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Give rural junior doctors the training opportunities they need, where they need them: AMA

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Governments nationwide have been urged to work together to create a rich network of rural training opportunities for junior doctors to help boost the medical workforce in country areas.

Concerns are mounting that the health of Australians living in rural and regional areas will slip further behind that of city dwellers as the rural medical workforce ages and access to health services becomes increasingly difficult.

The extent of the problem has been underlined by figures showing that, in 2012, there were 394 doctors for every 100,000 people living in the major cities, compared with just 222 per 100,000 in remote and very remote areas.

In its Position Statement on Regional Training Networks, released early this month, the AMA has proposed that governments collaborate to develop regional training networks (RTNs) which will provide quality opportunities for junior doctors to advance their training in country areas, increasing the likelihood that they will stay on and practice in rural communities.

Most efforts to boost practitioner numbers outside the cities focus on the creation of medical schools in regional centres or enticing doctors already established in practice to uproot their lives and move to the country.

But AMA President Associate Professor Brian Owler said evidence showed that one of the most effective ways to bolster the rural medical workforce was to help trainee doctors already living and working in country areas to complete their training there.

“Many medical students have positive training experiences in rural areas, but prevocational and specialist medical training often requires a return to metropolitan centres,” A/Professor Owler said. “At this point in their lives, trainees develop personal and professional networks that are important to their future life and career path, and many are less likely to return to practise in rural areas.

“RTNs would enable junior doctors to spend a significant amount of their training in rural and regional areas, only returning to the city to gain specific skills.”

A/Professor Owler said the idea made sense because of the increasing pressure on vocational training places caused by recent rapid growth in the number of medical school graduates.

He said investment had already been made in training medical students in regional centres, so it was only logical to give these graduates local prevocational and specialist training opportunities as well.

“We currently recruit almost a quarter of medical students with rural backgrounds, and almost a quarter of Australian medical students go through rural clinical schools,” A/Professor Owler said. “We have the graduates – now we need effective training pathways to convert into them into a well-distributed workforce for the future.”

In its Position Statement, the AMA said that building and maintaining a critical mass of doctors within a region was important, not only to improve the viability of practices but also to enhance professional development and increase training opportunities.

It said that to work effectively, RTNs must have flexible entry and exit points, and the support provided to junior doctors rotating from metropolitan to country areas – such as housing support and transport and relocation payments – should also be extended to those rotating from rural to metro areas.

A/Professor Owler said the creation of RTNs should be part of a comprehensive set of policies to address regional and rural medical workforce shortages.

“The development of RTNs would help to promote careers in regional and rural centres and improve patient access to medical care,” he said. “If doctors have a good training experience in a rural area, they are more likely to stay.”

The AMA held up the South West Victorian Regional Hub established by the Royal Australasian College of Surgeons as an example of an RTN.

Through the Hub, junior doctors get general surgery placements in regional hospitals in Geelong, Ballarat, Warrnambool and Hamilton, and partnerships have been established with Melbourne’s St Vincent’s and Alfred hospitals to provide further specialised rotations.

The AMA Position Statement can be viewed at position-statement/regional-training-networks-2014

Adrian Rollins