Rewards of rural practice
For the first time in 12 years, a home-grown GP settles in a South Australian bush town, writes Lynnette Hoffman
WHETHER there’s a traumatic car accident, a pressing cancer case or that ubiquitous winter flu, if there’s a situation requiring a doctor in the itsy-bitsy South Australian town of Wudinna, population 600, or the district surrounding it, there’s one doctor around to handle it all. Emergency or otherwise, Scott Lewis, 28, is it. Lewis arrived in February, the first permanent GP the area has had in three years and the first Australian-born, Australian-trained GP to set up a solo practice in South Australia in 12 years.
Shortages in the medical workforce outside major metropolitan areas have not only persisted, they’re getting worse. The shortage isn’t just restricted to GPs. Nationally, at least 16,000 more health professionals are needed in the bush, according to the latest figures released by Rural Doctors Association of Australia.
That’s despite a host of government initiatives in the last five years, including doubling the number of medical students by 2012, creating ‘‘ rural clinical schools’’ where GPs can train in a rural environment and adding bonded placements and scholarships for students who agree to work in a rural area.
The Rudd Government has added several more of its own: it will double the number of John Flynn scholarships for medical students taking on clinical placements in rural areas, set up a new scheme to get allied health students into rural and remote areas and pour money into getting nurses, medical specialists, obstetricians and others into rural and remote areas, among others. But as yet the shortage is showing no signs of abating.
‘‘ It’s too little, too late,’’ says Steve Sant, chief executive officer of the Rural Doctors Association of Australia. ‘‘ It’s like a tidal wave of graduates, they’re only going a metre or two off the coast.’’
Rod Wellington, chief executive of Services for Australian Rural and Remote Allied Health, can second that. ‘‘ The same applies to all sectors, not just ours — take mining, for example. Unless we inject capital into developing infrastructure in rural and remote communities, that’s unlikely to change.’’
Research shows people from rural and remote areas are more likely to return to work in those areas long term, which is why organisations such as the RDAA and SARRAH have pushed for more programs to encourage students from these areas into medical and health professions.
In 2006 and 2007, the Australian Government provided 130 undergraduate scholarships for students from rural and remote areas to train as allied health professionals, but demand far exceeded that with SARRAH receiving more than 1600 applications for those scholarships, Wellington says.
Health professionals who do take the plunge and work outside metropolitan areas say there are definitely rewards to be had: a distinct lack of boredom, for one.
Nearly 70 per cent of GPs in rural and remote areas also provide emergency care, Sant says, and a quarter provide ‘‘ procedural services’’ such as obstetrics, major surgery and anaesthetics as well. Lewis is trained in both anaesthetics and obstetrics, for example.
Doctors will find themselves treating everything that comes through the door, which makes for rewarding and varied work, if stressful.
‘‘ In my first week here I had a child come in with both bones broken in his leg. I had to stabilise it and settle it down with strong pain relief, and organise him to be transported by air to Adelaide. The same week someone came in with a dislocated hip that I had to put back in place and that uses anesthetic skills as well — it’s pretty painful, so you have to sedate them pretty heavily and basically put them to sleep before you can do it. In a city those are the sort of things that gets taken straight to emergency, that a GP never gets to see,’’ Lewis says.
The same is true for allied health professionals, says Ruth Chalk, a speech pathologist and member of SARRAH who works in northwest Tasmania. ‘‘ There’s a great variety of work,’’ she says. Chalk’s patients include people with all manner of swallowing and speech disorders — they may be people who have developmental and intellectual disabilities, people who have suffered strokes or have cerebal palsy, or who stutter . . . babies with feeding problems.
‘‘ In cities you have people specialising much more, so a speech pathologist may be working in a clinic where they are only working with babies with feeding problems, for example. That would be all they see. Out here we are much more generalist.’’
Working in rural areas has also meant lots of opportunity to travel within the state: her previous job saw her regularly visiting remote places such as King Island or Flinders Island.
But added opportunities can come with drawbacks. On average, health professionals in the bush work longer, about four hours extra each week, according to the latest figures released by the Australian Institute of Health and Welfare in January.
To that end there is a fair bit of anecdotal evidence of rural health professionals experiencing high stress, Sant says.
‘‘ When you have to work long hours and you can’t fulfil the needs of your patients you’re going to get stressed, and we often hear from doctors that feel like they are up to their eyeballs in work and can’t provide the quality of care that they would like.’’
Often health professionals don’t have access to adequate support or back-up, not to mention technologies enjoyed by their peers in big cities. And they are under significant pressure.
Long distances to specialists and facilities for investigative procedures mean Lewis has to think creatively to provide the best care rather than referring everyone straightaway — after all, it’s 220 km to the nearest centre where radiology is available.
The isolation can also make professional development more ‘‘ challenging’’, Chalk says. ‘‘ I’m here on my own and the nearest doctor is over an hour’s drive away. You have to be more creative about how to keep up to date with evidence-based practice.’’
For her, that has meant using technology such as video teleconferencing and accessing training sessions online, as well as securing scholarships for professional development. ‘‘ It’s an adventure. You learn to use your own resources.’’
Groundbreaker: Scott Lewis has taken on rural practice, which requires a GP to attend to a variety of ailments