Best in Country

A COUPLE of months ago, I was at a friend’s birthday in Sydney. While conversing with guests, the usual questions flew around with one guest asking ,“What do you do?” I responded that I was currently a doctor working in Dubbo in western New South Wales. His response was unexpected. Instead of asking how I am finding the role or what I planned on specialising in, his demeanour changed considerably. “I’m sorry,” he said, eyes pinned to the ground. “I heard that doctors these days are struggling to find jobs in the city and only those that get PhDs or top their class get into metro jobs.”

Naturally, I wanted to go for the jugular, but I mustered some energy to explore this naivety further and dispel some myths about rural doctors. I explained that I chose to work rurally and wasn’t the poor leftover that couldn’t get a job at St Elsewhere’s. I described my experience as a rural junior doctor as incredibly fulfilling and that at no point in my career considered myself at a disadvantage for working in a rural centre. In fact, I believe my opportunities have been the exact opposite. I just wish that everyone would realise this.

Unfortunately, this naivety is not isolated to the general public. Myths still exist about rural practice amongst our medical peers. I thought when I had left medical school, the fable of working rurally being a disadvantage for your career was long gone – sadly not. Two weeks ago, I had a lengthy discussion with a first-year medical student who had been talking with some senior clinicians at her university. Being a country girl, she expressed to them that she wished to work rurally when she graduated, to which she received the unfortunate rhetoric of “you’ll be wasted out there,” and “it’s so unsupported when you work rurally.” Unfortunately, this is not an isolated incident. It’s really frustrating when I hear that mentors of students are saying this. Don’t get me wrong, I think we have come a long way to promote the benefits of rural practice, and there has been much work done to promote it. However, in our prestigious universities, there remains a small cohort of white-haired professors that believe we all have no teeth and no brains out in the bush.

For those considering a career in rural medicine – do it, you won’t be disappointed.

Here are three things that I wish everyone knew about rural medicine.

1. Australian rural doctors are some of the best in the world

This shouldn’t be surprising. I recently attended the World Rural Health Conference held by WONCA in Cairns. At this conference, there were over 20 countries represented. As I spoke with delegates from around the world, a recurrent theme came up – they wished that rural pathways, training programs and particularly an emphasis on rural generalism, could be replicated in their home countries. Australia is a shining beacon for rural practice, not just regarding mechanisms to promote it, but in terms of training rural generalists. We should be proud of this as a medical community.

2. Rural and remote training is beneficial for your career

Naturally, as an aspiring rural generalist, I’m biased when it comes to this. I do believe I have gained so much more in my career by searching out rural and remote work. For those purists of medicine, there is nothing more magical then having to rely on your clinical acumen to diagnose, manage and treat patients in remote settings where you don’t have to luxury of MRIs, a pathology service on your doorstep or a barrage of sub-specialists next door. It can be confronting for some, but the learnings are immeasurable. Even in more resourced facilities, you can find
yourself with a wealth of support and knowledge from mentors and supervisors who have often spent a lifetime working broadly in their chosen field. If you turn up, have a positive attitude and contribute to your team and community, these mentors will often be your biggest supporters through your career and will be just as passionate as you are in ensuring you pave a successful and fulfilling path through medicine.

3. Not everyone has to like rural practice (but we all have a responsibility to support it)

I don’t expect every doctor to pack the bags, buy a pair of RM Williams boots and say goodbye to the city lights. Rural and remote medicine for a variety of reasons will not be everyone’s cup of tea. I do hope, however, that we as a medical community we do acknowledge the many positives of working rurally – the sense of community, the capacity to learn and work with a broad range of skills, an ability to truly make a difference and the ability to chase the unicorn of work-life balance. We should be promoting rural practice as an opportunity in training, not forecasting negative aspects of rural practice to JMOs and registrars. We should also realise how we all can help those who work in rural settings. Next time you see a patient from a country town that has driven five to six hours to see you, consider whether you could make that appointment via telehealth. Next time you receive a patient from a rural hospital, instead of tearing apart your medical colleagues, consider how your hospital network can help improve patient journeys. Rural health is not for everyone, but as a medical community, we all have a responsibility to improve it.

Dr Shannon Nott is a rural generalist trainee in anaesthetics based in Dubbo. He is currently an ACRRM and RACGP registrar and also works as Rural Health Director of Medical Services for Western NSW Local Health District.