President’s Word: Rural and regional opportunities

I recently had the pleasure of visiting the Central West of NSW, and spent some time talking to both junior and senior colleagues at Orange and Dubbo Hospitals about the issues affecting them. As I have always found, doctors in rural sites are deeply committed to providing great care to the people in their regions, but also connected to the community in a way that we city-based practitioners rarely are.

After sustained investment by the State and Federal Government, it would appear that the option of living and working in rural settings is becoming a more popular option for doctors. Increasing numbers of graduates have spent a substantial period of their undergraduate medical time at rural clinical schools in places like Orange, Dubbo, Wagga Wagga, Bathurst, Lismore, Port Macquarie and Coffs Harbour. For many years junior medical officers have rotated out to rural and regional hospitals. Advanced trainees are now increasingly able to spend large chunks of time in rural settings during their specialty training. It would appear that these doctors are establishing roots in rural cities and towns and building their lives there.

The junior doctors I met talked about the broad range of hands-on experience they achieve right from internship, and higher levels of responsibility than their city-based colleagues. They feel well supported by each other and the consultants. The physicians I spoke to talked about the breadth of their practice, and the satisfaction of being able to provide both high quality care to patients, and high quality education and training to students, and trainees alike. They were at pains to point out that, while supportive of the rural generalist training program, rural settings badly need good coverage of specialists. AMA (NSW) has lobbied the NSW Government for a number of years now to establish and maintain funding for rural registrar positions, and the Government has delivered. This funding was again delivered in this year’s State Budget.

Unfortunately, there remains some bias against the quality of specialist training in rural settings. This is reflected in a very cautious approach by some of training colleges who, in my opinion, could do more to promote specialist training outside of the big cities. I am pleased to report though that the RACP now holds its clinical exam in Orange, Wagga Wagga, Port Macquarie, Tamworth, and Dubbo. Albury will be coming on board next year, and hopefully Lismore and Coffs Harbour in the future.

I was also privileged to visit the Aboriginal Medical Services in Orange and Wellington, and we were able to discuss a broad range of issues relating to the community and the work of the AMS.

In many ways, Aboriginal community-controlled medical services provide a model of care that is a template for quality comprehensive medical care more generally. Dedicated Aboriginal health workers, with deep connections in the community, work alongside nursing, allied health, administrative staff, and very special medical practitioners. I witnessed some very innovative programs and a very holistic approach to care, delivered by people with great passion. An increasing role for visiting specialists is integral to the development of these services. Finding doctors with the right skills remains a challenge, especially in areas such as paediatrics and mental health. Remunerating these dedicated doctors adequately remains a challenge.

I also had a very interesting discussion with the staff at Wellington AMS about “Closing the Gap”. I have felt for a while that the term “Closing the Gap” has lost some of its impact, but had to pause for thought when the staff expressed how anxious and embarrassed they feel every year when the CTG report is released, seemingly always showing very negative statistics. For Aboriginal and Torres Strait Islander people, this is an annual reminder of their struggle, and for non-Indigenous people, an annual reminder of our failure to do better. The data is important. But the way it is presented may not be doing anyone much benefit. It also makes me wonder why our only aspiration for our First People is to “Close the Gap”? Surely as a society our aim should be for our own Indigenous people to be leading the rest of us?

I also wish to reiterate my support for AMA’s position statement on marriage equality. I am disappointed that the Federal Government has decided to hold a postal plebiscite on this issue, and my fears that this will be an opportunity for people to express homophobic and damaging opinions are already being realised. I believe that, as doctors, we have a duty to not only provide the best individual care to our patients, but also to advocate for the health of the community generally. That advocacy includes fighting against discrimination, and ensuring the human rights of all. I stand with my LGBTIQ patients and colleagues, and I will vote ‘yes’, albeit with reservations about the process.