Rural GPs taking care of obstetric and ophthalmological business where specialists are scarce
Because of shortages of surgical specialists in the bush, GPs in rural and remote Australia are performing much of the obstetric and ophthalmological care their patients require, according to a survey reported in the latest issue of The Medical Journal of Australia.
Dr Russell Gruen, Surgical Research Fellow in Surgery and Associate Professor Ross Bailie at the Flinders University and Menzies School of Health Research, NT, and Ms Stephanie Knox and Associate Professor Helena Britt, from the Family Medicine Research Centre, University of Sydney, surveyed data from 3030 GPs through the Bettering the Evaluation and Care of Health (BEACH) program.
Twenty-two per cent of Australia's population, 20 per cent of our GPs, but only seven per cent of our surgeons, are located outside metropolitan and large rural centres.
According to the Australian Institute of Health and Welfare, people from rural and remote areas usually travel to major centres to access specialist services or, on a third of all occasions, travel to a capital city. This is expensive and disruptive to their daily lives.
Against this backdrop, Dr Gruen and colleagues examined the effect that proximity of a surgical specialist has on Australian GPs' referral rates of surgical problems to specialist care.
Dr Gruen said they set out to determine whether GPs in rural or remote areas are as likely as those in urban areas to refer surgical problems.
"Absence of a local specialist did not significantly influence the proportion of surgical problems referred by GPs overall, but the proportion referred was significantly lower for obstetric and ophthalmological problems," Dr Gruen said.
"Other factors independently associated with referral of a lower proportion of problems included the GP being male, the patients being female and younger or holders of a Health Care Card, and the patients' problems being injury-related and non-cancer-related. Follow-up presentations, and patients with more than one problem managed at each visit were also less likely to be referred.
"The analysis shows that the presence or absence of a local specialist does not significantly affect the proportion of general surgical, orthopaedic, ENT, urological or gynaecological problems referred by GPs.
"Antenatal and eye problems, however, are over 40 per cent less likely to be referred by GPs without a local specialist.
"These are important considerations for policy relating to the rural specialist workforce, outreach services, telemedicine, and maintenance of broad skills in rural and remote general practice," Dr Gruen said.
In an editorial in the same issue, Dr Anthony Green, Senior Visiting Surgeon at Atherton Hospital, Queensland, says that logistically, or for geographic reasons, some remote and rural towns will continue to rely on GPs for 'on the ground' initial assessment and management of patients with surgical problems.
"Despite advances and improvements in the availability of aeromedical evacuation services, many rural and remote parts of Australia will continue to need appropriately trained and supported GPs to provide acute surgical care," Dr Green says.
"These GPs will know when it is best to refer to larger centres.
"And these larger centres will continue to need professional onsite specialist services, staffed by local surgeons, with appropriate financial resources to provide their rural or remote general practice colleagues with ongoing support and advice."
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACTS: Dr Russell Gruen (Research) 08 8922 8888 Switchboard (B/H + A/H)
Royal Darwin Hospital
Dr Anthony Green (Editorial) 07 4091 1800 (B/H)
(0419) 911 800 (A/H)
Sarah Crichton (0419) 440 076
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