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Flood of new doctors a rare chance to improve rural health

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By Dr Nigel Stewart, Regional Paediatrician, Northern Regional Paediatrics Unit, Port Augusta Hospital

For my sins, I am President of the Australian Paediatric Society, representing around 300 rural and regional paediatricians, and am a member of the AMA’s Rural Medical Committee.

Currently, there is a huge increase in the number of young doctors graduating. This is a once in a generation, if not once in a century, opportunity to rectify the maldistribution of doctors in Australia.

In the past 15 years, large numbers of overseas-trained doctors, both GPs and specialists, have been recruited to work in rural areas where few Australian doctors are prepared to go.

While acknowledging the great contribution those doctors have made, as well as their right to improve their lives and that of their families and to move around the world, this does have the effect of denuding countries that are already incredibly short of doctors.

The right measures at this time would minimize this, and see Australian doctors moving into a rural and regional practice in Australia. What are particularly needed GPs, rural generalists and those from the specialties of paediatrics, obstetrics, gynaecology, general surgery and medicine.  

In my state of South Australia, we talk about a tsunami of medical students and young doctors. Just like any tsunami, we expect it to wash inland for a mile or so and then to wash back out, with no long term benefit unless investments are made in rural health.

There are figures suggesting more doctors are working in outer metropolitan and inner regional areas. But they actually work fewer hours than the doctors who used to work in these areas, so community access has not really changed.

People often expect market forces and the “trickle down” effect to achieve a redistribution of doctors, but experience says this a vain hope.

If we want our least healthy and most vulnerable citizens to have access to access to these new graduating doctors, government intervention will be required.

Doctoring in rural communities is different. There is an aspect of professional isolation. These are often in towns that are seen as less desirable than living in a sophisticated urban environment for doctors and their families. There is a need to put in place social support services for doctors, their partners and their families. There can be issues around education, as well as financial concerns.

Importantly, people embarking on rural practice need to have the skills and support that gives them confidence to handle what will come their way.

All of these factors need to be taken into account and addressed to attract and retain modern day rural doctors. 

Given the upsurge in junior doctors, we need to put in place incentives and programs to enable some of these to come to rural areas and meet the current shortages. As I said earlier, this is a once in a lifetime opportunity.

If we don’t so this, some of these doctors will find themselves competing in cities over ever-smaller pools of patients and funds, while others will drop of practice early, or not even start.

To boost the number of rural doctors is one of the top priorities in health, and the solution is clear.

People say it can’t be done. Rubbish.

Remember, people once said this nation could not successfully build rural clinical schools, but it has happened and they are flourishing.

To get young doctors into rural practice will need a mixture of incentives that are ring-fenced and not simply reallocated at the next election to outer urban areas.

We will need to provide the social support and capital necessary to maintain doctors within a rural setting, as well as excellent professional support, training and mentoring.

We also need to be realistic and accept that most doctors will work in a rural practice for five to 10 years before moving to a city.

We need to make rural practice less heroic and more ordinary and, therefore, more accessible to a wider pool of doctors.

To achieve this solution will require great advocacy from the AMA, the input of training colleges, and co-operation between the State and Federal governments.

Unfortunately, there is as yet no great sense of urgency or clarity about this problem.

But we need to act now if we are to seize this rare opportunity.