Rural General Practice in Australia
Yeppoon in global context!
In Australia, disparities in the accessibility to and availability of medical services in rural areas have drawn comparison with inequalities in the global health arena. Factors which have been associated with this health divide include the country’s geography, the aggregation of the population in metropolitan areas and the tendency of most doctors to prefer practicing in cities. It is a problem which has been recognised by the national government and numerous solutions have been proposed in an attempt to redress this imbalance and encourage medical students and doctors to consider practicing in rural locations.
One such program is the John Flynn Scholarship Scheme (JFSS) which formed part of my elective this year. The JFSS provides medical students with the opportunity to spend two weeks each year for the duration of their studies in a rural location. This structure enables student to build links with a local community and be able to assess first hand what it is like to practice medicine in a rural area.
Each student is paired with a mentor and together develop a learning program for the duration of the scheme. The mentor is usually a general practitioner (GP). For those who are unfamiliar with the Australia health system, doctors are loosely grouped into two categories; there are those who work in hospitals, many of whom are pursuing specialist training in a particular area i.e. cardiology, neurology etc and then there are general practitioners, who work from community based clinics and are often the first line medical professionals whose the bulk of health problems and are responsible for the long term patient management. It is GPs which rural areas lack.
Yeppoon
This year, I spent the first of my four placements in Yeppoon, a small coastal town in Central Queensland. The clinic where I was based is staffed by 9 doctors as well as nurses and administrative officers. While officially considered a ‘rural area’, Yeppoon is not as isolated as other places in Australia. During my time there, I learnt about the dynamics of practicing medicine in a rural area, the differences in the demographics of the patients and the advantages/disadvantages of living in a rural community.
The main disadvantages which I have discerned were the initial social isolation and the lack of professional development opportunities. Like moving house or resettling in another country, you experience that sense of unfamiliarity when you first relocate. Away from family and friends, you often lack the comfort of an established support network. Rural practice is always difficult for partners/spouses and children who often do not have the support that you do.
Similarly, most doctors understand that their career is one of continuing medical education and the need to regularly update their clinical expertise. Being away from metropolitan areas means that you also do not have access to educational institutions and clinical facilities to renew your skills and build on your knowledge. However, there are also many benefits to working in a rural clinic. Since the population is much smaller, community engagement is significant.
Many of the doctors I worked with in Yeppoon had good rapport with and were on friendly terms with their patients, the patients’ families spanning generations and the patients’ extended friendship networks. There is a significant amount of trust and respect placed in the doctor, not only as health professionals but also as community leaders. The lack of supplementary health services and specialist support often means that doctors become more rounded and are able to apply a multidisciplinary approach. Again, most of the doctors I worked with completed minor surgical procedures which are not a common occurrence in metropolitan clinics.
Completing an elective in a rural general practice is an option that all Australian and international medical students should consider. Many of the issues which have been discussed with regards to rural health can also be applied to working in the global medical field, in countries which lack fundamental health infrastructure and adequate medical personnel. It will be interesting to see how these views change over the course of my medical degree and clinical placements in Yeppoon. More importantly, I hope that in that time we would have made progress towards remedying the disparities in Australian rural health services and in global health outcomes.
Alan Huynh
First year medical student
University of Queensland
Australia
alhuynh@hotmail.com