Methods
We analysed a longitudinal panel of regional and remote Australian Local Government Areas (LGAs) from 2013 to 2021 using generalised estimating equations (GEEs) causal mediation analysis. Bushfire exposure was assessed using three complementary measures: (i) binary (any occurrence), (ii) cumulative (repeated events) and (iii) severity‐based (intensity of exposure). Outcomes were full‐time equivalent (FTE) medical practitioner, adjusted for remoteness and socio‐economic conditions. Internal migration was included as a potential mediator.
Results
Across all exposure metrics, bushfire‐affected LGAs exhibited significantly higher medical practitioner FTE rates. Cumulative exposure showed a positive association (0.29, p = 0.02), with severity‐weighted exposure yielding a similar directional effect (1.32, p = 0.04). Although internal migration was positively associated with FTE rates, it did not significantly mediate the relationship between bushfire exposure and workforce supply.
Conclusions
Bushfire exposure is associated with higher medical practitioner FTE rates in affected LGAs. However, internal migration does not appear to meaningfully mediate this relationship for our study region. For extreme and consecutive bushfires, defined as bushfire occurrence in at least five of the past 10 years, the evidence for mediation through population movement is limited. These findings suggest that changes in the medical workforce following bushfires are more likely driven by direct health system policies rather than by broader internal migration patterns. Planning for future climate‐related disasters should consider mechanisms that support responsive allocation and retention of medical practitioners, particularly in regional and remote areas with historically lower workforce levels.