Health outcomes in the bush, while significantly better than decades past, remain the worst in Australia. Rural health care delivery is impeded by geography, attitudes, government funding, health workforce issues and other social determinants of health. I’ve been ruminating on rural GPs – how do we create a future sustainable rural workforce in Australia?
These common thoughts stop young GPs going bush:
It sounds intimidating out there, I don’t have enough skills to cope.
There will be crazy breech deliveries and airway emergencies everywhere!
I don’t know if I want to commit to a life in the bush.
I’m scared of ‘something bad happening’ and finding myself out of my depth.
I can’t face another few years in the hospital upskilling, I need out of the hospital – NOW.
We all know a capable, immensely experienced rural GP who’s seen and done everything, who’s as handy with a pair of obstetric forceps as they are with a tonsil snare, or a gas machine. Who’s worked around the clock, in the clinic and on call, for most of their working life – and has made an enormous contribution to the wellbeing of the local community. I was lucky enough to work with one such GP, Dr John Menzies from Camperdown, who was recognised by ACRRM for his outstanding service as a rural generalist.
Such skilled generalists are less common than they used to be, and they often have difficulty retaining younger doctors to fill their (formidable) shoes. In the traditional job description of the Rural Generalist, it lists long hours, relative professional isolation, and an intimidating list of competencies. I suspect it’s a generational thing: it’s hard to attract young doctors to such a career, particularly given Gen Y’s proclivities for a work-life balance, expectations of a satisfying intellectual career and multiple job changes during their professional life.
How then, do we attract young docs to the country? The Rural Generalist Pathway has a role. At the very least, it offers a certain ‘frontier allure’ with a no-ties-here-sleeves-rolled-up kind of attitude towards medicine, attracting bright young things back to the bush again. It also recognises that a different skill set is required by the true rural generalist. However, I suspect it also intimidates the hell out of many young GPs, who now think they can’t go bush because they haven’t stocked their saddle-pack with every Cert. and Dip. known to humankind.
How then do we encourage more young GPs to give the bush a go? There is a simple truth worth considering – you can’t be an expert in everything, all the time. No matter how many scout badges you’ve earned prior to leaving the hospital system, if you don’t deliver any babies for the next 10 years your Dip.Obs is next to useless. If you only tube 1 one patient in a crisis every year, you’re hardly an airway expert anymore, despite your Dip.Anaes. If you don’t have the opportunity to continually practice in these specialty areas, your skills will wane. It’s not a realistic solution to train up large numbers of GP registrars before they leave the hospital, disperse them across the countryside and expect the skills to last them a lifetime. Continuing education and professional development is key, and its vital to be able to access it at all stages of your career.
What if we focused on trained every cohort of GP Registrars to be ‘GP Chameleons’? A GP Chameleon who is taught to be adaptable, practical and confident with uncertainty. A continual learner, who is capable of utilising the resources available to them to up-skill as the need arises, depending on the community they’re in. This would suit Gen Y down to the ground, of course.
Gen Y loves an unplanned adventure, an Odyssey – they’re always off backpacking around the world, hiking in far-flung mountains and roughing it in desert villages. How do we tap into this desire for an experiential existence, coupled with itchy feet, and use it to tempt young doctors to the bush? We have the ability to metamorphose in General Practice, more so than our specialist colleagues. Rather than labeling it a ‘failure’ of this generation to commit to one long career for the next 40 years, we should be embracing change and encouraging more adaptability and flexibility in rural General Practice.
Besides, across all fields of medicine, there is a rapidly expanding knowledge and evidence base. It’s impossible to ‘know’ everything, because ‘everything’ changes rapidly these days. With the advent of FOAMed, rural GPs may even find themselves outpacing of some of their specialist colleagues in evidence-based practice. The modern rural GP must have the personal and professional resources to adapt and upskill as required for the community they are working in.
It would be great to open up the bush to more GPs – through confidence-building, and professional development. Ideally the options would be wider for upskilling in specialty areas at any point in your career, including on a part-time basis. It would be wonderful if the State and Federal powers could improve the accessibility of the hospital learning environment for GPs.
Attracting capable GPs to the bush is critical. However, applying historical expectations onto young doctors is likely to be a fruitless exercise in solving the rural workforce shortage. I don’t claim to have the answer, but I suspect we need to re-brand rural medicine. If we can train all our Registrars to be adaptable, practical and confident GP Chameleons, we can then sell rural medicine as an exciting – not scary – adventure.
Thoughts, y’all? *chews on a piece of straw*