Unique challenges and unique rewards: General practice in the NT

Amanda Lyons

14/05/2019 11:36:05 AM

Two GPs from the Northern Territory discuss the reasons behind shortages in their jurisdiction – and what they think might help to fix it.

Chris Clohesy and Bronwyn Carson
L–R: Dr Chris Clohesy would like the NT receive registrars before more populous areas; Dr Bronwyn Carson is concerned people in the NT aren’t able to access healthcare due to GP shortages.

Conditions in the Northern Territory often present distinctive challenges for healthcare provision, including general practice. 
‘Many communities in the NT are Aboriginal communities and they’ve got a significant workload of medical problems,’ Dr Chris Clohesy, Deputy Chair of RACGP SA&NT and a GP who works in remote NT, told newsGP.
‘So it’s not just mainstream rural and remote practice, it’s like an intensive care unit.’
Significant health needs combined with little or no medical infrastructure and resourcing in remote areas can put GPs in some tough situations, such as the one Dr Clohesy experienced over Christmas last year.
‘We had an influenza outbreak with hundreds and hundreds of people coming to the clinic with respiratory infection,’ he said.
‘We evacuated 20 because I don’t have the ability to admit anyone here – so my only choices are evacuation to Darwin, 600 km away, or send them home.’
As with many other rural and remote parts of Australia, the NT is experiencing a GP shortage, especially in areas where they are needed the most.
‘Often the people with the highest health needs become the first affected, because the health workforce contracts into the urban areas from the most rural and most remote areas,’ Dr Bronwyn Carson, NT Representative on the RACGP SA&NT Council and Director of Training for Northern Territory General Practice Education, told newsGP.
‘It’s ironic, in a way, that in a developed country we would be struggling to provide practitioners to people with such a high level of need.’
Dr Clohesy understands the notion that the challenging nature of conditions in the NT can make it seem an intimidating choice.
‘A lot of these remote communities in the Territory, they’re very different from the rest of Australia, and it challenges people to work in these environments with limited resources, not much gear – it’s really tough,’ he said.
‘A lot of registrars stay in the big smoke; not many come out remote, for a variety of reasons. So, yeah, it’s a serious challenge.’
Dr Clohesy is also keen to point out that working in remote areas of the NT offers many unique rewards, both professional and personal.
‘This is pretty awesome work, and you feel as though you are making a difference and having an impact,’ he said. ‘The people here are just awesome, and they put up with so much hardship and appreciate anything you can offer.
‘But I think I take away more than what I actually give them.’

‘Many communities in the NT are Aboriginal communities ... you feel as though you are making a difference and having an impact. The people here are just awesome.’ GP Dr Chris Clohesy on some of the unique advantages of working in the Northern Territory.

Dr Clohesy experienced remote work early in his career and credits that experience with influencing his later decision to return to the bush. He would like to see a greater number of medical students receive the same opportunity.
‘I work out remote because I was exposed to it as a medical student, had it imprinted onto me when I was young,’ he said. ‘I think those early experiences are really important in terms of getting people back at some point in their career.
‘You don’t have to make a whole career out of living out remote – do six months, awesome. Everyone has their different ability to come on back and work and do it, for a whole lot of circumstances.’
Dr Carson has found that doctors who train in the NT get a lot out of the experience.
‘We … find that they develop skills in emergency management, they become much more self-reliant,’ she said.
‘They also have an advanced level of decision-making, simply because there’s often only two doctors in the community, themselves and their supervisor. They develop high-level skills in chronic disease management and managing competing demands of patients.
‘So it’s a unique footprint. We can’t ignore the fact that it’s a challenging environment, often because of the isolation and the weather. But those that train here often find the experience very fulfilling.’
Dr Carson agrees that early exposure to work in the NT is crucial to recruitment and retention efforts, and believes the elimination of the Prevocational General Practice Placements Program (PGPPP) has impacted the NT’s numbers.
‘The PGPPP program enabled hospital doctors to have a try-before-you-buy approach … I myself was a PGPPP [member], and my colleagues here in leadership were PGPPP registrars who went out and tried general practice,’ she said.
‘There’s good evidence in the literature that if opportunities are given for medical students to have rural and remote placements, that often leads to different career choices later.’
GPs who want to try rural and remote medicine later in their careers represent another cohort that may be drawn to the NT, but Dr Clohesy acknowledges they can face their own particular barriers, such as a lack of preparatory training – something with which he is familiar, following his own experience.
‘I had to be very imaginative about how I was going to reskill, as a GP in the city coming back out remote,’ he said. ‘You can’t just go back and get an RMO [resident medical officer] job.
‘I did things like 12 months of surgical assisting in private, to get into the milieu of being in theatre and scrubbing up and assisting anaesthetists.’
Dr Clohesy believes a policy focus on ensuring the NT has the numbers it needs, as well as providing better remuneration for doctors willing to work there, would be very helpful to help boost numbers.
‘I think the Territory should really have their fill [of registrars] before the middle of Sydney, to get the balance right,’ Dr Clohesy said.
‘I’m sure there could also be some more imaginative incentives for getting doctors to work out in remote areas. The current financial incentives aren’t totally spectacular for the sacrifices and the pressures you’re under.
‘And then training to make them feel more confident about coming out remote.’
Dr Carson would like to see the reintroduction of the PGPPP, or a program like it, to enable people to try working remote before they make a decision of where to settle. 
‘I think reintroducing the PGPPP, where people can try before they buy, is valid. Providing opportunities for medical students to actually get out there and say, “Oh, actually, this isn’t as scary as it looked from suburban Melbourne or Sydney”,’ she said.

GP workforce Northern Territory rural health shortage

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Daniel Byrne   15/05/2019 7:16:31 AM

Two of the best doctors I know. Great role models for General Practice.
And bring back the PGPPP!!

Dr Sarah Joan Edmundson   15/05/2019 8:45:12 AM

“I think I take away more than I actually give them” - completely agree. It’s an incredibly challenging but rewarding job, working in remote NT.

Dr Rodney Paul Jones   15/05/2019 3:44:32 PM

Yes agree with the GPPPP re introduction. I think this is the right stage to introduce young ones to the NT

Jocelyn Abrahams   18/05/2019 10:29:46 PM

GP's working out bush see pathology that you would otherwise only read about in text books! It's sad for the clientele that the burden of disease is so great, but makes the remote GP's work very interesting.