‘Life is too short’: The rewards of being a rural generalist

Despite holding two disciplines as a rural generalist, it was by chance that Dr Mahmoud Al-Najjar had his first taste of rural medicine some 20 years ago.
 
As a medical student at the University of New South Wales Rural School he did rural and remote rotations in Lismore and Port Macquarie, before completing his degree in 2005 and undertaking a hospital internship on the Gold Coast in 2006.
 
Not long after he joined a program for junior doctors to support GPs in remote areas, the Queensland Doctors Country Relieving Program, and it was during this time he gained exposure to rural medicine.
 
Dr Al-Najjar enjoyed the experience and was offered a job to stay and joined the RACGP. But not long after he decided he wanted to do surgery so returned to the city, spending time on the Gold Coast, in Brisbane, Ipswich and Mackay.
 
After getting into a general surgical program and moving to Western Australia to do vascular surgery, his mind drew him back to general practice.
 
‘I realised that I needed to have other avenues, so I reactivated my GP Fellowship,’ Dr Al-Najjar told newsGP.
 
‘So I actually gained my FRACGP before I became a vascular surgeon.’
 
Fast forward some years, and Dr Al-Najjar was awarded a Rural Generalist (RG) Fellowship – Surgery and Emergency Medicine at the RACGP WA ceremony in November last year.
 
Now holding dual Fellowship with the RACGP and the Royal Australasian College of Surgeons, meaning he holds two disciplines as a rural generalist, he counts himself lucky to experience what both offer.
 
‘I like the variety of things I can do now – vascular surgery, emergency medicine, I have a lot of options,’ he said.
 
‘I’m not attached to a single hospital being a hospital doctor, I have more flexibility … and I love the travel.

‘Although I’m still attached to the city as a vascular surgeon most of my patients are based in regional WA, and I travel to Geraldton, Albany and Bunbury where I spend time in other hospitals doing emergency work as well as some minor procedures which GP surgeons would do.’
 
Likening vascular as the closest type of surgery to general medicine and general practice, Dr Al-Najjar says holding these specialties is ‘very helpful’.
 
‘For example, diabetes and chronic disease is widely available for a GP to see in a practice and you need to know a lot about diabetes being a vascular surgeon,’ he said.
 
‘Exposure to chronic disease was early on in my career when I started doing vascular surgery, but strengthened when I got my GP Fellowship.’
 
Being a Senior Clinical Lecturer at the University of WA’s Rural Clinical School also supports Dr Al-Najjar’s love of the diversity that rural medicine has to offer, having signed up to teach in Geraldton, Bunbury and Albany.
 
‘We’ve got students coming to the clinics and theatres when I’m in these places, and I get to meet very good people who I enjoy working with as well,’ he said.
 
‘The other day, I got a patient coming to see me as a vascular surgeon whose daughter was my student last year, so that keeps the connection interesting.
 
‘I find in these areas there are less politics than in the city, I don’t have to worry about running a practice and … I’ve got more flexibility, less stress.’
 
However, Dr Al-Najjar does acknowledge the challenges that come with rural and remote communities, namely the workforce shortages currently plaguing Australia, which he says has been a topic of conversation since he began working as a doctor close to 20 years ago.
 
‘The problem can be fixed locally, we don’t have to bring people from overseas, we just need to invest more in GP training,’ he said.
 
‘A big issue is general practice registrars’ salary, because with inflation they can’t really support a family, so if the Government or the training program wants to invest or have a solution for the shortage of GPs that’s how they should start locally, before jumping into getting people from overseas.
 
‘We just need to continue promoting how good general practice is, especially rural general practice.
 
‘A lot of junior doctors in the city want to just go through the metro rather than rural pathway, and they actually don’t understand how rewarding it is to work in rural places.’
 
After growing up in the United Arab Emirates as a child, then in Canada for secondary school and university before moving to Australia to study and work across rural, remote and metro areas, Dr Al-Najjar is happy to have landed in rural WA.
 
When he spoke to newsGP, he was standing in front of the beach in Busselton before a shift in the local hospital.
 
‘I can do something else if I want but I decided to do this, and it’s good fun,’ he said.
 
‘Everyone has a different pathway in life, but for me this is it. In the city you might go to an ED and everyone is stressed out.
 
‘Life is too short for that.’
 
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emergency medicine GP workforce rural general practice rural generalism vascular surgery