Rural Generalist Training

IN JUNE this year, the Federal Government passed the National Rural Health Commissioner Bill through the Senate. The passing of this Bill brings Australia one step closer to a National Rural Generalist Pathway.

At the time of writing this article, we may be just days away from an announcement of who our National Rural Health Commissioner will be. Our College team looks forward to working with this leader to develop the National Rural Generalist Pathway and open up training opportunities for aspiring rural doctors across Australia.

The planned Rural Health Commissioner appointment fittingly comes at a watershed moment in ACRRM’s history – the year of our 20th anniversary.

Our College was built by dedicated rural doctors. These doctors saw the need for a special approach to training for quality practice in rural, remote and Aboriginal and Torres Strait Islander communities. The ACRRM Fellowship was designed to describe their model of practice, now known as Rural Generalist Medicine.

THE RURAL GENERALIST MODEL

Rural Generalist Medicine encompasses general practice at its full scope. The model is based on the recognition that in situations where patients do not have access to a full suite of specialist services and resources, general practitioners have a heightened level of responsibility to meet a broad and diverse range of community needs.

Rural generalists are trained to be able to work at the top of the license across the spectrum of general practice services and to attain high level competency in at least one advanced skill area. This may be in one of 11 disciplinary areas including obstetrics, anaesthetics, paediatrics, mental health, emergency medicine and Aboriginal and Torres Strait Islander health.

The Rural Generalist model also recognises the important role a rural doctor has to play as the medical professional on the ground who can work through cooperative models such as FIFO consultant specialist programs to bring urban-based specialist expertise to patients in their locality. This role requires its own set of skills and practice standards.

CHALLENGES

Jurisdictional programs to support Rural Generalist training have been established across Australia for some time, with specialised models being applied to reflect the differences in health systems, infrastructure, and underlying philosophies within each State and Territory. A key challenge for a national pathway will be to provide interjurisdictional portability and coordination without compromising the regional integrity of programs.

The College believes a key to achieving national consistency will be national agreement on a common definition of Rural Generalist Medicine. The ‘Cairns Consensus’ definition is already in place and should be adopted for this purpose. It is an international consensus statement which arose from the second World Rural Generalist Summit in Cairns in 2013 and has been endorsed by 23 national and international medical organisations.

The College sees positive progress in this regard and welcomes the jurisdictional mapping report which advises that: “Most jurisdictions have expressed support for / adoption of this definition; it is already in use in Tasmania and soon to be in Queensland.”

Other challenges need to be addressed. The national general practice training support scheme, Australian General Practice Training (AGPT) is a poor fit for Rural Generalist training. In particular, it only supports three-years of training while the ACRRM Fellowship involves a four to five year program.

We need to improve support for doctors who are moving to a rural and remote community. Isolation and relocation, especially for partners and children, provides additional pressures for doctors and these are exacerbated by the need for advanced skills training. We must ensure that trainees build a solid professional network with other Rural Generalists, as well as assisting them with strategies to integrate into the community as a community member.

A critical challenge is to ensure that having gained these skills, doctors can be employed and enabled to practice their unique skill set. This requires recognition and valuing of the important role these doctors can play in improving the medical care of people in rural, remote and Aboriginal and Torres Strait Islander communities across Australia.

OPPORTUNITY

Even though we have a national oversupply of doctors, in rural and remote communities medical practices, hospitals and wards continue to close and there is a lack of training positions for junior doctors. The continuing maldistribution of medical professionals coincides with persistent health inequities between urban, rural and remote Australians.

A National Rural Generalist Pathway can help overcome this.

A National Rural Generalist Pathway will enhance coordination of training and the integration of the Rural Generalist model of practice into health service frameworks. It will provide a clear national training and career pathway. The College believes these developments will expand the pool of rural general practice doctors equipped to provide advanced procedural, primary care and public health skills. This network of Rural Generalist doctors will provide a sustainable solution to chronic skills and workforce shortages in rural and remote communities.

Associate Professor Ruth Stewart is the President of the Australian College of Rural and Remote Medicine.