A brave new world

My hairdresser remarked that I was “brave” for packing up my bags and starting a new job in the middle of NSW.

And yet what this person called “brave” is what many junior doctors call just another part of training.

Across NSW, there are hundreds of doctors-in-training undertaking secondment. Experiences can be anywhere from 10 weeks to six months or more, depending on whether it’s part of prevocational training or a formal part of a training program.

Removing doctors from all their major supports is a good way to challenge a JMO’s resilience (a word which I hate). And it’s not uncommon to see doctors struggle. The 2013 BeyondBlue survey of doctors and medical students showed that doctors from regional, rural and remote areas may be particularly vulnerable to psychological distress.

But far from drawing the short straw, my regional placements have forced me to take greater responsibility, learn how to do more with less, and experience working closely with some great teams.

These rural spots are well sought after – and for good reason. Our metropolitan hospitals are often “top heavy” – there are senior consultants, junior consultants, fellows, senior registrars, junior registrars, senior residents, residents and interns. And as someone lower down on that pecking order, it can be difficult to get a look in. I have literally been the sixth person scrubbed in an elective operation.

It’s true when people say you learn a lot more on a rural placement. Maybe it’s because consultants aren’t running between two or three different hospitals. Or maybe it’s because operating lists accommodate for teaching time. Regardless of why, the reality is there are fewer resources and greater opportunities to step up.

My first two secondments were at Wagga and I’m currently at Griffith Base Hospital (which is less well resourced than Wagga). Working in a regional hospital can feel like a different world. All hospitals are affected by chronic underfunding, but regional facilities even more so, and you’re forced to make do with older equipment or second-hand CT scanners.

Rurality is one of the most important social determinants of health. Access to healthcare is often limited – due to distance, availability or even health literacy, and so hospitals have higher rates of potentially avoidable hospitalisations. It is not uncommon to see uncontrolled diabetes, morbid obesity, hypertension and low levels of exercise, so patients tend to have a lower life expectancy. These patients deserve the exact same care as any other patient and should be able to access it as close to home as possible.

And yet rural and regional patients can routinely travel one to two hours to receive a surgical review as district hospitals are only equipped with their clinical examination and an istat machine. Despite these barriers to access, patients are grateful for our care and philisophical about their healthcare situation.

One of my patients remarked – ‘well sometimes you can travel an hour in traffic in Sydney to see a specialist, and take another 15 to 30 minutes to find parking – whereas here, if you’re driving, you’re at least getting somewhere far.’

It’s important to have this insight into rural, regional and remote health, as the experience helps us become better advocates for our rural patients.

I consider myself lucky to have been able to go on three rotations over the past three years. Each experience has been educational, enlightening and enjoyable. And I’ve been able to work with some great consultants and great teams. Working in a rural town has definitely made me a better doctor and helped me grow as a surgeon. I have made some great friends and enjoyed old and new hobbies. And, as the ‘Cheers’ theme song goes, I love working in a hospital where ‘everybody knows your name’. I can’t wait to come back to work here once I’m qualified.