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

The Weekend Australian - Travel - - Career One -

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.’’

Pic­ture: Kelly Barnes

Ground­breaker: Scott Lewis has taken on rural prac­tice, which re­quires a GP to at­tend to a variety of ail­ments

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