‘By the country, for the country’: The progress of rural generalism

Doug Hendrie

18/10/2018 3:35:23 PM

Strong progress has been made on advancing rural generalism nationally, according to the National Rural Health Commissioner.

National Rural Health Commissioner Paul Worley believes the future of rural generalism has to be led by the RACGP and ACRRM.
National Rural Health Commissioner Paul Worley believes the future of rural generalism has to be led by the RACGP and ACRRM.

‘We’re now at the pointy end in terms of government policy and funding,’ National Rural Health Commissioner Professor Paul Worley told GPs at an RACGP Rural meeting at GP18 last week.
‘The next approach is led by the country, in the country, for the country.
‘Can we organise our system … so rural Australia has responsibility for its own workforce?’
Professor Worley said the future for rural generalism ‘has to be led by [the RACGP and ACRRM] and has to be seen as a specialised field within general practice, not creating a new specialty somehow separate’.
Professor Worley said the efforts to give Australia’s rural and remote regions the same quality healthcare as the cities had long been stymied.
‘There’s frustration that although we have research showing what we need to do over the last two decades, we as a society have failed to actually deliver … what’s required to make it happen,’ he said.
The push for rural generalism has come out of the decades-long crisis in rural health workforce, with many rural GPs over-stretched and without a team around them.
Rural generalism is pitched as a training pathway giving GPs the ability to deal with the breadth of healthcare in country areas where there are few other healthcare professionals. At present, around 50% of Australia’s rural GPs are overseas-trained doctors who must work for up to 10 years in a rural area.
In February, Professor Worley worked with the RACGP and ACCRM to agree on the scope of a rural generalist in the Collingrove Agreement as part of the development of a national pathway.  
This agreement describes a rural generalist as a medical practitioner
‘who is trained to meet the specific current and future healthcare needs of Australian rural and remote communities, in a sustainable and cost-effective way, by providing both comprehensive general practice and emergency care, and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team.’
Professor Worley said the future of Australia’s rural GP workforce is a mix of GPs and rural generalists, ideally drawn from rural areas.
‘We have a connection with our country, where we grew up, where we see our home, where we see our kids living,’ he said. ‘Yet medical education tries to work against that.
‘We recruit kids, the majority still from the cities, and then hope they have a road to Damascus experience and think, “I’m going to the country”.
‘Let’s allow our rural regions to select their own, train their own, [conduct] research into their environment. We don’t have to turn the world around – we know undergraduate medical students do fabulously well in the country … and that teachers in rural practice are great.
‘The difference with rural generalism is that we don’t have all those other people we can delegate to [in rural areas]. Rural generalism is not a series of little bits of other specialties, it is something that comes out of general practice.’
Professor Worley also stressed his preference for the phrase ‘additional skills’ rather than ‘advanced skills’ in reference to rural generalism.
To illustrate his point, he gave the example of a rural generalist undertaking a caesarean section and a city GP seeing a regular patient with multimorbidities and marital difficulties leading to mental health issues.
‘What does “advanced” say about the rest of the skills? That they’re lesser. It’s a totally false dichotomy,’ Professor Worley said.
In response to a question about how rural generalism would be structured, Professor Worley stressed that GPs need to lead the curriculum development for rural generalism.
‘We need to be leading the curriculum and collaborating with colleges to whom we need to delegate in the city – and they have a lot to offer. What they don’t have to offer is to tell us what our profession is,’ he said.
Looking forward, Professor Worley is considering how to best make rural generalist training attractive, such as making it possible to start a family while being a trainee.
‘You need to be able to have a baby while you’re a trainee and not be told you have to move,’ he said. ‘You need to have maternity benefits that cross over whether you’re in hospitals or private practice.
‘These things are not impossible – they’ve been done before. Other specialties have adopted these good practices, and junior doctors are choosing with their feet to go to them.’

National Rural Health Commissioner paul worley rural generalism

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