Rural practice and general practice are not silver medals
BY MADELEINE GOSS, PUBLIC RELATIONS OFFICER, AUSTRALIAN MEDICAL STUDENTS’ ASSOCIATION
Recently, I was at the AMA National Convention, where there is an opportunity for attendees to express opinions, ideas or concerns related to the medical profession. The session was aptly named Soapbox.
One doctor stood up and said that senior doctors should be telling medical students to be realistic in their career aspirations. We ought to be directed to areas of workforce shortage and not lured by fancy equipment and procedures offered by specialties. This was in the context of rural workforce shortages and is particularly pertinent considering the decreasing numbers of GP registrars.
We know that medical workforce distribution is a multifactorial issue, with inter-professional support, career development opportunities and financial recompense being significant bones of contention. For instance, the AMA passed a motion which encouraged a more flexible and portable training and employment model for GP registrars, as the remuneration is less compared to non-GP registrars and standard workplace entitlements are not protected. The medical culture must also be addressed as part of the puzzle to meet future workforce demand. There is an unspoken stigma surrounding rural practice and general practice which compels capable and passionate doctors and medical students to justify their career choices.
I completed a longitudinal program in regional Western Victoria, with fantastic GPs who also staffed the local hospital and nursing homes. Nineteen other students in my cohort were placed in similar sites across the state. We came together every six weeks for formalised teaching and exposure to specialties we may not see in our towns. The most common opening line of a specialist who would come to teach was “oh, you’re just going to be GPs; I’ll change what I was going to do.”
This was frustrating to us, because, as medical students, we should be receiving standardised teaching. However, it was much more insulting to GPs. It is true that the minutiae of some topics are not relevant to general practice, but this detail is not taught at the medical student level, so why were our teachers changing their lessons? These types of interactions insinuated to my peers and me that doctors choose general practice because they “couldn’t make it” elsewhere and because we were going to follow that path, we needed to know less. That is not to say there aren’t specialists who appreciate the unique skill set of general practitioners, but it only takes one bad apple to spoil the barrel; one throw-away comment or action that one medical student will not forget. As we know, those in the medical profession are often perfectionists and enjoy challenging themselves, so once this idea of “settling” for general practice has been planted, it is difficult to uproot.
Rural medicine has a similar undercurrent. While completing my job applications, I heard many students say site X was their “rural backup”. This may not be as much of an issue outside of Victoria due to the ballot system used to allocate interns, but the current Victorian z-score system reinforces the idea that the “best” interns are in the metropolitan hospitals and the rural hospitals get whatever is left over.
I am pleased to say that this attitude seems to be changing, in that, at least among my cohort, many students aspire to practise rurally. However, we are often required to justify this choice. The doctors who came to teach my rural cohort would often express their condolences that we had to practice rurally. A friend of mine is based at a regional Victorian hospital and got an excellent intern-z score; she was one of the top five students in our cohort. She wants to stay where she is because she loves the hospital and has settled in the area with her partner. She tells me she often gets looks of sympathy when people hear she is placing this rural hospital as her first preference in job applications because there is an assumption only people who performed poorly would preference rural hospitals. She must justify that she did not do poorly; she has a genuine interest in rural practice. Meanwhile, our classmates who want to work in city hospitals are accepted as the status quo.
This brings me to my point. Perhaps we would not have such a degree of rural workforce shortage and loss of interest in general practice if these career choices were not looked upon as consolation prizes. Like AMSA President, Jessica Yang said in her AMA National Conference address; we need to lift each other up. We need to encourage all doctors in their endeavours and back this with our actions. We must foster equality within medicine, providing fair pay, access to support, education and respect so that we can put it into practice for the betterment of Australian healthcare.
Published: 13 Jun 2019