Objective: Most rural and remote regions face chronic health workforce shortages. Strategies designed to redress this problem include Fly-In Fly-Out (FIFO) and Drive-In Drive-Out (DIDO) health services. The aim of this paper is to examine the opportunities and challenges involved in these forms of service delivery. Design: Detailed review of recent literature relating to FIFO and DIDO services in rural & remote Australia. Results: FIFO and DIDO have obvious short-term benefits for rural Australians seeking health care services in terms of increasing equity and accessibility to services and reducing the need to travel long distances. However, there are significant long-term disadvantages such as the potential for burnout among FIFO and DIDO health professionals who travel long distances and work long hours, often without adequate peer support or supervision. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary health care system in small rural communities.Conclusions: Given the potential negative consequences for both health professionals and rural Australians, this paper cautions against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary health care services in rural and remote communities.

This thesis presents a qualitative study of counsellors' experiences of indirect trauma exposure, the factors that facilitate counsellors to thrive personally and professionally, and sustain their engagement in trauma counselling work. The existing literature details the challenges of indirect trauma exposure in trauma work. However, the ways that counsellors are able to derive rewards and maintain their engagement in trauma counselling work are less well recognised. The current study examines these factors using a grounded theory approach, with semi-structured interviews conducted to explore the issues. The findings of this study demonstrate that multiple interrelating factors influence the impact of indirect trauma exposure on counsellors. These factors were conceptualised into a three-component model linked by the process of self-reflexivity. This model, termed the Self-Reflexive Model, refers to how counsellors manage the impact of indirect trauma experiences, and consists of three main components: 'developing perspectives'; 'empathic balance'; and 'sustaining capacity'. Under these three components, the model encompasses new insights about the influence of the subjective interpretation of indirect trauma experiences, the rewarding aspects of trauma counselling work, the strategies that maintain empathic boundaries, and the pivotal role of self-reflexivity. The model demonstrates an integrated perspective of these influencing factors, and how the risks and rewards of indirect trauma exposure can be effectively managed. This study builds on existing research about the impact of indirect trauma exposure, while offering greater insight into the processes, practices, and strategies that promote the rewarding and sustaining aspects of trauma counselling work. This information may be applicable to counsellors across different areas of practice that may experience indirect trauma exposure, regardless of whether they are employed in trauma specific or non-trauma specific roles. The findings provide important information for the counselling profession as increased knowledge of these issues will guide clinical practice, education and training, and address issues that influence the sustainability of counsellors in trauma counselling work.

Context: Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners.

Issues: FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities.

Lessons learned: Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.