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15 Nov 2018


You’d be forgiven for thinking that our current issues with recruitment and retention for bush medics were a recent development. The formation of the Rural Generalist Taskforce has brought with it a renewed focus on the challenges of rural and remote medical workforce staffing. If you’ve been following Professor Paul Worley on twitter (@PaulWorleySA), you’d be well aware of how busy he’s been talking to stakeholders and interested parties across the country, gaining consensus on need if not direction.

But this isn’t a new issue. In the late 1990s, workforce figures released by the federal Department of Health identified a growing disparity in the number of GPs per head of population in rural and remote Australia compared to metropolitan centres. The response at the time was about as nuanced as a sledgehammer – a rapid up-titration of medical school positions without much thought for downstream training or how people would actually move from a city start point to a country end point. Surely they would just migrate out to where they were needed, right?

Since then we’ve seen a number of further initiatives trying to tackle the same problem, all with varying and at best limited success. On the more successful side, the Rural Clinical School has given early career exposure to people interested in rural medicine, with an associated increase in the number of people working rurally down the track. This approach has been shown to increase the likelihood of working rurally for both students from regional and urban backgrounds.

We’ve also upped the number of students with a rural background we select for medical school to around 25 per cent, which instinctively you’d think would increase the number of rural doctors, however clearly 25 per cent of graduates are not returning to the bush.

Other programs aimed at getting doctors out of the city and into the regions have been far from a success. The Bonded Medical Placement and Medical Rural Bonded Scholarship schemes have not driven a generation of docs to practice in the bush.  Conversely, the schemes have created resentment at the way naïve teenagers were tied to draconian contracts without full knowledge of what they were signing. The AMA is currently in the process of working with the Department of Health to unpick the mess and find a model that works for both the participants and the communities they were intended to serve.

So has anything changed since the ill-fated policies of the early 2000s?  The answer is subtly, yes. There’s growing recognition that a medical student does not equal a qualified doctor, and that the (often forgotten) bit in-between, those years as a doctor in training, are key to where you end up working.

It’s something that the Council of Doctors in Training has been rabbiting on about for years. You can’t expect someone to spend their formative years in a metropolitan centre and then just pick up stumps and move to the bush once they’ve got a fellowship because there are lots of doctors in the city.

Just like trickle-down economics that approach hasn’t worked. 

Training years are also spent doing things other than training, like finding partners, having children, growing support networks and creating financial stability. If we want people to end up working in regional areas, we need to support more people to train in regional areas.

And that’s the difference in the current approach. Professor Worley and the Rural Generalist Taskforce are joining the dots between students and independent, competent rural generalists, offering suggestions on how that path might be travelled. This is by no means a straight-forward task, but at least we are now acknowledging the need to look beyond graduating more students and the trickle-down approach to solve workforce distribution issues.

Chris Wilson


Published: 15 Nov 2018