National Rural Generalist Pathway: An essential workforce initiative
As Ochre’s DMS and President of the Rural Doctors Association of Australia (RDAA), Dr John Hall has been instrumental in developing the long-awaited National Rural Generalist Pathway here in Australia. We talk to him about why he believes this is an essential workforce initiative for rural communities, and why now, more than ever, we need to reinvest in our rural healthcare system.
As President of the Rural Doctors Association, how have you been involved with the development of a rural generalist pathway here in Australia?
I had always taken a strong interest in the concept of rural generalism. I did a form of rural generalist training before a formal program was in place, having completed an advanced diploma in obstetrics in my third-year postgraduate, which then enabled me to be credentialed as a GP obstetrician working in rural sites to provide birthing services.
Developing a pathway was just putting a framework around what was already happening in Queensland, including training doctors towards procedural disciplines like obstetrics, anaesthetics and surgery. Initially, this was in response to a shortage of doctors providing services in rural towns, particularly around the area of obstetrics and maternity care. There had been several rural hospital downgrades and closures of maternity units, and part of the political response to that was to ramp up the training of doctors to support these hospitals to make sure they could continue to supply hospital-based procedural services.
In that context of having lived it, and completing my fellowship with the Royal Australian College of General Practitioners, I was very interested in the development of this program. I was working with the Director of Rural Generalist Pathway in Queensland at the time and was on the initial founding committees to develop this further. Queensland was very much a leader in this field and had an established Rural Generalist Pathway about five years before anyone else. This then led to other states and territories getting on board and trying to develop their own pathways. To be honest, no one has been able to create an end-to-end pathway in the same way Queensland has.
Why do you think a National Rural Generalist Pathway should be implemented?
We've been pushing for a national pathway to enable the rest of the country to put some structure around what they are doing and build some consistency. Doctors in training need to know they could move seamlessly between jurisdictions and enjoy the same recognition and processes from state to state.
Ultimately, it’s an essential workforce initiative for rural Australia. This is about protecting and servicing rural communities to make sure they have the same access to healthcare as our metro cousins. At the end of the day, we need the right doctors with the right skills, in the right place, and to achieve this, we need structured and supported training. But this also needs to be professionally recognised in its own right. It also needs to be adequately remunerated and supported by incentives. These key components have already led to a significant increase of doctors in Queensland working in medium to large-sized rural hospitals providing the very best procedural services.
Why do you think there are still so many health inequalities between rural and metro-based populations?
In my view, the ongoing health inequalities are all to do with politics. Unfortunately, rural Australia does not have the same voice that metro Australia has based on population. Also, the nuance of the political spectrum, where most of our rural states are safe, conservative seats, leads to an environment where these populations are less likely to see action on healthcare compared to a marginal seat in a large metro area.
Sadly, I also think Australia as a community has fallen out of love with the bush. Historically, we all viewed rural Australia as the backbone of our culture and were willing to reach into our pockets and support rural communities when it came to infrastructure, roads, education, health and more.
Today, this generosity has dried up. Our 24-hour news cycle and the politics of hip pockets and individualism have led to a reduced appetite for supporting rural Australia, even though it’s the engine room of our economy and our national food bowl. It’s a real travesty that these areas are being neglected when it comes to infrastructure and support—and particularly health. We truly need to reinvest in the healthcare system west of the Great Divide.
With the recent droughts, bushfire crisis and now COVID-19, do you think metropolitan doctors are more reluctant to explore rural career opportunities?
There’s no question rural Australia has experienced some of the most devastating impacts of climate change and public health crises in recent times. The drought in particular and now the national economic downturn is certainly having a knock-on effect, creating difficulties across rural Australia and we are seeing some attrition and reduction in rural populations. All of these things certainly contribute to reducing the interest in rural generalism, but do not diminish the responsibility of the Australian government and people to share our wealth equitably. It’s a national responsibility to make sure all members of our society have access to essential government funded services such as health and education.
Today, there is a $2.1 billion underspend in rural health simply because there is a lack of access to services. There are not enough doctors in allied health rurally, which means rural Australians are not accessing the Medicare rebates that go with these occasions of service. When you add all of this up, the Australian government is actually saving money because people can’t access services rurally.
We've called on the Federal Government many times to look at this underspend and to look at reinvesting it in rural health services, and particularly into hospitals, to make sure allied health services, nursing and medical care are maintained at a level that rural Australians can access.
What response have you received so far?
This mention of underspend often falls on deaf ears. It's considered as some kind of ghost money. We have raised this with individual politicians in the past and their view is this is not money in the bank they can spend, therefore they believe this argument doesn't hold water. In my view, I think an average, reasonable Australian would think if they are paying their Medicare levy and their taxes, then it is fair and reasonable to expect the government would fund health, education and infrastructure services for people wherever they live. I appreciate that providing these services in rural Australia is less efficient and does often cost more, but I still think we have a responsibility to provide these services, and also recognise the huge contribution rural Australia makes to our economy and to our way of life.
What impact does this underfunding have on the doctors who work in rural Australia?
From a healthcare point of view, underfunding leads to fewer rural doctors and healthcare workers, which leads to an increase in demand for the doctors based in rural centres. Many of our rural GPs are booked out two or three weeks in advance. With an injection of funds and support for the National Rural Generalist Pathway, we should see an increase in the number of doctors and other healthcare workers moving into rural Australia, which will certainly take the pressure off our existing workforce.
At the moment, an undersupply of medical workforce in the bush from nurses through to allied health practitioners and GPs means everyone is overstretched. And this is one of the key disincentives for GPs considering a rural move. It’s a Catch-22 situation: we need the medical workforce to make rural Australia appealing, but how do you attract those people out there in the first place? We therefore need significant investment and incentives, and need to support people with the training they need so they can provide the skills and work that is required in those areas.
Following our recent devastating bushfire season, do you think rural-based GPs need better access to disaster training?
Currently, the way GPs are deployed as a resource during natural disasters is very ad hoc across Australia and there is definitely a need for a more co-ordinated and integrated approach. We need to work with retrieval services and emergency disaster response teams to embed GPs into their processes.
Many of our doctors at Ochre who work in rural areas are highly skilled in trauma care, pre-hospital medicine, anaesthetics and airway control—all essential skills required on the ground in serious trauma and disasters. GPs are also often leaders in their communities when it comes to healthcare and emergency response so it makes absolute sense that they be integrated into disaster preparedness protocols and systems.
Again, we have called on the Federal Government to bring in a national register of doctors who want to opt into this process so that in the future we could respond more quickly and effectively to a serious event.
Thanks again for your insights John.
Stay tuned for our upcoming spotlight on Rural Generalism in the 'Land of the Long White Cloud'. You can read more about the Rural Generalist Pathway on our Rural Generalism page.
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