Rural doctor shortage linked to complex medical system for graduate doctors, new research finds

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March 15, 2019 06:52:47

A program designed to streamline rural health training for post-graduate doctors is being proposed as the latest idea to overcome the shortage of doctors in regional areas.

The move comes as the far-west New South Wales town of Hillston had 18 months with a new hospital but no doctor to admit anyone into care.

Carrathool Shire Mayor Peter Laird said the shortage of regional doctors was becoming an emergency.

“At a meeting recently in Albury with about 50 regional and rural councils, it was quoted that there were 277 medicos needed for rural and regional NSW,” Mr Laird said.

“I am going to suggest that we have a crisis looming.”

Improvising to survive

Hillston lost its full-time doctor 18 months ago, during the Medical Board of Australia’s crackdown on foreign-trained doctors.

It has subsequently operated without a full-time GP, depending on sporadic locum stints and coverage from a Griffith-based GP who travelled the 220-kilometre round trip for Thursday and Friday consultations.

On a day-to-day level, the town’s diagnostic ingenuity is impressive, relying heavily on local pharmacist Heather Lyall and the town’s paramedics.

This is something Ms Lyall said was not necessarily orthodox, but essential for survival in the bush.

“It wakes me up at night occasionally. Pharmacists have always been a first port of call but in the majority of cases if you feel you need to refer them, you’ve got someone to refer them to,” Ms Lyall said.

“At the moment I don’t have that luxury of having someone I can refer them to.”

‘You can’t be what you can’t see’

The struggle to attract and retain rural doctors was nothing new and was being felt in rural and regional towns across the country.

But it could be argued it was increasing in urgency and scale.

Rural Doctor Association of Australia President Adam Coltzau suggested that a lack of cohesion at all levels of government was contributing to the critical shortage of regional doctors.

“The answer for how do we attract and retain [a medical officer] is really complex. But it does involve considerable investment from all levels of government,” Dr Coltzau said.

“In an ideal world, the constant cost-shifting that occurs between state and federal could probably go some of the way in alleviating issues we all have, all over Australia, in attracting and retaining rural doctors.”

Doctors Skye Kinder and Louise Manning have recently scrutinised the current medical training system via a survey of more than 60 junior doctors.

Their findings illuminated gaps in the current system where potential rural generalists (general practitioners) were being lost.

They found that rural medicine was well represented at the student level, with medical students exposed to rural communities and practitioners as well as encouraged to pursue rural programs as part of their study.

But this dropped off dramatically on graduation and a complex and siloed system of metro-based specialist training and secondment took over, often severing any connection students might have started with rural medical training.

“The majority of junior doctors who responded to the survey had not actually received any promotion about rural health since they had graduated medical school,” Dr Kinder said.

You work to death

There are additional practical challenges facing the recruitment of general practitioners to the regions.

Dr Coltzau said general practice was the lowest remunerated specialty and GPs were required to be across disparate body and social systems, meaning a certain personality type was required.

“Thirdly, the cost of doing business is rural parts of the country is more expensive and GPs, essentially, are running a private business,” Dr Coltzau said.

Beyond the systemic issues facing rural generalist training, an alchemy of human factors can further complicate the decision for those weighing up a career in regional Australia.

Issues such as spousal employment opportunities, quality of schooling, and ease of access naturally impact any decision to relocate.

And when finally on the ground, many rural GPs battled with a sense of professional isolation.

“The trouble with a lot of rural towns if you’re the only doctor there — or there’s one or two of you — is you work to death and you burn out,” Dr Coltzau said.

“You need a situation where you have a couple of doctors working in town, collegiate doctors who you can discuss difficult cases with or work out a plan for managing difficult cases.”

A possible cure

Working closely with National Rural Health Commissioner Professor, Paul Worley, the Rural Doctor Association of Australia has developed a proposed National Rural Generalist Pathway.

The pathway was outlined at the federal politicians’ briefing on February 12 this year, ahead of May’s election.

“The [proposed] pathway would essentially be a very streamlined pathway from graduation right through until practicing independently,” Dr Coltzau said.

“It would remove some of that silo-ing and some of the bureaucratic hurdles because it would already be coordinated for you and you don’t have to find your own path.

“Within the National Rural Generalist Program, the majority of the training happens by rural generalists and GPs in rural areas.

“This will go a long way to changing junior doctors’ perceptions of rural practice because all your mentors and your senior colleagues who are teaching you on a daily basis are in the bush and are working rurally.

“That becomes your norm and you see that as a viable, exciting career path.”

‘Days of the town doctor are gone’

Changing expectations in work-life balance meant that new generations of doctors simply don’t want to be on call 24/7 for their entire careers — as was previously the case for rural doctors.

But this lifestyle trend could end up in rural doctor recruitment’s favour.

“There was a time where rural health was viewed as unpopular but I think the times really are changing, because the communities are wonderful and the work life balance is better,” Dr Kinder said.

“You don’t have drive 40 minutes to work. You can drive two minutes and still have a just as fulfilling professional career.”

Dr Kinder said that while some approaches, such as local recruitment drives and house and car packages, could bear short-term fruit, the wider problem would not resolve until it was addressed within the medical profession, at a structural level.

“Whether it’s a town like Hillston today or a different town tomorrow, the only way that we can prevent these towns from recurrently having these issues is actually addressing the big picture problems that are occurring

While you’re here… are you feeling curious?

Topics:

health-administration,

healthcare-facilities,

health-policy,

regional,

regional-development,

orange-2800,

hillston-2675,

canberra-2600,

geraldton-6530,

bendigo-3550



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