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Background Historically it has been challenging to recruit and retain an appropriately trained medical workforce to care for rural and remote Australians. This paper describes the Queensland North West Hospital and Health Service ( NWHHS) workforce redesign, developing education strategies and pathways to practice, thereby improving service provision, recruitment and retention of staff. Concept The Mount Isa-based Medical Education Unit sought accreditation for a Rural Generalist ( RG) training pathway from Internship to Fellowship with the Australian College of Rural and Remote Medicine ( ACRRM) and the Regional Training Provider ( RTP). This approach enhanced the James Cook University ( JCU) undergraduate pathway for rurally committed students while improving recruitment and retention of RMOs/Registrars. Achievements Accreditation was achieved through collaboration with training providers, accreditation agencies, ACRRM and a local general practice. The whole pathway from ignore Internship to Fellowship is offered with the RG Intern intake as a primary allocation site beginning in 2016. Comprehensive supervision and excellent clinical exposure provide an interesting and rewarding experience - for staff at all levels. Results Since 2013 RMO locum rates have been <1%. Registrars on the ACRRM pathway and Interns increased from 0 to 7 positions each in 2015, with similar achievements in SMO staffing. Three RMOs expressed interest in a Registrar position, Conclusions Appropriate governance is needed to develop and advertise the program. This includes the NWHHS, the RG Pathway and JCU. [ABSTRACT FROM AUTHOR]