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14 Nov 2017


Readers of this column will know that improving access to health care for rural Australians is one of my chief motivating passions.

We know there are many indicators that show people living in the bush generally suffer worse health outcomes than those in major cities.

Regrettably, many of the initiatives put in place to increase training places in rural Australia and expand the local medical workforce have not improved these discrepancies, kept pace with the demand for rural medical services, nor resulted in a better distribution of suitably qualified doctors.

The challenge remains – we need to get doctors to rural communities, and give them the opportunity to experience rural and remote medicine and make it an attractive and valuable career option.

Some may feel achieving real change is a truly Sisyphean task.

But with the recent appointment of Professor Paul Worley as the nation’s new Rural Health Commissioner, there is perhaps some cause for optimism. Professor Worley has made a substantial contribution to rural health over many years; all of his experience will be needed for this welcome opportunity to build a strong health care workforce in regional, rural and remote Australia.

One of Professor Worley’s important tasks is to help the Government design and roll out a national rural generalist pathway. The pathway will try to address the lack of access to training for rural generalists with the ultimate aim of improving the supply of doctors to rural and regional communities.

Many people have been waiting for the announcement on the Rural Health Commissioner for a long time; we are not alone in believing that Australia’s medical workforce needs more generalists to meet the healthcare needs of rural (and metropolitan) communities as the demographics of the population shift and the numbers of patients with long-term chronic conditions and co-morbidities rises.

The AMA has been championing for a long time an improved and expanded advanced training pathway for rural generalists, with the proper resources to attract and train the appropriate number of doctors with the right skills mix necessary for rural practice.

The Queensland Rural Generalist Pathway is often put forward as the model for vocational training that could increase the numbers of doctors training and staying in rural locations, and able to deliver a broad range of hospital and community-based medical services, as well as the much-needed specialised services.

The Queensland model is a good starting point, and there is the potential to apply its principles to a national pathway that can be adapted to suit the geography and demographics of different regions.

Nonetheless, there are some contentious and vexing issues that will need to be addressed as the national rural generalist pathway is conceived and put into effect. For example, should there be quarantined procedural training places for rural generalist trainees? Should some thought be given to extending the training pathway beyond general practice as a strategy for ensuring a balanced rural workforce with the right skills mix?

Concerns around accreditation, training and recognition will need serious collaboration between the Colleges and health services.

Several AMA committees are considering the design principles for the national rural generalist pathway.

We look forward with great purpose to meeting with Professor Worley soon to discuss our ideas. Overall, the signs are positive for rural health.

Published: 14 Nov 2017