Rural & Remote Medicine:a Specialty

Professor Ian Wronski•Immediate Past-President ACRRM•Executive Dean, Faculty of Medicine, Health and Molecular Sciences, JCU

The Rural and Remote Medical Workforce

• 4000 rural and remote doctors

• Middle aged workforce

– 70% male – 30% Female

0

500

1000

1500

Under35

45-54

FemaleMale

Source ARRWAG, 2004

Practice Style

• Private office practice 80% ¾ Owners/partners ¼ salaried by the practice½ involved in hospital care especially A&E

• Registrar 9% ½ salaried • Hospital only 5%• Community team 3%• Locum < 1%• Fly in Fly out 1%• Other 1% Source Reality Bites

ARRWAG

Workforce

81%

1%

3%

0%

5%

9%

1%

Resident generalistpractitioner 'Fly in Fly Out'

Member of a PrimaryHealth Care Team General P Locum

Hospital Based GP

Registrar

Other

Source ARRWAG, 2004

Procedural activity

0

500

1000

1500

3 4 5 6 7

Surg

Anaes

Obs

A&E Away fromsurgery

Source RDAA Viable Models report

Workforce Shortages

• Workforce shortages in all health professions

• Particularly in rural and remote practice

• Shortages exacerbated by international competition for health professionals

• Difficulties in attracting and retaining health staff to regional areas

Current Government Initiatives

• Educational Programs – Students – RAMUS– Medical school intakes– NRHN– JFSS– RCS/UDRH– RMBS(100 pa) +234

• Interns– RRAPP

• Registrars– GPET Regionalised RTP– ERT Framework

• Rural Doctors– Procedural medicine

What do we know about going Rural? - the Evidence

• Rural origin 2.5X (1.68 to 3.9)• Rural schooling 2.5X (2.2 to 5.42)• Rural spouse 3.5X• Rural undergraduate 2.05X (0.7 to 3.0)

plus anecdotal - seem to want to stay on• Rural Intern 3X (Peach et al, Ballarat 2004)

• Rural Training 2.5X (Rural Stocktake, Jack Best)• Rural upskilling/support - Stay longer (Hays

et al, Wilkinson et al)`

The Argument for Rural and Remote Medicine as a

Specialty

•Meets three core criteria for recognition as a specialty

1. Improve Safety of Health Care

• By ensuring dedicated education and training targeted at the realities of rural and remote practice

• Provide appropriately benchmarked guidelines for managing clinical risk in rural practice

• Foster further growth in research into safe clinical care

2. Improve the Standards of Health Care

• Provide an adequately trained workforce• Increase understanding and focus on service

needs of rural communities• New models of care and complementary

training, accreditation and professional support structures

• Consolidate acceptance of rural standards by professional organisations responsible for safety (e.g. clinical privileges)

• Provide support and clear points of articulation for entry and exit to other specialties (e.g. general practice into RRM)

• Assist other specialties to deliver appropriate support and education to their rural and remote colleagues

• Advance more effective medical service models within resource and distance constraints

3. Result in More Cost Effective Health Care

• Create most effective rural medical workforce service models

• Reduce costs of unnecessary retrieval, referral and transportation for patients

• Facilitate resource and administrative sharing amongst training programs and allow for streamlining of training time and arrangements

• Create clear and facilitated career paths and continuity of education from undergraduate to postgraduate practice – organisational and professional efficiencies

• Assist to recruit doctors by improving status and attractiveness of rural career

• Provide impetus for continued growth of intellectual and service infrastructure in rural areas

Community Benefits

• Better rural doctor recruitment, retention and support

• Better targeted training for medical services that rural communities want and need

• Opportunity to nurture better inter-specialty teamwork models

• Sustaining rural communities themselves by maintaining and retaining rural doctors

• More medical services available at home communities

Benefits of specialisation

• Identity and recognition (retention)• Specialist Rebates (complexity)

– Infrastructure support– G/S– Access to MRI referral etc

• More Rural Doctors (recruitment)• Career pathways for rural students• Mentoring and teaching next generation

of rural doctors• Opens up alternative pathways to doctors

interested in rural medicine, but not attracted to standard GP training

What’s missing?

• Recognition some recent developments

• VR (Partway with PDP)• Specialist (AMC process under way)

• Rural Training Pathway enabled and integrated(Part way with GPET enhanced rural

training framework)

ACRRM• ACRRM

– 1700 members– FACRRM – 1330 (generalists)

• Advocacy• PDP - unified

– For VR– Procedural– Radiology

• Education - Filling the gaps– Telederm, Ultrasound, Anaesthetics, Surgery,

Obstetrics– Population health (Collaboratives)

• RRMEO

The Future – what it could it look like

• A different educational pathway with flexibility and rural focus

• The same infrastructure • Targeted selection to a different

cohort• Targeted incentives to learn not just

be there

Future  • Recognition and specialisation • Simpler pathway to RRM - choice• Further development/refinement of standards • Further development of assessment incl exam• Educational gaps addressed e.g. procedural• Increasing rural infrastructure incl Regional

Training Providers, Rural Clinical Schools University departments of Rural Health and rural teaching practices

• CPMC and College collaboration

Future workforce

• Important determinant of other factorsWorkforce Lifestyle Family

• Ground work done and infrastructure in place

• Wave of students coming

• Attract and keep

• Nourish and keep them up to date

• RECOGNISE and REWARD