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How do you keep them down on the farm?

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Specialist training in the first two postgraduate years must be made available in both large and small rural hospitals

Some years ago, when I was seeking views on priorities in rural health, I went to a rural town, where the desert met the sea, the local river flowed under the sand and the streets were wide enough to turn a bullock train, to interview the mayor. What did she want for her municipality with a population of 7000? A radiotherapy service and a cardiac catheter laboratory — her husband had both cancer and cardiac disease.

While her wish was extreme, it illustrates the high expectations within our communities — large and small — for medical care. Indeed, these expectations are reinforced by the popular mantra that ours is the best health system in the world, and a pervasive myth that health care is free. Australia’s population, spread over an area the size of the United States minus Alaska, is concentrated along the eastern seaboard. It is in the area where this population is concentrated, particularly Melbourne and Sydney, where subspecialty medicine is sustained. Can anybody find a similar demographic collage elsewhere in the world from which our policymakers can draw inspiration?

The Australian Medical Workforce Advisory Committee (AMWAC) has set benchmarks for numbers of specialists per 100 000 population.1 Such ratios do little to inform…