Rural Training Vital For Retention Of Regional Doctors

Medical specialists who are given ample opportunity to train in rural areas are almost three times more likely to choose to work in the country after completing their training, according to an Australia-first study led by the University of Notre Dame Australia.

The study of 1220 medicine graduates from nine Australian universities has for the first time conveyed the impact of doctor’s specialisations on their decision to work in rural areas later in their careers.

It comes amid a critical shortage of doctors in rural, regional and remote areas of Australia, with both general practitioners and other medical specialists in short supply.

The study found about 30 per cent of general practitioners – a specialty that gives doctors the opportunity to do most of their training in rural areas – were practicing in the country 10 years into their careers.

But only 10 per cent of other medical specialists, such as psychiatrists or pediatricians, and 15 per cent of surgical specialists ended up in non-metropolitan areas a decade after graduation. These specialists do most of their training in the city.

Lead author and researcher from Notre Dame’s Wagga Wagga Clinical School, Dr Alexa Seal, said meeting the medical workforce needs of rural Australians continued to be a major challenge.

“This study reinforces the impact of rural training pathways on a doctor’s longer-term work location,” she said.

“Specialist training needs to be expanded to support more rural training opportunities for doctors outside general practice because we know that rural exposure is associated with the likelihood of living rurally in the future.”

According to the Australian Medical Association, research continues to show rural Australians have higher rates of hospitalisations, death and injury, and poorer access to primary health care than people living in major cities.

There are seven times fewer specialists in remote areas than in metropolitan areas, leaving many patients with no choice but to travel extensively – often with significant financial and familial burden – to attend appointments.

The research built on two earlier studies of the same cohort of medical graduates from the class of 2011 – one that looked at their practice location after five years and another after eight.

It found the number of specialists working in regional, rural or remote areas increased from 15 per cent at five years after graduation, to 19 per cent at 10 years. This is mostly attributed to non-GP specialists moving to the country after finishing their training in the city.

The latest study will be published later this month in the medical journal BMJ Open.

How a rural immersion can change a life

For Notre Dame graduate turned GP obstetrician Dr Clare Hardie, the decision to work in the Wheatbelt region of Western Australia was born out of a rural stint during her third year of studies.

Dr Hardie was doing her Rural Clinical School Placement in Narrogin in 2015 when she met a farmer who would change the course of her life.

The pair hit it off and Dr Hardie made the decision to join her now-husband in the town of Wandering, but before that could happen she had to do most of her obstetrics training in Perth.

She was grateful to be able to finish her training under a mentorship program in Narrogin, but admits the move from being well supported in the city to working far more autonomously in a country hospital was daunting.

Dr Hardie is now the only local obstetrician in Narrogin, with the on-call service run by locums.

“I am here because of the Rural Clinical School and all of my GP training could be done regionally, but not the obstetrics,” she said.

“When I came there were two obstetricians but they have both since left, so if I was to go there would be no one here permanently to replace me.

“That continuity of care is so important. If you see a woman throughout their pregnancy you have automatic rapport in the birth suite – and they have trust in you – which makes the birth experience more positive.

“If you’re relying on locums, these women are relying on someone they have never seen before during the most special time in their life when their baby is being delivered.”

Four years into her job in Narrogin, Dr Hardie is now starting to see some mothers for their second babies, which is one of the most rewarding parts of her work.

“I seem to get hit up at Coles a lot now,” she said. “Every time I do my click and collect I run into a mum who is eager to show off their baby to me.

“You get that because it’s a small town. You’re seeing the same patients, you see them continually, you see them for the birth and then a few years later you get to do it all again.”

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