Pioneering registrar labels remote posting a ‘wonderful experience’

Travelling along a winding little road after a six-hour drive into the small town of Mallacoota, Victoria, for the first time in February of this year almost had Dr Crystal D’Souza turning back.
 
But the general practice registrar has not looked back down that road since.
 
Now undergoing a Rural Generalist pathway, Dr D’Souza is the first registrar to commence the Small Town Rural General Practice (STRGP)­­­ post in Victoria at the Mallacoota Medical Centre – which was identified by RACGP Rural’s Workforce Planning Team as a priority area for incentivised funding and recently accredited for the STRGP Additional Rural Skills Training (ARST).
 
So far, her experience has been nothing but positive.
 
‘I have had a wonderful time getting started in the STRG position,’ Dr D’Souza told newsGP.
 
‘[My supervisor] Dr Sara Renwick-Lau has an incredible wealth of knowledge and experience which she is very passionate about and keen to share. The clinic itself has been super supportive and the team is just wonderful.’
 
The Mallacoota Medical Centre is the only medical centre servicing the Mallacoota and district area and is a two-hour drive from the closest 24-hour emergency department and hospital. There are also limited state-funded and public services available in the region.
 
The centre therefore provides the bulk of primary healthcare services to the population of around 1000 permanent residents.
 
The opportunity to offer the new 12-month STRGP ARST at Mallacoota Medical Centre is recognised by the RACGP as a step forward in changing the landscape around ARST funding, with the majority of ARST posts to date nationally mostly funded in hospital, rather than in community general practice.
 
One of the RACGP’s priorities has been to address GP workforce shortages and develop rural pathways for general practice registrars, particularly in rural communities where many have gone without a registrar for years.
 
The recent incentive placements have helped to fill much-needed places across Australia, including in Mallacoota where there has been no general practice registrar since 2016.
 
For Dr D’Souza, she was attracted to general practice because of the variety and opportunities for ‘ongoing and constant change’ in day-to-day practice.
 
‘I love the long-term patient interaction and medicine that spans across populations, from newborns to the elderly,’ she said.
 
‘Particularly in rural general practice, I have found I love how every day presents something completely unexpected and there’s always the opportunity to see how diseases and conditions change in the long run.
 
‘We don’t have the support of huge hospitals, or a variety of specialists, so lateral thinking, problem solving, and long-distance relationships with our non-GP specialists are super important – and I really enjoy being a part of it all.’
 
L–R: Mallacoota Medical Centre supervisor Dr Sara Renwick-Lau, RACGP Rural Clinical Lead Victoria Dr Jacqui McDonnell, registrar Dr Crystal D’Souza, practice manager Marcus Renwick-Lau, RACGP training coordinator Lisa Kassell, RACGP Rural Pathway and Rural Generalist Training Manager Julieanne McLuckie. (Image: supplied)

However, it wasn’t always such a positively charged experience. Having worked in the Gippsland region of Victoria for the previous few years where there was always a hospital within an hour or so, Dr D’Souza recalls arriving in Mallacoota and being the only point of call for medical care in a large radius as ‘quite daunting’.
 
‘I didn’t really understand how challenging remote medicine could be until I came out here,’ she said.
 
‘[Since arriving] I have found myself constantly challenged, humbled, excited, and learning at a rate I certainly would never have expected.’
 
The RACGP’s registrar incentive placements provide funding to support registrars with the additional costs associated with living and training in an area of workforce need, as well as ongoing support for them to move and settle in to a new area.
 
Dr D’Souza believes there needs to be more financial incentives offered to help registrars make the large move to the country, and more ‘trial periods’ or shorter contracts.
 
Current contracts and programs are usually for one year or more, and particularly for people with families, this can be a disruptive move.
 
‘Several of my colleagues have expressed that they want to work outside of a metropolitan setting but are intimidated by getting “stuck” or otherwise hating being so far away from the cities,’ she said.
 
‘One of the big reasons people don’t choose regional or remote work is because they would be leaving family behind in big cities. Speaking from personal experience, it’s quite difficult to juggle your personal relationships when you’re more than 600 km from the people you love!
 
‘If there were better financial incentives for housing, or help for family members to move, I think a lot more registrars would be interested in taking up remote and regional posts.’ 
 
Once her STRGP ARST term finishes, Dr D’Souza intends to continue working as a GP in Gippsland. In the meantime, she is reaping the rewards of being able to expand her experience and skills, while contributing to the delivery of accessible and sustainable care to her rural community.
 
‘It is genuinely great to be a part of a person’s health journey – to be there when they are well, when they need some more help, when things change,’ she said.
 
‘It’s a privilege that few other medical specialties get to experience. Being a rural GP, well, you just get to really see how your participation in that person’s health journey can affect an entire community.
 
‘You see you are making a difference on a more personal level, and that’s something quite special. I love being part of a town, part of a community and getting to live and play in our beautiful country.  
 
‘There are hard days, as with any role, but for the most part, this has been a wonderful experience so far and I’m looking forward to the coming months.’
 
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