title: The Fly-in Fly-out and Drive-in Drive-out model of health care service provision for rural and remote Australia: benefits and disadvantages.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: CRN, University of New England, Armidale, New South Wales, Australia. rafat.hussain@anu.edu.au.
authors.forename: Rafat
authors.initials: R
authors.lastname: Hussain
authors.affiliation: CRN, University of New England, Armidale, New South Wales, Austalia. mmaple2@une.edu.au.
authors.forename: Myfanwy
authors.initials: M
authors.lastname: Maple
authors.affiliation: SRM, University of New England, Armidale, New South Wales, Australia. drsallyvhunter@gmail.com.
authors.forename: Sally V
authors.initials: SV
authors.lastname: Hunter
authors.affiliation: CRN, University of New England, Armidale, New South Wales, Australia. vmapedza@une.edu.au.
authors.forename: Virginia
authors.initials: V
authors.lastname: Mapedzahama
authors.affiliation: Bloomfield Hospital, Orange, New South Wales, Australia. crrmh@newcastle.edu.au.
authors.forename: Prasuna
authors.initials: P
authors.lastname: Reddy
mesh_terms: D017732:Air Ambulances; D001315:Australia; D005260:Female; D006078:Government Programs / Q000191:economics; D006282:Health Personnel / Q000193:education; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D037141:Mandatory Programs; D008511:Medicine; D017146:Models, Organizational; D020380:Needs Assessment; D010558:Personnel Loyalty; D010560:Personnel Selection; D010561:Personnel Staffing and Scheduling; D019114:Remote Consultation; D019035:Rural Health Services; D014186:Transportation / Q000379:methods*; D035862:Vulnerable Populations; D000078329:Workforce
keywords: Australia/Pacific; Health Needs Assessment; Primary Health Care