Medical Forum Special Edition: Going Bush by Medical Forum WA

GOING BUSH The best medicine

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Brecken Health support regional communities with access to health care. We are currently seeking practitioners for: - Albany - Margaret River - Bunbury Considering a sea change? Help us, help regional communities Dr Brenda Murrison: M: 0418 921 073 E: brenda.murrison@breckenhealth.com.au Damian Green M: 0423 844 268 E: damian.green@breckenhealth.com.au Image: Emu Point, Albany

It will come as no surprise to those seasoned in the task of recruiting doctors across WA’s vast expanse that ﬁrst-hand experience pays off in spades.

A recent study in the Medical Journal of Australia conﬁrmed that medical graduates who have a rural background or spend extended time in a rural clinical placement are considerably more likely to be found as country doctors eight years down the track. And its conclusion reinforced the importance of the nuts and bolts – the crucial roles of rural and regional training pathways, rural clinical schools, regional training hubs and the rural generalist training program. The chronic shortage of doctors in the State has been an ongoing thread during the more than 20 years that Medical Forum has been publishing. But the pandemic has added an extra layer of complexity in the past two years, with border restrictions – while helping to protect country WA from a sharp spread of COVID-19 – impacting on the already lean medical workforce. Campaigns to get more doctors in the bush are certainly nothing new and go back many decades. In the mid-1950s, there was a concerted effort to establish a medical school in WA, marketed to the public under the banner of ‘Grow Your Own Doctor.’

Today we have many stakeholder organisations singing from that same song book, stressing the importance of not relying on more overseas-trained doctors to ﬁll the gaps, but instead cultivating our own workforce. And there is also a broader economic imperative at stake for rural and regional areas, because a lack of medical services hinders their growth and deters people from moving to the country. There are some positive signs, including State and Federal Governments investing in training Australian medical students, which will see more than 400 students graduating from WA’s three medical schools this year alone. But there is no easy ﬁx. In this special publication, we look at the key players working in this space and explain how a co-ordinated, multi-pronged approach is needed to offer support and incentives for doctors and their families to ‘go bush.’ Cathy O’Leary, Editor Medical Forum

Contributors: Jan Hallam, Kathy Skantzos and Suzanne Harrison GOING BUSH | THE BEST MEDICINE

SUPPORTING CAREERS FROM START TO FINISH It’s exciting times in the bush for WA’s growing cohort of junior doctors and medical students.

As the WA Country Health Service’s ‘growing our own’ strategy matures, so has the menu of prevocational and vocational training options. The dream of having a sustainable regional medical workforce – largely comprising our own graduates in a variety of roles – is starting to take shape. Over the next 10 years it is hoped WACHS will be able to train and, with good experiences and management, retain doctors in critical hospital and community roles throughout the seven regions of the state. WACHS’s Director Medical Education Dr David Oldham says all the regional hospitals are involved in junior doctor training in some

way, but the service is developing regional hubs where interns and residents can immerse themselves into the community and into their careers comparable to the educational experiences of their metropolitan colleagues. “Currently, we employ interns in Albany, Bunbury and Broome hospitals on three-year contracts, and next year Geraldton will come on board,” he said. WACHS INTERN PROGRAM “In the past four years, we’ve greatly increased the numbers of interns and hope to increase the current 20 to 30 by 2025. This expansion will continue as more graduates come out of Curtin University.”

There has been continued infrastructure investment into regional and rural hospitals over the past decade. Bunbury is currently undergoing a $200 million redevelopment and work has started on Geraldton’s $73.3 million building program. This has had a ﬂow-on effect of attracting a full-time, committed workforce, from generalists to specialists, who are now the core of advanced training hubs which are creating training pathways not only for interns but also for residents looking to do specialty training. “Currently, a lot of our 100-plus residents are international medical graduates and there are metro doctors on rotation from the tertiary hospitals,” Dr Oldham says. “As the

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intern programs kick in, there will be more locally graduated interns staying on, ﬁlling those regional resident positions, along with metropolitan doctors keen to go rural.” The proven credentials of the Rural Clinical School of WA (RCSWA) over the past 20 years to deliver gold standard education and memorable experiences for the hundreds of medical students it has seen pass through, has been the platform for much of the initiatives being put forward by organisations such as WACHS. “Like the RCSWA, we at WACHS have to prove that we can provide training pathways that sustain our workforce as well as provide great career opportunities for doctors in specialty and general practice,” Dr Oldham says. WACHS RURAL GENERALIST TRAINING “We expect about half of our interns will become GPs or rural generalists. And for GPs, it’s very straightforward. They can do their hospital years and the GP time in the same town. “WACHS is the coordinator of rural generalist training in WA and oversees the training of the advanced skills, some which can be done in regional sites, and others, like obstetrics and anaesthetics, need training in Perth. “Whilst it’s still relatively straightforward training for GPs and rural generalists, they do change employer when they leave a hospital and go into general practice and that can affect things like annual, personal and parental leave entitlements. So WACHS is looking at becoming a single employer for rural generalist training. GOING BUSH | THE BEST MEDICINE

“When it’s fully developed, maybe in ﬁve years’ time, there could be 30 rural generalists a year across the 10 different advanced skill areas, but with a major focus on emergency medicine, obstetrics, anaesthetics and Aboriginal health.”

“It is a very successful program. It supplies most of our workforce in Kalgoorlie and Geraldton, and about a quarter of the workforce in Bunbury. This year we’ve got about 30 doctors going through the assessment.”

WACHS SPECIALTY TRAINING PATHWAYS

WACHS COMMUNITY RESIDENCY PROGRAM

WACHS is also committed to creating specialty training pathways and networks at its own sites, which will be explored in depth in the following pages. Dr Oldham said WACHS was keen to grow its own generalist specialties – general surgery, general medicine, anaesthetics, obstetrics, emergency medicine and psychiatry. Ophthalmology (with a Far North focus) and intensive care medicine are in the pipeline.

WACHS also works to support health care in rural communities with its Community Residency Program, for which there are eight positions per term open to metropolitan residents at Fiona Stanley Hospital, Royal Perth Hospital and Sir Charles Gairdner Hospital.

Another initiative is the Workplace Based Assessment (WBA) program, for which international medical graduates (IMGs) are the target audience. This program will substitute for the clinical component of the Australian Medical Council (AMC) exam. “There is only a limited number of sittings of the clinical exam, which before COVID was a faceto-face exam. It left hundreds of doctors unable to fulﬁl their requirements,” Dr Oldham says. “The WBA program, which has been going for eight years, is an alternative to the clinical exam, and it’s offered by WACHS at three sites – Bunbury, Kalgoorlie and Geraldton. Doctors work for 12 months in normal resident or registrar jobs and are continuously assessed by consultants in the hospitals during that period. On successful completion, they can obtain their AMC certiﬁcate, which enables them to apply for general registration.

“At least 20% of their time is based in the community as a GP, in Aboriginal health and paediatrics – the positions all have a different community component,” Dr Oldham says. “So, participants might spend four days working at the local hospital and then work a day in the community, based at either an outpatient clinic or with an Aboriginal Medical Service or a private general practice. “We hope that it will make people think about working in the country. While it is not expected that a rural term will inspire everyone to work in the country, it would give all junior doctors a greater appreciation for the challenges their rural colleagues experience.”

Work with us: www.wacountry.health.wa.gov.au E: meu@health.wa.gov.au

JUNIOR DOCS ARE OUR ESSENTIAL WORKERS

Dr David Forster, WACHS Director of Clinical Training at Broome Hospital, describes the 25 interns and resident medical officers (RMOs) at the hospital as essential workers and valued colleagues.

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they’re working the emergency department, medicine, psychiatry and paediatrics, and they do a some of work in the theatre as well.

biggest tourist year I can remember, and I think this year’s going to be the same.

That says a lot about the culture of the hospital as well as the key role junior doctors play in the bush, and in return, Dr Forster says the hospital endeavours to give them the most rewarding, educational and fulﬁlling ride of their lives.

DIVERSE EXPERIENCES

“So, we prepare for an inﬂux of people coming into the ED, and the GPs in the community are the same. They have a waiting list of three weeks sometimes.”

Dr Forster has been at the Broome hospital since 2009 and back then junior medical ofﬁcers (JMOs) were thin on the ground. It has been a remarkable transformation, he says, that in his time he has seen Broome become the bustling medical hub of the region catering for general medicine, paediatrics and mental health patients.

Dr Forster, whose own GP fellowship includes advanced anaesthetics and emergency training, leads two formal teaching sessions a week for interns, RMOs and Rural Clinical School of WA medical students.

As head of training, Dr Forster says when it comes to learning, he and the rest of the senior staff gain a lot from the steady stream of interns, fresh from up-to-date textbook knowledge. They in turn offer varied and challenging clinical experience and procedural skills, and open access to supervisors and senior staff. “We rely on JMOs in all parts of the hospital, they’re essential workers for us. We work incredibly closely together and we all teach each other,” Dr Forster said. “As far as the kind of work they do, it’s fascinating work up here. Broome Hospital is the hub hospital for the Kimberley, and we get lots of interesting cases, both locally and regionally, coming in. JMOs are involved directly in different rotations, so

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“There are other rotations they can experience through Kimberley Aboriginal Medical Services (KAMS), Royal Flying Doctor Service (RFDS) and the renal unit. So, there’s a few varied experiences.”

“We try to make these sessions practical, with simulation-based training. Even with COVID, we’re still managing to do that in our own special way. And it’s a good opportunity for the cohort to get together and just talk as well. “Our consultants are also fantastically helpful and always giving of their time.” When it comes to patient time, JMOs can expect to spend a considerable amount in the emergency department. “The ED is the hub of the hospital and along with the medical ward are the hungriest areas for medical staff. “About 70% of the patients we see are Indigenous – all ages, but mostly younger, compared with other populations in other areas. In the Dry season, Broome’s population explodes with tourists. Last year was the

BUSY IN THE DRY

As the Broome site has expanded into the region’s hub hospital, so too has the number of resident and visiting specialists, which offers JMOs insight into the full scope of medical regional practice. “Broome now receives most of the regional patients. There is a negligible number of transfers from other sites direct to Perth because we have a lot more services here now, particularly with our own surgeons, paediatricians, physicians, O&Gs and so on,” he says. “But the work is not just in Broome. Broome docs and visiting specialists do regular visits to Derby, Fitzroy Crossing, Kununurra and we respond to requests from the Aboriginal Medical Service for sessions in remote communities. “We are a solid Kimberley unit. It is a seriously awesome place to work – the team of doctors, nurses and hospital staff here are just crazily good. We rely on each other, we learn from each other, and it is a really safe place to work with the common goal of quality patient care and a positive experience for staff at work.”

RURAL GENERALIST PATHWAY WA Rural generalists are the backbone of the health system beyond the city limits. Dr Abby Harwood

They are there in the heat of the ED, in theatres performing anaesthesia, in the labour wards delivering babies and in Aboriginal communities caring for a range of complex health needs. WACHS has been appointed to host the Rural Generalist Pathway WA Coordination Unit and is led by Director of Clinical Training and rural generalist, Dr Abby Harwood. The Coordination Unit works closely with local and national stakeholders and GP training organisations to ensure that the Rural Generalist Pathway WA is aligned with the National Pathway. The aim of the Coordination Unit is to streamline the training journey for aspiring rural generalists. Once on the pathway,

trainees will be assigned a mentor who is an experienced rural generalist and are provided individualised career navigation from internship through to fellowship to enable transition between the various training requirements for rural generalist medicine. “Our focus is to look across the WACHS network to identify and map opportunities where someone interested in rural generalist medicine can get the exposure they need to develop,” Dr Harwood said. “It could be a position that is a stepping stone into rural generalist medicine, or support for someone to pursue advanced skills training, or along that continuum. “Medical training is a long journey, any rural training system needs to have some degree of stretch and ﬂexibility, as we know there are points in a training that become hurdles.

“That’s where the Coordination Unit comes in, to remove those barriers. Engagement with other players in rural health is vital. “Our stakeholder reference group has members from 13 different organisations, and we really appreciate the advice, support and cross-pollination of ideas that occur within that forum.” The Rural Generalist Pathway WA is a separate program which supplements the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP) rural fellowship programs. All doctors accepted into ACRRM or RACGP rural training are strongly encouraged to join the Rural Generalist Pathway WA to streamline the rural generalist training journey. One of the beneﬁts of participating in the Rural Generalist Pathway includes priority access to

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training opportunities including courses and workshops.

she says her medical practice is challenging and rewarding.

Trainees can complete their Advanced Skills Training in Emergency Medicine which is recognised by both ACRRM and RACGP. This will see trainees prepared for complex management of emergencies including use of inotropes, dental emergencies, management of Diabetic Ketoacidosis in paediatrics, suprapubic aspirations, and even pericardiocentesis.

“There is some really tough medicine sometimes, with complex cases and you’re in an area where there’s limited access to specialists and some of the services, so you are thinking on your feet trying to treat people.

Dr Gemma Johnston

“But it’s rewarding. I really love my job.”

Rural generalists bring a wealth of skills and experience to the diverse communities and locations in which they practice. Much like the tight-knit communities that they serve, rural generalists are resourceful and resilient.

Dr Harwood says doctors who choose the generalist pathway thrive on providing an extended scope of practice. They are required to be adaptable, perceptive medical practitioners who think outside the box and have the ability to work in a range of environments.

Darwin-born Jawoyn woman, Broome-based Dr Gemma Johnston has been experiencing different areas of rural medicine since her student days where she was so enamoured with her GP rural term in Wyndham that she extended it over her university holidays.

“Rural generalists are highly valued and appreciated by the communities they serve, which makes for a truly rewarding career,” she says.

Still in the Kimberley and doing her RACGP fellowship, she is focusing on Aboriginal health, working for the Aboriginal Medical Service in Broome and in local communities. Not only has she found an ideal work-life balance in and around the beautiful Kimberley,

For more information about the Rural Generalist Pathway, contact 08 6553 0873 ruralgeneralist@health.wa.gov.au or visit https://ruralgeneralist.health.wa.gov.au/

Photo credits: © West Australian Newspapers Limited & RACGP GOING BUSH | THE BEST MEDICINE

O&G – THE ESSENTIAL PIECE OF THE RURAL PUZZLE Country doctors have always done the heavy lifting when it comes to delivering babies in rural communities – it’s just these days, their service is looking very sophisticated in well-equipped hospitals with highly trained, credentialled GP Obstetricians (GPOs). Dr Jared Watts & Dr Chevaun Howard

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RETURNING DOCS

This means, of course, that fewer women, regardless of their location or their presentation, are ﬂown to Perth to be delivered. WACHS Director of Obstetrics and Gynaecology Dr Jared Watts says that in his own Kimberley region, there are three O&G specialists and about 12 GPOs.

“We have so many more junior doctors being exposed to the immense variety of medicine in the region. One of my junior doctors was my medical student three years ago, and that’s fantastic.” Dr Watts’s own trajectory mirrors that of this student, having been in the rural clinical school in Broome before returning as a junior doctor. After his specialist training, he returned to Broome to the WACHS position over ﬁve years ago.

“Together we try and provide the best possible care for the women right here at home,” he says.

For him, the region offers both professional and personal fulﬁlment.

Doctors can apply for RANZCOG accredited diplomas and advanced diplomas at Albany, Broome, Bunbury, Geraldton, Hedland and Kalgoorlie hospitals as well as at some large Perth hospitals. These graduated GPOs have become the backbone of the regional obstetrics services.

“The variety of presentations every day and the opportunities travelling to meet colleagues and patients in the ﬁve hospitals we look after is tremendous,” he says. “Our patients want to be involved in their own health care, they’re very receptive. And then there’s the team. People come to the Kimberley to try and make a difference. Everyone’s here for a good reason and that makes for a great team environment.”

Dr Watts said that in the Kimberley, his units, of which he is head, delivers roughly about 360 babies in Broome, 120 in Kununurra and about 90 in Derby. “And then we have a group of higher risk women for whom we deliver most of their antenatal care before going to Perth towards the end of their pregnancy, he says. “In Broome, the hospital has become a lot bigger so we’re able to look after a lot more patients locally, which I think is very important, especially for Aboriginal women to deliver on country and to keep close to their family and supports. GOING BUSH | THE BEST MEDICINE

However, Dr Watts knows that it’s not always straightforward for doctors to make the decision to leave their comfort zone of the city. “I had signed up for a job in Perth when I saw this Broome job advertised which had always been my dream job, but I didn’t think I’d get it day one out of training school. So, I was very nervous, and I think a lot of people are about losing their skills or they might not have much support if they go to a rural area.” “My experience has been the most amazing broadening of my skillset. Now, I sit on the college’s board in Melbourne, and I am getting

an understanding of medicine from political and administrative angles. “We also have some incredible research going on here. The RCSWA and the Kimberley Aboriginal Medical Service (KAMS) have been allocated $3.2 million in the Federal budget to study diabetes and pregnancy in rural areas. We also have a project, which will be a world ﬁrst, where women in their own remote communities can do their own cervical screen test and we will be able to get them a result within 45 minutes and provide treatment if required.” AT THE FRONTLINE “City people have to realise that while me may not have all the gadgets up here, we’re real frontline workers and that includes research, service improvement and politics. You can get involved in all of it in the country and that’s what makes every day an exciting challenge.” Dr Watts said O&G training pathways have been highly developed – with accreditation by the Conjoint Committee for the Diploma of Obstetrics and Gynaecology (CCDOG) made up of the RANZCOG, RACGP and ACRRM, and on the applied side with WACHS. He also makes special mention of the support programs provided by Rural Health West for doctors and their mentors. “We work closely together to ensure that any junior doctor who wants an O&G career or training in country areas, is matched to the best possible training site. And those decisions take into account the applicant’s spouse and family needs,” he says.

Continued page 11

EMERGENCY MEDICINE It’s the heart of every hospital, but an emergency department in a regional area of our big state takes on extra signiﬁcance.

Dr Bron Peirce is the recently appointed WACHS’s co-clinical director for emergency medicine. The Bunbury-based Dr Peirce has until now split her time between the roles of senior staff specialist in emergency medicine and academic at the Rural Clinical School of WA. She has also taken on the academic lead for the Integrated Regional Training Hubs and is its co-director. Bunbury Regional Hospital has been an accredited site for fellowship training with the Australasian College for Emergency Medicine (ACEM) for a number of years and Dr Peirce says in that time, a strong culture of education and training has ﬂourished in the ED. “There is a positive regard for trainees and the

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value that they can bring, both in a workforce sense, but also in a professional sense in that they are the consultants of the future,” she says. As testament to that, of the 12 consultants who are currently working in the ED, four have worked as registrars at the Bunbury ED. “That is a reasonably high proportion, and it was because of the good experiences that they had. One of our registrars has just passed his exams and will be the ﬁrst consultant to have been a medical student with us,” she says.

options is to do a special skill, and medical education is such a skill.” she says. “The beneﬁts of an education registrar are two-fold. For the hospital, it is having someone dedicate time to medical education, both within the department but also within the hospital, to support junior staff in their learning. It also supports consultants in providing teaching and learning opportunities for their peers.

Dr Peirce believes this success is partly due to having secured funding for a medical education registrar.

“For trainees, it is ensuring they get structured learning alongside the constant on-the-job learning that is typical of a busy ED. Part of the program is registrars teaching students and that is invaluable exposure to some really special skills.

“So, for emergency medicine fellowship, you have to spend 6-12 months outside of the emergency department and one of the

“What we’ve managed to achieve here in Bunbury is down to ‘growing local’ to a large extent. Of course, it’s not the exclusive way

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of creating workforce and I don’t think it will be in Western Australia for a number of years yet, but it is starting to create a viable and proficient recruitment pipeline. “In doing that, you need to support people who are training to achieve their educational and training goals and to align them with their personal goals to ensure their wellbeing. For me, that is making sure we treat people well. “It seems fairly basic, but one of the things I think that Bunbury has always been good at is that we treat everybody equally and we aim to provide useful, positive and constructive feedback. When people do something that’s good, it is rewarded.” The deep-rooted culture of the Bunbury ED could also have something to do with it being nominated as pilot training site for an ACEM certificate and diploma. The flowon effects have been diplomates staying on at Bunbury, becoming supervisors and spreading the knowledge and ethos. As these programs are relatively new, some doctors may not have had the opportunity to undertake those additional qualifications and Dr Peirce said it was something she will be advocating for in the future.

O& G – THE ESSENTIAL PIECE (CONTINUED) “There is also funding for training days in Perth and the collegial support is amazing. If you run into trouble, there is always someone to help you.” GPOs Dr Chevaun Howard (Broome) and Dr Alice Fitzgerald (Kununurra) both did regional terms as junior doctors and have now returned to build their lives in the Far North. Dr Howard was inspired to pursue a rural GPO career after being mentored in Kalgoorlie during her RCSWA year. Another GPO in Derby added fuel during a postgraduate experience, adding a mix of Aboriginal health and obstetrics at the hospital. “When I went back to Perth, I added an application for my DRANZCOG to my GP training application. I spent 18 months at KEMH, with rotations that were mindful of my desire to go rural,” she says. “My 18 months was broken up by six months of maternity leave for my ﬁrst child, and then I applied to do my rural GP placement here in Broome, with one day a week at the hospital so I could use the obstetrics skills.” Nearly nine years on and a set of twins later, Dr Howard mixes her busy week with hospital work and antenatal clinics for Broome Aboriginal Medical Service (BRAMS) and teaching at the RCSWA. A GREAT SYNERGY “I have really nice continuity. I get to see my BRAMS patients in the clinic and if they need

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an induction or a caesarean, I can book them in on days when I am rostered on. It gives both the patients and myself continuity of care, which is one of the things I love about my mix of jobs,” she says. Dr Fitzgerald has been at the Kununurra hospital for five years. As a bonded student she always knew that she wanted to be a rural GP, but O&G became an interest as she came across patients and colleagues who inspired her to pursue that course. She grew up and graduated from medical school in Adelaide, where a lot of her studies focused on Indigenous health. She now lives on a small farm just outside of Kununurra with her husband and child and is part of the local community. But it has taken time. “The biggest challenge in the early days was knowing all your patients in the community. I really struggled with that in my first 12 months, not being anonymous outside of work. Now, being known is one of the best parts of my job,” she says. “I’ve been here long enough now that I am delivering women’s second babies, having delivered their first ‘bumps’, which is pretty special. From the outset, I was really lucky to have two very good supervisors and mentors – Drs Catherine Engelke and Stephanie Trust. They’re both local Aboriginal women who are also GPs. “I have a great relationship with the Broome O&G team. Jared has motivated me to keep my obstetric skills up and there’s always help just a phone call away.”

INSPIRING ASPIRING YOUNG SURGEONS Albany-based Mr Tom Bowles is WACHS’s Director of Surgery and its lead for the new pre-vocational Applied Surgery Pathway in Rural Environments (ASPIRE) program – he’s also a patient man who knows that the seeds he helps sow today may take almost a decade to mature.

“The end point of ASPIRE is either a rural generalist with surgical interest or a general surgeon who works in the country, so in reality we are looking at 10 years away – a fair bit of time on the ground before we know if we’ve been successful,” he says. Mr Bowles, who is also Director of Surgery at the Albany Health Campus, has a deep commitment to his town and his region – and that enthusiasm for rural practice isn’t lost on his trainees.

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Raised in rural Victoria, Mr Bowles set his own career trajectory early on. After graduating from the University of Melbourne, he started surgical training in Perth and that decision was based entirely on a long-term aim of living and working in Albany. ASPIRE is a two-year contracted program for WACHS junior doctors (PGY3 or above) who are interested in pursuing a career as a rural general surgeon. On successful completion, they will be well placed to apply for the general surgical

Mr Tom Bowles

training program with the Royal Australian College of Surgeons (RACS). The ﬁrst year is based in Albany and/or Bunbury Hospital with rotations including general surgery, emergency, ENT/urology, orthopaedics and critical care. The second, the doctors will be employed as a service surgical registrar in those towns’ general surgery departments. Mr Bowles says the program has been running for three years, with its ﬁrst graduate reporting that she had excellent experiences

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Dr Joe Ipsen and exposure to cases. Two candidates commenced the program, but no candidates were selected last year. “We thought that we would be choosy rather than just run it for the sake of running it,” he says. “We are after people who have a dedicated surgical mindset and who are keen to work in the country – ASPIRE is not a steppingstone for people to get on to training who have no interest whatsoever in the country. “The resident level job is well supervised but there’s also a degree of flexibility. So, for instance, if somebody has a keen interest in ENT surgery, even though they’re attached to general surgery in Albany, they can assist the ENT surgeon. That’s something that’s a lot harder to do the city – walking out of your day job briefly to do something else like plastic surgery and urology. There are these opportunities for broad surgical exposure. “The resident is the first on-call at least one night a week, and one weekend in four they are actually covering, so it’s just them and the consultant.” Mr Bowles believes that ASPIRE has enormous community benefit all along its continuum. “While the candidates have some exceptional learning opportunities in Albany and Bunbury, if they have a year of general training and then a year as a general surgical registrar under their belt, they will be extremely useful in other WACHS sites when regular surgeons are unavailable,” he says. “After two years, they will have a good CV, where they have fulfilled all the RACS prerequisites. In the past a master’s degree or GOING BUSH | THE BEST MEDICINE

a PhD carried extra points to get onto training programs. Now, to encourage more people in training to consider rural surgery, the college has made a registrar rotation in country Australia the equivalent of a master’s degree. So, completing ASPIRE gives candidates a boost and saves them having to take 12 months off to do a PhD. “This is a college initiative, but we’ve taken advantage of it.” ASPIRE is based on the proven notion that the more doctors who go rurally, the more likely they are to want to stay long term. There are many communities hoping that’s the case. ASPIRE 2022 candidate Dr Joe Ipsen, right, is enthusiastic about the opportunities the program offers. He has spent his internship and ﬁrst two Resident Medical Ofﬁcer years in Albany and Bunbury, which he says was “the perfect blend of work, lifestyle, and experience.” “Every day is a 10-minute drive to work where you are a valued member of the team. You get to see an extreme variety of medical conditions and almost all of these can be managed locally by our fantastic emergency and inpatient teams. “These are specialist-based practitioners who provide gold standard treatment, and they give true meaning to the term ‘general surgeon’. The hospital framework closely links junior doctors to consultants and because of this, the exposure and learning opportunities are fantastic.

funding for PDL; access to terms required; maximisation of rural points and education opportunities. I am excited to progress my career with the intent to return to a regional centre as a general surgeon in the future.”

For further information on ASPIRE, contact meu@health.wa.gov.au or phone 08 6553 0856. For Junior Doctors with an interest in a career as a rural generalist or GP surgeon please contact RGPWA@health.wa.gov.au or phone 08 6553 0873.

“ASPIRE is intended to streamline application for general surgical SET training through additional |

RURAL PHYSICIAN TRAINING PATHWAYS A new era of opportunity is opening up in WA Country Health Service’s regional hubs as physicians are establishing and growing their activity. Dr Sarah Straw

There are exceptional training opportunities at varying levels for junior doctors who either want to extend their rural experiences or for others a chance to head out of the city to discover what they might have missed in their student days. The Rural Adult Physician Training, Opportunities and Rotations (RAPTOR) program is a 12-month program for PGY2+ doctors offering relevant rotations and professional development to prepare them for basic physician training. Broome-based general physician Dr Sarah Straw is overseeing the RAPTOR program

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in the Kimberley alongside her resident colleagues Drs Lydia Scott and Justin Barton and a team of experienced visiting physicians. She says the Kimberley has advanced general physician trainees but has never had basic physician trainees. “RAPTOR was devised to mentor people working rurally who might want to apply for basic physician training (BPT),” she says. “They tend to be very keen on learning the complexities of internal medicine, and want to ﬁnd out more about what a career as rural physician would look like. They tend to be our standout residents, such as Dr Tamisha King, our RAPTOR participant for 2022.

“She conducts ward rounds with the physicians, consulting on the most complex inpatients in the region, which involve bedside teaching and increased responsibility for her, so she can take ownership of her own patients and expedite her learning. “Tamisha also has access to our physician clinics, which are probably some of the most interesting in Australia. We see everything and manage it all, as the only resident physicians in the Kimberley. “The Kimberley now has a tele-chemo service, where our oncology patients receive chemotherapy in Broome as an outreach from Sir Charles Gairdner Hospital, and Tamisha is involved in the care of those patients. She has

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excellent exposure to complex medicine on the inpatient ward, plus clinics and oncology.” While there is this hands-on experience, RAPTOR participants also perform a clinical services improvement project with guidance from the WACHS central education ofﬁce on leadership, research and quality improvement methods. “We believe the education is equal, if not above and beyond what residents would receive if they were in a metropolitan centre. A RAPTOR graduate will have great experience and a good-looking CV to put them in good stead to apply for BPT.” For further enquiries on the RAPTOR program email meu@health.wa.gov.au or phone (08) 6553 0856

Further along the physician continuum, WACHS is working to have physician trainees work through their sites on a rural term rotation on a 6-12 month BPT contract. Dr Anna Kelly is a Medical Registrar in her ﬁrst year of BPT in Bunbury for WACHS after successfully completing her internship and the year-long the RAPTOR program in Albany. For her, the rural experience has offered excellent, small-team and often one-on-one teaching by consultants and senior registrars and mentoring. “Importantly, working regionally doesn’t mean less exposure. The range of pathology that you will see and be involved in managing will GOING BUSH | THE BEST MEDICINE

surprise you. As there aren’t onsite dedicated subspeciality teams, you get a real breadth of experience.” In Bunbury, the variety and complexity of work continues to stimulate. “The senior clinicians are approachable and supportive, and very receptive to suggestions for service improvement. There is also a fantastic junior doctors’ organisation that provides support as well as snacks (!) and additional learning opportunities.” Under the leadership of the Western Australian Adult Medicine Basic Physician Training Network Committee, three sites are accredited as Level 3 teaching hospitals with the Royal Australasian College of Physicians (RACP). Trainees are strongly encouraged to undertake at least one three-month rural term as part of the three-year BPT program. Both Royal Perth Hospital and Fiona Stanley Hospital BPT Networks have rural BPT terms. Teaching is conducted on both a formal and informal basis at WACHS sites and BPTs will be supported to dial into BPT teaching at their parent tertiary hospital. Terms in WACHS are accredited for both BPT and advanced physician training (APT). Dr Jaye Martin is WACHS’s Director of General Medicine in addition to a bursting timetable of public, private and Royal Australasian College of Physicians engagements. She spent 12 years working as a physician in various regional sites.

These days, her WACHS’ role sees her focus on strategic planning for general medical services and developing regional physician training pathways. She also runs the WA General Medicine Advanced Training Program for both the metro and rural health services. There are 65 advanced trainees on the program in WA, including in Albany, Bunbury and Broome. Advanced trainees in these WACHS sites experience varied medicine with close supervision. An exciting development in the general medicine training area is the increasing number of trainees opting to dual train in both general medicine and a subspeciality. Not surprisingly, the dual-trained physician is in high demand in regional areas. “It does extend your training, but it is becoming more and more popular with health service employers in both the metropolitan and regional areas,” Dr Martin said. “For those of us who have worked for a long time in the Kimberley, we were ‘gen med’ trained but because of the nature of the work, we’ve become good at lots of things, and we’ve got our own little niches. Viral hepatitis became my personal little subspecialty. When I was in the Kimberley, we set up and ran a Hep B and Hep C treatment program, and that continues to go from strength to strength. “You can really develop your own areas of interest in rural practice, there is so much scope.”

OUR STORY Everyone everywhere is entitled to good health and access to quality health care. For more than 30 years, Rural Health West has worked hard to improve access to health care in our rural communities by delivering programs to attract, recruit and support medical and health professionals to rural Western Australia.

COMMITTED TO EQUITY AND QUALITY HEALTH

We support our rural and remote health professionals through a diverse range of programs and services including conferences, professional development workshops, scholarships and bursaries, rural immersions, personal and family support, outreach programs and business support and advice to rural practices. HELP TO FIND A PERFECT FIT Rural Health West provides a free health workforce recruitment service free to health practices across rural WA. Each year, we work with hundreds of health professionals, including general practitioners, nurses, midwives, dentists, occupational therapists, psychologists, speech pathologists and physiotherapists, to help them ﬁnd the right role in the right location in WA. We provide comprehensive orientations to health professionals who are new to rural communities, so they have the best chance of success when they start work. FULFILLING PROFESSIONAL AND SOCIAL LIVES An important aspect of our work is providing support mechanisms that encourage health professionals to be successful and fulﬁlled in their roles. We provide a short-term relief placement service/locum service, sourcing more than 3,000 days of cover each year to enable rural health professionals to take leave or attend professional development. Family integration and satisfaction are important factors in retaining health professionals in rural locations. We provide Partner Education Grants to enable partners to upskill and retrain to improve their

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GOING BUSH | RURAL HEALTH WEST

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Rural Health West provides a comprehensive suite of education and upskilling opportunities, with about 1,200 health professionals participating in more than 30 regional workshops, conferences and forums each year. employment prospects and also family programs at our main conferences to provide families with opportunities to engage with one another. We work closely with other health sector organisations to support professional networking in each region to provide opportunities for shared education, the building of collegiate networks and delivery of regionally integrated health services. ONGOING EDUCATION Rural Health West provides a comprehensive suite of education and upskilling opportunities with about 1,200 health professionals participating in more than 30 regional workshops, conferences and forums each year. In partnership with WA Country Health Service, we provide procedural mentoring programs to support general practitioners with newly acquired procedural skills in anaesthetics, obstetrics and surgery to become more conﬁdent and proﬁcient in their extended practice. GOING BUSH | THE BEST MEDICINE

Each year, through the Australian Department of Health we provide Health Workforce Scholarship Program grants valued at $1 million to provide ﬁnancial support for health professionals to access education and upskilling. PROMOTING RURAL HEALTH CAREERS Rural Health West works with WA universities and other health sector organisations to showcase the beneﬁts of rural health careers to students and new graduates. We help deliver rural immersion experiences, provide grants for current health students to support them on rural clinical placements, and provide scholarships to support students to attend relevant conferences and events. We also work with medical students and doctors in the Bonded Medical Program, providing support to help them meet their return-of-service obligations.

easy access to specialised health services. The Australian Government Department of Health’s outreach programs enable health professionals to deliver much needed visiting specialised health care to rural communities. Rural Health West administers visiting services through a range of outreach programs, facilitating the delivery of more than 70,000 occasions of service to people in about 130 rural communities across WA. OTHER INITIATIVES Rural Health West is involved in a range of other initiatives that aim to ensure rural communities have access to quality healthcare including support with new technologies and advancements such as workforce planning, advocacy, strategies and approaches to tackle speciﬁc health issues, and providing data and insight into the rural health workforce.

DELIVERING VITAL SERVICES Many communities in rural WA do not have |

WRAPAROUND SUPPORT NURTURES GOOD MEDICINE

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Doctors can face numerous challenges while working rurally, but distance does not mean isolation when there’s support at hand.

GOING BUSH | RURAL HEALTH WEST

challenge while he was working in a rural community.

Rural doctors have access to support through organisations like Rural Health West, with grants and bursaries for professional development, spousal and family support, and networking opportunities, which in turn helps not only medical professionals but the communities they serve. Dr Osama Ghanem, an international medical graduate from Saudi Arabia, says Rural Health West helped him and his wife surmount any

Dr Ghanem was in Manjimup for three years, doing short stints in Darwin, Katherine and Kalgoorlie, before returning to the metro area for his children’s education. “I would have liked to work rurally for longer. It was a great experience. I enjoyed meeting the local people and doctors from different backgrounds,” he says. While there were some challenges, Dr Ghanem said help was never far away.

“You are away from big hospitals, and you don’t always have the facilities you have when you are working in the city,” he says. “But in Manjimup there was very good support from other doctors and nurses. If you ask for help you can deﬁnitely ﬁnd it.” When he moved to Manjimup with his wife who had limited English skills, they turned to Rural Health West to provide funding for his wife to take TAFE English classes and gain her driver’s licence through a Partner Education Grant. Dr Ghanem also undertook courses through

“

I would have liked to work rurally for longer. It was a great experience. I enjoyed meeting the local people and doctors from different backgrounds. – Dr Osama Ghanem

GOING BUSH | THE BEST MEDICINE

Dr Carol Valdez & family

Rural Health West’s Supervised Clinical Attachments to brush up his anaesthetic skills and several bursaries through the Health Workforce Scholarship Program to attend emergency medicine, paediatrics, contraception and skin cancer medicine workshops. “There was support if I wanted to do any courses and also, after ﬁnishing my fellowship, if I needed to have any courses related to anaesthetics or emergency, I was able to do them.” Dr Ghanem says working regionally boosted his conﬁdence as a doctor. “If a doctor is working regionally, especially fresh graduates, they learn how to be independent because in the rural areas we have a lot of broad things to do,” he says. “I would encourage doctors to work in the country. Some people would be happy to stay there for all their career and they don’t have to come to the city.” Rural Health West also facilitates networking opportunities for doctors to collaborate in a community environment through the Health Professionals Networks. When Dr Carol Valdez arrived in Karratha 12 years ago from the Philippines with her husband, who worked in the area, she was drawn to the relaxed lifestyle where they could make the most of the outdoors. “We really wanted to stay here in Karratha,” she says. “Even though GP life can be quite challenging, you have weekends to look

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forward to where you can just relax with nature and spend quality time with friends.” She turned to Rural Health West for social support to help bond with the local community, often attending social events such as sundowner drinks as a way of meeting other doctors in the area. “We don’t really get time to meet the person on the other end of the phone, so that’s deﬁnitely a great opportunity to mingle and meet them in person,” Dr Valdez says. Rural Health West offers a range of professional development opportunities in the form of conferences and workshops across WA for doctors, nurses and allied health professionals to access upskilling and networking. They also support families of rural health professionals attending the Perth-based conferences to accompany them and participate in the partners and children’s program, which enabled Dr Valdez’s partner and young daughter to attend. “Every year we have the annual conference, and they offer free ﬂights for doctors and partners to go. We don’t need to worry about the cost of going to the conference with the whole family, we all get to go,” she says. The social programs provide opportunities to experience activities and events that may not be accessible in a rural or remote location and to meet other rural families. “During the conference, the kids get to go to the zoo, they go to Rottnest, they have different things to keep them entertained GOING BUSH | RURAL HEALTH WEST

“

Rural Health West keeps asking us how they can improve their services. They are very good at listening to what works and what rural GPs appreciate, and they adapt their programs to that effect as well. – Dr Lorin Monck

while us doctors get to use our brains over the weekend,” she adds.

“There is amazing support for doctors to upskill.”

“Hats off to Rural Health West because I think they really support the doctors well up here,” she says.

Kalgoorlie-based GP Dr Lorin Monck, who has been working rurally for more than 20 years, says GPs can feel they don’t have the skills to work in rural areas, but Rural Health West offers plenty of opportunities to bridge the gap.

Dr Valdez has also taken advantage of the Rural Health West professional development grants. “I was interested in doing further studies in skin cancer. I enrolled in one of their programs because skin cancer up here is one of those things that you see every day, so I felt like I needed to be upskilling in that ﬁeld to be able to support the community,” she says. GOING BUSH | THE BEST MEDICINE

“They’ll facilitate the payment of those courses so you can feel more conﬁdent. They make it very ﬂexible and easy to get grants to help maintain skills,” Dr Monck says. The Rural Procedural Grants Program* provides $2000 a day to GPs who are practising unsupervised procedural and

emergency medicine in rural and remote areas to assist them in maintaining or updating their skills. There is also a Workforce Incentive Program* for doctors, which is a ﬁnancial incentive to compensate for the challenging nature of remote medicine. “Rural Health West keeps asking us how they can improve their services,” Dr Monck adds. “They are very good at listening to what works and what rural GPs appreciate, and they adapt their programs to that effect as well.” * These programs are funded by the Australian Government Department of Health

MEDICAL CAREERS CAN BE ALL SHAPES AND SIZES

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Taking different roads and turns makes life and work worthwhile. These doctors are ﬁnding their own special niche in their rural communities.

GOING BUSH | RURAL HEALTH WEST

mental health so they’re not having to use public services or go to Perth if they ﬁnd themselves in need of help,” he says. ASSOCIATE PROFESSOR MAT COLEMAN: RURAL PSYCHIATRY, GREAT SOUTHERN “One of the things about being a psychiatrist regionally is that you wear multiple hats,” Albany-based psychiatrist Dr Mat Coleman says. Even though he has speciality training in child, adolescent and addiction psychiatry, Dr Coleman describes himself as a “generalist specialist” with a variety of roles. “The roles of being a specialist in a region are marked and varied and sometimes send you in directions you never would have anticipated,” he says. Dr Coleman holds an academic position with The Rural Clinical School of WA and is involved in advocacy expanding the remit of psychiatry into rural areas including into training, research, innovative rural mental health services and workforce expansion and development. He is also a clinical director for WA Country Health Service in the Great Southern and South West of WA. “Because there are so few of us, I also have roles that represent rural psychiatrists with the college and other organisations,” he says. In addition, Dr Coleman has the responsibility of providing clinical care and support to his colleagues. “As a psychiatrist working regionally you have an ethical and professional role to support medical and health colleagues in their own GOING BUSH | THE BEST MEDICINE

“Regional specialists are also required to train junior doctors, medical students, interns, RMOs and registrars in psychiatry as well as other disciplines such as general practice. They also supervise trainees who are doing additional advanced mental health training,” he adds. Overall, his rural role is multidisciplinary and varied. “No day looks like another. The fact that you can lean into areas of medicine that take your interest, I find that really rewarding but it’s also the fact that the work and its impact goes beyond the clinic room for individual patients,” he says. “You can have a public health role and a strategic role enhancing capacity and sustainability in a region, and that’s what gives so much more meaning to my role as a psychiatrist working regionally,” he says. “You’re more integrated and the community is more relational, so you know people on a firstname basis and it is also more collegial. I think I know just about every general practitioner in the region and that has benefits both professionally and for the community.”

DR GRAEME FITZCLARENCE: PALLIATIVE CARE, PILBARA Before becoming a doctor 26 years ago, Dr Graeme Fitzclarence had worked in many

Associate Professor Mat Coleman

roles, from being a jackaroo and a pilot to a registered nurse and paramedic, before entering medicine as a mature-aged student. Now a district medical ofﬁcer for WACHS in Karratha covering anaesthetics, ED and palliative care, and the local director of clinical training, Dr Fitzclarence’s days are equally rewarding and challenging. They’re also varied, where one day he could be the anaesthetist for a woman undergoing a caesarean and the next providing end-of-life care for an elderly man in the outback. Working remote stretches in the Pilbara is quite the change from ward rounds at Sir Charles Gairdner Hospital and being on the road from suburb to suburb in Perth as a palliative care community doctor with Silver Chain. “The Pilbara holds a special place for me. I love doing what I do here,” he says. “My regional role now takes me anywhere from Port Hedland to Marble Bar to Nullagine and Newman to Paraburdoo to Tom Price to Pannawonica to Onslow and back to Karratha. My ward round now is over 2000 kilometres whereas before it was maybe 300 kilometres.” Working in rural medicine goes beyond the everyday experiences in tertiary hospitals.

Dr Graeme Fitzclarence

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“The autonomy and responsibility and the reward that I now have is far and beyond, and immeasurable by comparison,” Dr Fitzclarence says. “It really does allow you to test your boundaries, to really know that you can make an important or signiﬁcant decision often where people’s welfare or life is concerned and back yourself to make the right decision.”

Despite the isolation of the far outback, there is still help around to call on day and night. “It’s always with support, of course, from local colleagues and tertiary referral partners. You’re never alone, as far away as you are,” he says. Whether he’s the only doctor on the ground in the remoteness of Cotton Creek or caring for an elderly Pilbara resident in his last days, Dr Fitzclarence’s days are fulﬁlling beyond measure. “Yesterday I had one of the most rewarding days in my palliative care career, caring for an elderly gentleman who had been a long-term resident of the Pilbara. He had his own turn of events recently and had become my palliative patient quite suddenly but nevertheless it was a real pleasure to be looking after him,” he says. “Just a few weeks ago I was down at Cotton Creek on the Canning Stock Route seeing a palliative patient out there. Being the one out there on the ground at Cotton Creek, sitting at the end of the bed with my patient who passed away a week or so later during an east Pilbara sunset, you’re never going to get that in the city.”

DR SARAH MOORE: MINDFULNESS IN MEDICINE, SOUTH WEST GP obstetrician Dr Sarah Moore is marking 10 years as a RCSWA teacher in Busselton this year where she teaches practices such as mindful communication and mindful GOING BUSH | RURAL HEALTH WEST

compassion to junior doctors and medical students. “When I started out as a GP registrar, I never thought this would be where I’d end up but that’s the beauty of rural medicine,” she says. Dr Moore developed her mindfulness program during her master’s degree which extended into her PhD. She is now running the course with doctors at Fiona Stanley Hospital as well as trainee doctors in a rural setting to take into their medical practice and their own lives. “One of my passions is delivering mindfulness to my medical students. I’ve developed the program in a way to teach them the different tools and applications and elements of mindfulness that’s very practical and relates to the work they’re doing as medical students and junior doctors,” she says. Mindfulness started out as a personal journey for Dr Moore for her own health and wellbeing. After her second child, she was looking for tools and strategies to prevent herself from burning out as a working mother. It worked for medical practice as well. “Medicine can become very stressful and lead to problems and practitioner burnout but it can also lead to medical errors. Having a mindfulness practice can help prevent those sorts of adverse outcomes which we’re all at risk of when we’re working and living these busy and overwhelming lives,” Dr Moore explains.

Dr Sarah Moore

GOING BUSH | THE BEST MEDICINE

“Mindfulness is very simple and yet brings your attention to things with curiosity and kindness rather than judgment. It’s a tool that you can apply in any situation, whether

that’s as a mother with children, or as a doctor with a patient or as a medical educator with a student.” Dr Moore ﬁrst started teaching at RCSWA Broome in 2010 while completing Advanced Rural Skills in Aboriginal Health, before heading south to Busselton at the beginning of 2012 with her baby daughter and husband in tow. “I love my job and that’s because I do different things that complement one another,” she says. Working rurally affords Dr Moore the autonomy to bring in the elements of whole person care while practising as a GP obstetrician, enabling her to work between both the primary care and hospital setting to provide continuity of care for women and their families. “One of the things I really love about being in the country is being able to have a procedural skill like obstetrics. Being able to offer that is increasingly difﬁcult in the city, whereas GP obstetricians are critical to providing maternity services in rural areas,” she says. Dr Moore enjoys getting to know her patients not just in the clinical setting but outside in the small community as well. “I see my role as a GP in a community like this as a real privilege and it provides me that capacity to really engage the community in a way that I can support its growth and wellbeing and help it thrive,” she says.

LOCUMS COMING TO TOWN Locums are essential workers in many rural practices, and the good news ﬂows both ways.

DR LORIN MONCK Kalgoorlie-based GP Dr Lorin Monck has been a locum for 24 years, having undertaken assignments all over WA, from Esperance to Ravensthorpe, to Pannawonica and Kununurra. He has also started working in clinics with the Royal Flying Doctor Service. Depending on where he is stationed, Dr Monck could be working in a remote farming community or treating tourists travelling through Esperance, which allows him the opportunity to see a vast array of patients of all different ages with various needs. “The community needs are different and that’s interesting to someone who is in the middle of their career,” he says. Dr Monck enjoys being able to experience

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new places while being useful in different communities, especially in one-doctor towns when the only reprieve the local GP might get is when a locum comes to town. “I enjoy the scope of work and I like giving the doctors a break. The GP in a one-doctor town will often say they haven’t had a break in some time,” he says. The patients in small communities are also very appreciative of being able to see a doctor and go out of their way to look after the locums. “A general practice service is highly valued by the local community,” Dr Monck says. “Recently we went out to one of the stations to do COVID immunisations and the local people all came out with their children and brought out damper and biscuits and cake and they gave us a morning tea. You get to chat and get an insight into what they do at

the stations. They’re very down to earth and almost apologetic when they go see the doctor,” he says. Rural Health West provides support and services for locum doctors to ease the transition into a new community. “They really look after you. They’ll tell you about some of the facilities nearby and connect the GP or locum into the community, so they have an instant sense of belonging,” he says. “Even though I’ve been doing short-term locums, you quickly feel you are a part of the community, whether it’s where to do your shopping or local knowledge that you wouldn’t know. They bring you into the community very quickly.” “If you want to do a locum and you’re a bit anxious about your skill level or being in an area without much peer support, they’ll look at it and put you in a medium-sized town,” Dr Monck says. GOING BUSH | RURAL HEALTH WEST

“If you’re more skilled and you’re able to cope with things like trauma or acute medicine, they’re more likely to suggest a remote posting.” No matter how remote you are, help is never far away, with face-to-face peer support and telehealth and video services. “There’s a huge network of telehealth services now so even if you’re in a remote area you never feel as if you’re on your own. You always feel like there are people you can ring and discuss cases with,” he says. “They can guide you through doing some practical things over video.” Dr Monck encourages young graduates to come out to the country to experience it for themselves. “Going around to the different communities I can see that there is a signiﬁcant shortage of Australian-trained doctors. I encourage them to come out bush. And there is, of course, the lifestyle, especially down at the beach in Esperance.”

Dr Weber says she likes being the “new doctor” in town, and doing short stints affords her a lifestyle where she can take time off to do her master’s degree and pursue other passions.

people to explain that to you and the patients understand the system,” she says.

“I thought being thrown into new places would be hard, but it hasn’t been. The doctors and the clinics and the patients, too, are really understanding,” she says.

The highlight is the “cool places” she gets to see and experience, with weekends and evenings free to explore.

Even though there can be high turnover in very remote towns, Dr Weber feels welcomed by other medical staff wherever she goes. “I’ve always felt part of the team; they’re really grateful to have me there. I ask questions and call the permanent doctors and they’re always helpful,” she says. Dr Weber has a non-negotiable list when looking for a locum job, which helps her take roles where she feels comfortable. Rural Health West will source her positions, and she also keeps an eye out on the weekly email with upcoming locum listings. “Rural Health West knows that I don’t want to be the sole doctor. I want to be in a bigger town that has a hospital where I can send people I’m worried about, and that there are other doctors I can call,” she says.

DR HANNA WEBER This young doctor from Melbourne has taken locum jobs that have covered vast expanses of Australia, including Kununurra, Kalgoorlie, Darwin, Albany and most recently Hobart. “I’m keen on travel and you see places at a different level living there,” she says. GOING BUSH | THE BEST MEDICINE

“I’ve got a checklist of things that make me feel supported and safe. “Each town will have different services available. In Kununurra patients have to ﬂy to Perth if they want an MRI. You do have to change what you do. I’m not practising the same way as I would in Melbourne, but there’s

“I’ve had a great experience everywhere I have been.”

“I like experiencing different places, not to live necessarily, but I think you see a totally different angle staying and working for a couple of weeks,” she says. After experiencing the embracing sense of community spirit in the country, Dr Weber says she is now reluctant to practise medicine in bigger cities. “When I was in Albany, one of the doctors invited me over for their family Christmas because they knew that I was there by myself. Small towns are like that. During my ﬁrst week in Kununurra, I was out in someone’s boat. It’s easier in small towns to make friends. Every Tuesday we would have trivia at the pub. You feel part of the community really quickly,” she says. Her stint in Kununurra, which was meant to be for six weeks, turned into six months when COVID sent Melbourne into lockdown. “I just decided to stay. I can say that I lived in the Kimberley and made friends and it was a totally different experience that I wouldn’t have had otherwise,” she says.

It’s been 20 years since seven adventurous ﬁfth year students from the UWA medical school left the leafy surrounds of the Crawley campus for 14 weeks of experiences unknown in Kalgoorlie, Port Hedland, Geraldton and Broome. These ﬁrst students of the RCSWA were followed over the next 19 years by another 1,524 students, helping to grow the school and its accredited curricula to 15 rural sites around the state.

CHANGING LIVES – RCSWA TURNS 20 As second semester 2022 dawns for the 129 students in the Rural Clinical School of WA, a remarkable milestone will be realised. 28 |

The immense popularity of the RCSWA among students from WA’s three medical schools keen to ‘go bush’ for a year of their degree, is a shining testament to the quality of the education delivered and the dedication and sheer hard yakka of the academic and administrative staff to deliver on a promise made to regional communities all those years ago. Speaking to the four past and present heads of school – Emeritus Professors Campbell Murdoch, Geoff Riley, David Atkinson and present incumbent Doctor Andrew Kirke – and one of the RCSWA’s longestserving administrators, Rhonda Worthington, it’s crystal clear that while Federal Health Minister Dr Michael Wooldridge may have set the political ball rolling in Canberra in the late 1990s, the RCSWA materialised here in the West because of persistent lobbying by people such as Kalgoorlie’s Vivienne Duggin (then the CEO of the Goldﬁelds Division of General Practice) and GP Dr Phil Reid and obstetrician and gynaecologist Dr Barney McCallum. They were tireless in their advocacy for sustainable health care for rural and remote communities. They knew that having a regular ﬂow of medical students being exposed to the diverse health needs of people living regionally was a cornerstone of that aim. They hoped the old adage ‘build it and they will come’ would expand to not only students coming, but also to them coming back with a medical degree in their pocket. Grass trees take many years to stand tall, and so does growing a sustainable rural medical workforce, but there are strong green shoots GOING BUSH | RURAL CLINICAL SCHOOL OF WA

and exciting developments such as advanced rural training pathways in the ofﬁng that give people like Ms Duggin and Dr Reid real hope that the dream is becoming a reality. Over the next few pages are the voices of some of the men and women who have helped make the Rural Clinical School of WA the precious commodity it has become and those graduates who have made rural medicine their vocation.

IN THE BEGINNING Rhonda Worthington, Senior Administrative Ofﬁcer A recurring catchphrase common among the heads of the RCSWA was: “Rhonda will know” and she does! As one of the longest-serving staff members of the RCSWA, Rhonda has been integral to its transformation. She has been based at the school’s headquarters in Kalgoorlie for the past 20 years and is responsible for ensuring all its RCSWA sites are appropriately staffed and students are recruited, accommodated and supported – and, of course, the numbers in all her columns add up. Being a sixth generation Kalgoorlie woman, she knows how regional towns work – who best to be the eyes and ears on the ground. In the nutshell, recruit locally and foster local ownership. GOING BUSH | THE BEST MEDICINE

“Vivienne Duggin was instrumental in identifying Campbell to head up the school. Getting a professor to Kalgoorlie was absolutely magniﬁcent and something that we never, ever thought would happen. He was employed by the time I met him, which was early May 2002,” she says. “Only four sites were funded initially – Broome, Geraldton, Port Hedland and the head ofﬁce in Kalgoorlie. With Campbell’s vision and determination, it expanded very quickly. The original grant was something like $2 million in recurrent funding and nearly $5 million in capital works, so there were operational surpluses, which we put into creating new sites.” The Esperance site was opened in 2003 as a Kalgoorlie satellite, and with a determined Scot at the helm and a commonwealth government that kept nodding, more sites followed in rapid succession. Rhonda has seen four heads of school bring their own strengths to the job – each of them with different styles, yet united in the common goal to ensure the school succeeds in growing local doctors who believe in equitable regional health care, just as they do. “Campbell’s vision was to expand the RCSWA across the state. By 2008, Geoff continued to open new sites but also consolidate those we had. David similarly, with a focus on Aboriginal health, and now Andrew who has been instrumental in opening the Warren Blackwood site and advocating pathways for graduates to continue their training,” she says.

The national terms of reference require 25% of medical students in their clinical years to do 12 months at an RCSWA site. Each year, there is an oversubscription of applicants for places. “We usually have about 160 applications and this year there were 110 spots. Students nominate their four top sites, and we try as hard as we can to get them into one of their preferences. Sometimes, it’s logistically impossible, but we try,” Rhonda says. One of the strengths of the WA model is that rather than each of our three medical schools (University of WA, University of Notre Dame and Curtin University) duplicating resources to create their own rural school, the RCSWA undertakes to deliver an agreed curriculum. This was achieved with enormous effort and negotiation, but the result has been not only cost efﬁcient, but has also produced robust medical education, with many more people invested and united in successful student outcomes. It has also meant a dramatic growth in student numbers and an introduction in 2019 of a ﬁnalyear curriculum for students serious about pursuing a career in rural medicine. But this is no cookie-cutter educational institution. “Every site is different, and we don’t compare because it depends on what facilities they have in each town. Some towns have a lot of specialists, so students can get teaching from specialists and GPs. Others like in Narrogin and Esperance have GPs and rural generalists, and, of course, there are the Aboriginal medical services. While teachers may differ, students have the same exams and the same outcomes,” she says. |

Flexibility is essential. Doctors’ varied skills and knowledge are used opportunistically as learning experiences and students take advantage of them. “I think this ﬂexibility of teaching and learning is why we are so successful,” she says. “And, you know, not all doctors charge us for their time, even though it is their right; they consider it’s their professional obligation to teach.” After 20 years living and breathing the RCSWA and seeing the beneﬁts of her work in improved workforce numbers around the state, Rhonda says “it’s been the best ride anyone could go on.” 2003 RCSWA orientation at Esperance

Emeritus Professor Campbell Murdoch, Founding Head of School (2002-2007) How does a globetrotting Scottish GP-academic ﬁnd himself in Kalgoorlie heading up a pie-in-the-sky idea to run a rural clinical school across 2.5 million square kilometres? “Well, a former patient of mine in Dunedin, New Zealand, knew Vivienne Duggin in Kalgoorlie, and Viv was lobbying for a rural clinical school and looking for someone to lead it, and Harriet told her about me,” Campbell says from his home in Blenheim, NZ. “It was a kind of a career progression. I graduated in Glasgow, went into urban practice for eight years, then to Dundee as

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senior lecturer in general practice for another six years, before going to New Zealand to be the first professor of general practice at Dunedin, and then to the Emirates in 1992 to establish a school of family medicine. Somewhere on that list is a year in Ipoh, Malaysia.” So, needless to say, the proposed RCSWA role and its location did not faze him at all, nor his wife, Annie. It was this ‘stop talking, let’s do it’ attitude that helped the RCSWA take its inaugural flight in 2002. In Campbell Murdoch, the fledgling RCSWA not only found a doctor steeped in clinical knowledge, but a seasoned academic who brought his own unique style to faculty meetings.

“I had ﬁrst heard about the concept of a rural clinical school at a conference back in 1999 and it sounded wonderful. It was the kind of thing I’d been waiting for, and it turned out to be the jewel in the crown of my academic career. “It was a totally blank canvas onto which I could put to use my experiences, and there were all these wonderful people around who wanted to work in the school, it was quite incredible. Very few of them left until they died or retired!” That Campbell was not from these parts and something of an iconoclast proved to be the ideal attributes to get this proposal off the ground. He was able to push (and sometimes) crash through the red tape and parochialism where others would stumble. GOING BUSH | RURAL CLINICAL SCHOOL OF WA

However, in those early discussions, he realised just how ready WA rural doctors were for an RCSWA campus and, if not immediately in their town, they were waiting to pounce when it did. Campbell was keen to establish a culture for the school that would reﬂect the close-knit communities in which they were based. “It became a kind of family thing, it wasn’t stuffy or formal, and based on the idea that we were all in this together. Any potential rivalry got sorted out by the fact that each site was different, and they had to be because their communities were different. “We began opening sites in places we had never intended to go. We went to Esperance, Busselton, Bunbury, Karratha, Derby and now, of course, it has extended beyond that. “In terms of curriculum, we were having to work according to a template. There was resistance in those early days from some sectors of the clinical academia. One of the strangest comments I had was a physician who doubted that the RCSWA would be able to expose students to patients who were dying. “I had to shake my head at that, but politely responded, ‘oh I think we can arrange that’.” The foundation stone of the RCSWA, then and now, is general practice, but there’s GPs and GPs – it is a ﬂexible branch of medicine that morphs to the needs of its community. “Students needed to feel anchored, and a GP practice is a good place to start. We also needed them to help deliver babies and that meant we had to make important links with not only GP obstetricians but also with midwives. GOING BUSH | THE BEST MEDICINE

“Hospital-based topics needed accident emergency, trauma, obstetrics and gynaecology, paediatrics, oncology, so I had to have a series of conversations with the people in charge of these disciplines in Perth. “Let me just say that the people who put up resistance to the RCSWA did me a favour because they made me and the team even more determined to make it work. In the end, Lou Landau, the dean at the time, made the call and we didn’t look back.” The fact that students were returning to Perth telling their friends that RCSWA was the place to go for good clinical training had Campbell a little perplexed. “I was worried because it meant that people were coming for our good teaching and not necessarily because they were interested in rural medicine, which was the whole point of the exercise,” he says. When the University of Notre Dame’s medical school opened in 2005, Campbell set to work convincing the heads of UND and UWA that there should only be one rural clinical school in WA. “I consider bringing the two universities together as partners of the RCSWA to be one of the triumphs of my ﬁve-year tenure. There was a lot of resistance in both camps, but we got it done and what followed was wonderful – with the decision made there was a lot of cooperation and goodwill. “The other thing that came out of that agreement was a wonderful movement

of specialist departments responding to requests. For example, Helen Wright was a paediatrician in Port Hedland, who took responsibility for ensuring that there was a kind of universality across RCSWA sites for paediatrics. Aboriginal health people did the same, as did ophthalmologist Angus Turner, cardiologist Johan Janssen in Kalgoorlie and Charlie Greenﬁeld in Geraldton. “Now, former students have come forward as RCSWA coordinators – these are going to be the school’s leaders of the future.”

Emeritus Professor Geoff Riley, Head of School (2008-2015) Transitions can be tricky things, but when Campbell called time, Geoff Riley had been deputy of the RCSWA for 18 months. “The school was still young and developing so a long handover was useful and important,” he says. Geoff has deep rural origins. He was born and partly raised in Dalwallinu, and his wife Lizzie in Toodyay. Geoff has worked in general practice and psychiatry in the South West, and he was a UWA academic, so he knew how medical schools worked. He was cut from a different cloth from his predecessor, but like everyone involved in the RCSWA, saw the potential it held for rural communities and for the profession. |

The sessional nature of the work also meant that the RCSWA became popular among women doctors starting their families. “Women would sometimes bring their babies to class and the children were handed around to the students, in fact the babies became honorary staff members helping to deliver classes on paediatrics,” Geoff says. “It was all very mature, and the students respected that they were treated as the adults they were. It was all ﬁrst-name terms and small-group teaching, which was exceptionally good and produced excellent results. Our students were returning to Perth and passing their exams and telling their peers that RCSWA was terriﬁc.”

Students in Kalgoorlie in 2005

“I had been a rural doctor and had been Associate Dean and Head of Psychiatry, so I thought I would be a good fit, but mostly I believed in the idea of RCSWA and like so many others wanted to be part of it,” Geoff said. “We had bought a property in Albany in 1988 as a retirement plan, so the RCSWA proposal fitted perfectly.” It shows the flexibility of the organisation that it can have a headquarters in Kalgoorlie with the head of school hundreds of kilometres away. But, then why wouldn’t it work for a team expert in working collaboratively from afar while delivering outcomes locally? In 2008, Geoff was overseeing sites in

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Kalgoorlie, Broome, Geraldton, Port Hedland, Esperance, Albany, Derby and Bunbury. Over the next six years, Karratha, Narrogin, Busselton, Carnarvon and Northam would be steadily added. “The RCSWA has a very ‘ﬂat’ organisational structure – not at all ‘top down’. We set about recruiting extraordinary people and opened sites carefully – and only when and where we had doctors to deliver the courses, but everyone was excited and keen as mustard. “We subsequently started a postgraduate diploma in rural health and that boosted the clinical staff’s conﬁdence in being academics. We had incredibly smart people involved.”

Research, which Campbell Murdoch insisted the RCSWA take up from the school’s inception and set aside 10% of its budget for that purpose, began to establish long-term projects, particularly in the areas of diabetes, which are starting to yield their results today. He also employed the late Professor Denese Playford who was an expert in medical education and the architect of the RCSWA curriculum. Her numerous papers on the RCSWA and the rural medical workforce are often cited and have helped shape policy to rectify rural medical workforce shortfall. “My job at RCSWA was to carry Campbell’s legacy forward and to maintain the extraordinary energy and enthusiasm, the spirit that characterised the school,” Geoff says. “From its inception, the school and its students have had to learn a different way of doing education. We couldn’t do the threeGOING BUSH | RURAL CLINICAL SCHOOL OF WA

month rotations like they do in Perth. We didn’t have those different specialist units, so we introduced a longitudinal integrated curriculum, which meant that students were learning different topics at the same time in parallel. “So, the RCSWA represented a radical new approach for medical school teaching, learning and administration. It was dramatically interesting, and important to get right. And we did, our results proved that.” By the end of Geoff’s tenure, the data told the story. There were almost twice the number of students applying for the RCSWA as there were places; exposure to rural medicine as an urban student meant they were three times more likely to return to some form of rural service; a student born regionally and undertaking RCSWA was seven times more likely to return to rural service. “It’s important to acknowledge that we didn’t necessarily increase numbers dramatically as people were hoping because the doctor numbers had been falling progressively for the past 50 years in the bush as towns shrank. But we did stop the decline. “Esperance for example was down to 10 GPs and over the past decade has risen to 20 and they have been mostly ex-RCSWA people. “And the RCSWA is not just about the numbers. It has been great for rural communities to have a university in their town. When we opened in Narrogin, the town put up a directional sign ‘To the Medical School’ in the main street, they were that proud of it. GOING BUSH | THE BEST MEDICINE

“The communities have opened their doors to our students because they know that deciding to come back isn’t all about the medicine, it’s about facilities and how welcome they are made to feel. “And for the local health fraternity to have students in town dramatically ramps up their own academic and professional activity. It lifts everyone’s spirit.”

Emeritus Professor David Atkinson, Head of School (2015-2019) David Atkinson has been part of the RCSWA landscape since its inception and has been the architect and the engine behind many of its Aboriginal health projects. While he is now synonymous with Broome, he was working at UWA in Perth as Director of the Centre for Aboriginal Medical & Dental Health at the time the Department of Health called for EOIs to establish rural clinical schools across the country. “I was interested in being involved straight away, and there was interest across the medical school. Fiona Lake was keen and asked me to join a committee, chaired by the then Dean Professor Lou Landau, to formulate a bid. “Kalgoorlie advocates Vivienne Duggin and Phil Reid also came to the meetings – they

recruited Campbell, which turned out to be a very good move.” David and his wife, Sue, moved north in 2002 to establish the Broome and Port Hedland sites, which had one trial student each, while Brenda Murrison was the Geraldton coordinator and Phil Reid in Kalgoorlie. The Atkinsons were no strangers to the Kimberley – David had been medical officer for the Fitzroy Crossing area in the 1980s and both enjoyed the experience. They also did a stint in Darwin. Broome ticked Sue’s only request of “somewhere near the sea!” “I was essentially doing Aboriginal health around the Top End until we returned to Perth for our children’s education, but once they had finished, we were both happy to return north,” he says. David’s earlier commitment to the RCSWA was half time as teacher, coordinator and supporting the GP registrar program, the second half of his week was working for the Aboriginal Medical Service. The mantle of head of school was not something he rushed to claim, even when Geoff Riley subtly asked him. It was wife Sue, who challenged him – “Why don’t you?” she said. “I rang Geoff back the next morning,” he says. “l had been so actively involved in the RCSWA and knew what was happening – in fact we all did because the structure is so flat. On top of that I was the UWA representative on the RCSWA Executive Committee. I was very aware of how the RCSWA operated. |

“One of the things I wanted for the school was more research. The budget was a bit tight back then, so we had to cut our cloth a bit. Campbell fought the Commonwealth early on about research – he thought it essential, the Commonwealth didn’t. He won. “I convinced Campbell to fund a research fellow in Broome. I was personally keen to do research, but I didn’t have time to take the lead. When I came back from leave, Julia Marley had just been appointed. [Julia has just been awarded $3.2 million from the Medical Research Future Fund to continue her work on the ORCHID study to optimise screening and management of hyperglycaemia in pregnancy among Aboriginal mothers.] “One of my aims as head of school, was to increase such opportunities for research and we’ve gradually got there, with increasing numbers of RCSWA staff ﬁnishing their PhDs.” Research has now become a bedrock activity of the RCSWA, involving staff, students and of course RCSWA communities around the state. Over the years, past students have been the RCSWA’s most powerful marketing tool, attracting staff is not so easy. He believes many doctors are interested in teaching but either don’t have the time, conﬁdence or opportunity. But he does have a trick up his sleeve. “It obviously depends on which type of staff you are looking for, but the medical coordinators are central. They are almost all part-time, often a day or half a day a week. The best way to encourage people to take the leap is to give them a ‘taster’ to see if they like it, if they do, they might do a bit more.

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“The pitch is variety. You’re working as a busy clinician, but this job gives you something else – it’s different, you can explore outside of your regular activity, get involved and then witness how students and community enjoy it. So, it feeds off itself. And it’s an incredibly friendly and ﬂexible workplace. “Word-of-mouth recruiting is still the best way and the fact that a lot of our staff now are former RCSWA students says a lot.” During his time at the helm, David oversaw the RCSWA involvement in the development of regional training hubs and, with the present head Dr Andrew Kirke, undertook negotiations with Curtin University to have its eligible students participate in the school. But called to name the most rewarding part of his leadership, he would safely return to the people of his community, which are healthier because the RCSWA came to town.

Dr Andrew Kirke, Head of School (2019- ) With the RCSWA so deeply embedded in the hearts and minds of communities, universities, doctors, students and health service providers, the present is taking care of business. That leaves the future, and Andrew Kirke has it very much in mind.

“I think we’re on the threshold of becoming the major source for rural medical workforce in WA and that’s where I see the RCSWA’s development being focused in the next ﬁve to 10 years,” Andrew says. “The combination of one quarter of all the medical students coming through our program for at least one year, plus a smaller contingent spending two years and then being able to go into full year internships and subsequent resident positions in rural hospitals, provides the foundation for a rural training pathway, which I think will turn the workforce model on its head. “So instead of relying on overseas doctors, we will be relying on homegrown doctors. We’ve still got a way to go, but we know that the program’s very successful in changing the intention of medical students from working in the city to working in the bush. “What we need to do now is build those opportunities for those new graduates so that they can actually act on that interest. And that’s a work in progress.” As evident in the preceding pages, much effort is coming from the WA Country Health Service into creating these intern and resident positions and then backing it up with the medical education and training supervision. The foundations need to be strong to address rural workforce pressures. “The other pieces that need to ﬁt into place are GP training and rural generalist training,” Andrew says. With 2023 seeing the handover of GP training GOING BUSH | RURAL CLINICAL SCHOOL OF WA

“

I think we’re on the threshold of becoming the major source for rural medical workforce in WA and that’s where I see the RCSWA’s development being focused in the next ﬁve to 10 years.

to the colleges – RACGP and ACRRM – these new arrangements need to bed down into the existing structures.

Andrew believes this new world needs champions who believe in the vision and will support it in their sphere of inﬂuence.

However, the RCSWA is playing its part in the development of rural specialist pathways.

“We’ve seen what doctors Mat Coleman and Steve Blefari can do in psychiatry – they saw an enormous need in their rural communities, and saw the potential for young trainees,” he says. “And this is key – unless you have a voice coming from the bush, and only hear voices in the metropolitan setting, it just doesn’t cut it.

“However, there’s opportunities for most of the specialties to have their trainees go through some rural training, which would enhance their skills and their career, whether they ended up working in a rural area or not. “In effect, what we’re talking about is building a workforce ecosystem, not just GPs, not just people in one particular skill set or one region but having the whole package so that there is a supported workforce.” GOING BUSH | THE BEST MEDICINE

The success of the RCSWA has not only grown rural doctors, but it has grown rural advocates and Andrew thinks that’s almost as powerful. Andrew’s association with RCSWA began in 2006 when he took a role as a clinical lecturer.

– Dr Andrew Kirke

“We have been involved with some early success advocating for psychiatry training in rural WA and had some success, but perhaps not as much as we’d like in rural obstetrics, rural paediatrics and public health positions.

For the past decade, there has been wider backing for a national rural pathway, so it is no longer a few voices crying in the wilderness. Good ideas ﬁtting national objectives also get a good hearing.

“It’s a similar story in paediatrics. We have a number of rural paediatricians who support trainees and sympathetic paediatricians in Perth who have been great advocates for rural training there. “And when it comes to obstetrics, it is one of those essential services. You can’t not deliver babies in the bush. You have to have a service available here. We’ve had great support from RANZCOG, and it has a signiﬁcant program for GP obstetricians. It requires all-round support.”

“I was in that role in Kalgoorlie for five years, then moved to Bunbury and continued in that role here. I guess at some point I started to take on more leadership roles within the school until David Atkinson asked if I’d like to take on the role as director of the school. “I loved what the school did for my career, and I love the fact that I’ve been able to do it all here in regional WA. It’s been a wonderful career opportunity for me and my wife (GP Clare Willix) but we also feel it’s been a great opportunity for us as a family. Our kids have grown up as rural kids and had a terrific lifestyle.” The future of the RCSWA is also the future of rural health in WA. When Curtin meets its target of students in several years’ time, WA will be producing significant numbers of graduates who have had rural experience. “We could easily swallow up 100 new doctors a year in rural WA alone. The challenge is to ensure training places. Metro hospitals have that problem too, but looking at the bigger picture, that’s probably a better problem to have than not having anybody at all,” Andrew added. |

RCSWA GRADS – PROOF IS HARD AT WORK

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The Rural Clinical School of WA celebrates 20 years of promoting the power of rural practice to medical students and ensuring they can conﬁdently and safely change lives in the bush.

GOING BUSH | RURAL CLINICAL SCHOOL OF WA

Being part of a rural community is a large part of the rich experience for medical students and doctors that Dr Watts says needs to be experienced to be fully understood.

Dr Jared Watts

DR JARED WATTS (UWA) It’s been a few years since Dr Jared Watts was a bright-eyed medical student doing a year in Broome along with six other UWA medical students with the Rural Clinical School of WA (RCSWA). It was 2004 but it’s etched in his memory as a lifechanging experience that fully shaped his rural medical career. “I can honestly say it was the best year of my life,” Dr Watts says. After ﬁnishing specialist training in obstetrics and gynaecology in Perth, Dr Watts took on his “dream job” in Broome as soon as the opportunity arose and six years later, he’s still there and now head of obstetrics and gynaecology in the Kimberley region. He is also a RCSWA medical coordinator for trainee doctors in Kununurra. In 2021, he became the co-director of Obstetrics and Gynaecology for the WA Country Health Service (WACHS). Dr Watts doesn’t believe he would have had the same “incredible opportunities” if he had stayed in the city, including being closely involved in patient care and having access to one-on-one learning with specialists and generalists while on rotations in Broome, Derby and Kununurra as a medical student. “I remember they were teaching us how to put drips into babies in Broome, and by the time we got back to Perth most of the medical students there were still learning how to put them into adults,” he says. GOING BUSH | THE BEST MEDICINE

Even though country life is not for everyone long-term, Dr Watts says it’s worth having the experience of going rural for part of your medical training or career. “If you do decide to stay in the city, just to see where country and Aboriginal patients come from is a skill that will stay with you for life,” Dr Watts says. “To be able to say to an Aboriginal person, I know your community, or I’ve been to the Kimberley, you make an instant connection, and you ease some of their isolation when they are in Perth.” Even though there are some challenges to practising medicine in remote locations, Dr Watts says there is always help nearby to call on. “Everyone working up here in the Kimberley is trying to make a difference, so if you run into trouble at 2am, you make one phone call and you have lots of people turn up to the hospital,” he says. Being in a close-knit team environment with other doctors and being able to travel to remote areas while helping people in the local communities are among Dr Watt’s highlights of practising medicine in the country. As a young male doctor working as an O&G in the Kimberley, doing what the local Aboriginal women call “secret women’s business”, might have posed a problem for Dr Watts, but he says he has been fully welcomed into the community. |

Dr Lloyd Diggins

As an advocate for rural women’s health, Dr Watts is affectionately referred to as “Ladies Doctor Jared” by the local community. “The country patients and the Aboriginal women are so fantastic to work with,” Dr Watts says.

DR LLOYD DIGGINS (UNIVERSITY OF NOTRE DAME) A Wongi Aboriginal man who grew up on Whadjuk and Wardandi Noongar countries, Lloyd Diggins is now practising in Darwin as an intern after spending his penultimate year of medical school in Kununurra with the RCSWA and his final year in Broome where he graduated. In Broome, Dr Diggins travelled to remote parts of the Kimberley for the year, including Derby, the Fitzroy Valley and other remote communities where he was taken under the wing of visiting specialists. Training in less resourced parts of the North West, where technologies such as MRI aren’t as accessible, Dr Diggins says he gained more practical patient examination skills. “The clinical part of my degree was rural which gave me training that was more hands-on with an emphasis on clinical examination,” he says. “I feel like I am definitely ahead of the other graduates just from that.” Being one of only four in a rural hospital as opposed to 200 final-year students meant he had access to more one-on-one teaching with other doctors. “You get immediate feedback about how your examination went and it was a much more individualised teaching than what I can see the equivalent students getting now in a bigger setting,” he explains. Dr Diggins gained a closer understanding of the patients who lived rurally and did not have access to the same level of health care as those in the larger towns and cities. “The rheumatologist might only come once a year, so I’d understand the health issues of someone who has not been able to access a visiting specialist and a follow-up.”

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GOING BUSH | RURAL CLINICAL SCHOOL OF WA

Dr Diggins was a recipient of the AMA Indigenous Medical Scholarship in 2020, and is passionate about Aboriginal health and helping regional and remote communities in Western Australia and the Northern Territory.

doctors or students or graduates. There are so many people who want to support you through it and organisations like Rural Heath West and WACHS are all trying to make these pathways happen.

“You are a part of the community that you’re helping, and you are also affected by the remoteness and your ability to access things like a GP. You’re immersed in it. You then become passionate about being someone who can help make your neighbours or your own family’s health outcomes better than just this idea of people who live far away having worse health,” he says.

“And kudos to the rural GPs – they’ve got additional skills in almost every area – surgery, internal medicine. As a student and as a general doctor, you get to learn from these people with a broad knowledge base. It stops you pigeonholing a patient and you think more holistically.”

The ﬁrst in his family to graduate from high school and university, Dr Diggins believes rural service is becoming attractive to more medical graduates. “I think more people studying medicine are going to want to do what I’ve done and go bush,” he says. People are realising that you can train to become a doctor and you don’t have to be in a city to do it. “Living, working and studying in the bush affords a better work-life balance, and it’s more rewarding health care. You’re not just seeing huge volumes of people you don’t see again. You get to know the patients and become invested in them,” he says. He was overwhelmed with the amount of support he received from the other doctors while training rurally. “Being rural I lost count of the number of people who made an effort to take me under their wing and offer to mentor me for the rest of my career. “You’re not lost in a big pool of other GOING BUSH | THE BEST MEDICINE

Dr Anna Robson

DR ANNA ROBSON (UNIVERSITY OF NOTRE DAME) Broome-based paediatrician practising across the Kimberley, Dr Anna Robson grew up in the Kimberley, the Pilbara and the Wheatbelt and entered medical school at Notre Dame as a mature-aged student after working in art therapy and social work in Perth. When the opportunity arose to do a year in Kalgoorlie with RCSWA in 2007 – the ﬁrst year that the University of Notre Dame was involved in the program – she took it with open arms.

rural practice was something that I wanted to do,” she says.

“Part of my reason for doing medicine as a mature-aged student was because of my interest in rural practice,” she says.

She felt part of a team and had hands-on practical experience with approachable medical staff. “They had embraced us warmly,” Dr Robson says. “You could come and go at any time and get great learning opportunities and your presence was always welcome in the hospital.

Dr Robson found a passion for paediatrics focusing on Indigenous child health during her medical training in Kalgoorlie, which shaped her career. “The applied experience I had out in Kalgoorlie was afﬁrmation that I knew that

“That general receptiveness to having students around was really nice and the open access to the learning as well as the opportunity to shape your own adventure as an adult learner was a much richer |

opportunity in the country than I had experienced in the metro area.” She says Kalgoorlie is “a town with a very can-do attitude” where she found a TAFE art group, a choir and yoga classes. “There’s an energy there that’s different to a mining town and the landscape, woodlands, open horizons, camping in the bush are all good for the soul,” she says. Dr Robson spent as much time as she could training and working in a rural context, which was 18 months but says now, 15 years after doing her training, there are plenty more opportunities for medical students and junior doctors to train rurally and get out of the conﬁnes of a tertiary hospital. “If you restrict your student and postgraduate training opportunities to purely metro locations, I think you miss the opportunity for independence of practice. By stretching yourself and taking on a different level of responsibility that you have in rural medicine is an experience you don’t get in the city,” she explains.

“

Being in the country has given me a really good springboard for pursuing different things I hadn’t considered. – Dr Lucy Irvine

“Many of the school’s teachers are longstanding doctors and that adds to the richness of the experience because it’s both their connection with their communities as well as the hospital medical practice they’re in,” she says. Dr Robson now teaches a short course to second-year Notre Dame students in the Kimberley to give them exposure to a rural context, alongside a program of Aboriginal cultural immersion.

at Bunbury Regional Hospital with the WA Country Health Service. Short holidays to the South West with her partner, a physiotherapist who is originally from the area, piqued her curiosity to see what it was like to live in the country for a year. “I’d heard so many positive things about the experience, not only medically and the opportunities you have in the hospital, but also being able to live in a nice community and being part of something bigger,” Dr Irvine says.

“One of the great rewards of that involvement is sharing with students the opportunities of rural medicine and the rural life we live and to reﬂect on those experiences with them,” she says.

“The RCSWA year in Busselton was deﬁnitely one of the greatest years of my medical school experience.”

“I have a real diversity of practice, from acute medicine to broad communitybased paediatrics with a diversity of patient presentations and acuity that you would really struggle to match in a metropolitan setting.”

DR LUCY IRVINE (CURTIN UNIVERSITY)

She said she enjoyed a perfect balance between the South-West lifestyle and having access to one-on-one learning opportunities from country doctors.

One of the strengths of the rural setting is the longevity of practice of some of the clinicians within the RCSWA.

As a member of the ﬁrst graduating cohort of the Curtin Medical School and an RCSWA alumnus, Dr Irvine has found herself an intern

“When I had the opportunity to stay in the country at the end of the year, I decided it would be a good place for me,” she says.

“There’s also a really different level of engagement with your patients because you live in the community that you practise in.

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GOING BUSH | RURAL CLINICAL SCHOOL OF WA

“Working in the country there are difficulties with staff shortages, but we all stand together and work really well as a team because we know each other so well inside and outside the hospital.” Dr Irvine says working rurally is a good opportunity to try something different and gain new skills while building confidence as a doctor. “It makes me quite an independent doctor and makes me develop really strong clinical reasoning skills because you have to think on your feet quickly,” she says. Being a country-based junior doctor is quite a step up from training as a medical student, but Ms Irvine says practising medicine in a smaller town has given her new opportunities. “I’ve received a lot of support and have felt like there are a lot of opportunities for future career moves. Being in the country has given me a really good springboard for pursuing different things I hadn’t considered.” As well as medical opportunities, there have also been occasions to be involved in the community, such as playing hockey for the local club and trying different experiences like stand-up paddle boarding. “Working rurally has allowed me to have these experiences outside of medicine which is really important as well. I’m definitely pleased with my decision. I haven’t thought twice about it.”

Dr Lucy Irvine GOING BUSH | THE BEST MEDICINE

MOTIVATING THE NEXT GENERATION

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In parallel with the efforts of the Rural Clinical School WA, University of WA’s Rural Medical Pathways program involves a dedicated team, hitting the road to encourage rural students to study in Perth.

GOING BUSH | UNIVERSITY OF WESTERN AUSTRALIA

For many young people living in remote and regional Western Australia, university study in the city is unimaginable, let alone undertaking a medical degree. But after 20 years of concerted effort, thanks in large part to a hard-working team of clinicians and as a complement to its involvement in RCSWA’s immersion initiatives offered to WA medical students in their penultimate of study, that is changing.

In a bid to break down barriers to medical education, the team travels from Carnarvon to the Great Southern, to the Goldﬁelds and increasingly the Mid-West. UWA’s MD Program Director, Associate Professor Helen Wilcox, explains that in various towns and some of the remotest regions, the rural pathway team meets with senior school students and educators to inform and inspire and – ultimately – break down barriers. “Now, with COVID restrictions eased, the team is re-engaging face to face with rural

and remote areas. The students and career advisors need mentorship from our team and that is better done by putting a face to a name. The recruitment team is now able to stand in front of students and say, ‘yes, medicine is for you and it’s within reach’.” Communication and mentorship of aspiring students are key, as is explaining how UWA can help such students manage living away from their home, family and support groups. “Traditionally, rural students may have been reluctant to apply to study medicine, as they think it’s only for those with the most

“

We continue to nurture the philosophy of bringing potential students to Perth from the country and let them see the campus and even the hospitals, so they can see it for themselves. This has been successful, and we hope to do that more. – Associate Professor Helen Wilcox

GOING BUSH | THE BEST MEDICINE

academic ability related to medicine, or they don’t have a clear vision of how a city campus can work for them,” she says. To that end, UWA also offers the opportunity for interested students to experience the campus and the hospital environs in which they could one day be working. “We continue to nurture the philosophy of bringing potential students to Perth from the country and let them see the campus and even the hospitals, so they can see it for themselves. This has been successful, and we hope to do that more.” A/Prof Wilcox says that UWA understands many from remote areas will suffer homesickness and a sense of isolation. As a result, the university offers social clubs and informal networking groups for rural students in a similar situation, as well as scheduled academic breaks allowing extra time for travel back home. UWA also recognises the need to facilitate access to UWA courses for the broadest range of rural students. Applications align with students’ ‘rurality’, ATAR ranking, aptitude test and interview. These initiatives have led to an increase in rural students ﬁnding the conﬁdence to study medicine, and, as recent history shows, these students often return to either their own or another rural towns. A/Prof Wilcox says that inspiring students from regional and remote areas to study medicine in the city is a process that has been proven here and in the eastern states to be the best determinant that they will then return to the regions to practise.

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GOING BUSH | UNIVERSITY OF WESTERN AUSTRALIA

“Rural students understand the scope of regional and remote practice – from a patient perspective, the availability of medical services and even to the financial constraints for regional patients. Students who return to practise in their home regions or similar areas understand what’s possible and what’s not.” Rural doctors also report that their jobs are fulfilling from a community connection perspective and because it can involve harnessing a broad host of skills. For example, a rural medical practitioner may have the opportunity to be the town’s emergency physician, its obstetrician, or an anaesthetist. Indigenous programs at UWA are also critically important, with an annual goal at UWA of allocating 20 medical places to Indigenous students and a flexible pathway that recognises the challenges for those from remote areas. And as it is with all rural and/or remote regional students, UWA’s pathways program encourages Indigenous students to undertake an undergraduate degree at UWA with a view to applying for medical studies as they progress. “This encourages all students to attain a level of performance during the undergraduate phase,” she says. Those studies can also be “a broad suite of subjects. The main thing is that it gives them a good academic base for the future of their student life”.

undergraduate degree as a certain academic performance standard is required to progress to medical school.

UWA also offers multiple annual scholarships for rural students ($5000 for undergraduates and $10,000 for medical students) on a rotational basis. Most are awarded to those recognised during studies for an

Such scholarships recognise that students are in full-time clinical placement and can’t rely on living at home or full-time work to fund themselves. Scholarships are not only meritbased, but also needs-based.

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“It’s so important that we do all that we can to increase the chances of an enthusiastic, young rural student entering the medical profession and taking that knowledge back to the regions,” A/Prof Wilcox says.

WHERE WE’VE BEEN… WHERE WE’RE GOING As WAGPET completes its 20-year contract for GP training in WA, CEO Dr Janice Bell reﬂects on how we can do better.

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GOING BUSH | WA GENERAL PRACTICE EDUCATION & TRAINING

As a lodestone, there’s hardly a better one to guide our endeavours, and almost every opinion I advocate and decision I make can, and does, emanate from that guiding light. In 2007, Kim Snowball challenged me – ‘It should be as easy to train as a doctor in the country as it is in the city. Look at every way we can, together, help make that a reality, and every way we might be impeding that from happening.’ It was a refrain he maintained not only as the CEO of WACHS but also as the DirectorGeneral of WA Health, and one that has stayed with me during my time as the WAGPET CEO, my stints with the RACGP state and national, with AMA state and national, and with Curtin University where until recently I chaired the medical school’s external reference board.

Rural ain’t rural, of course, and so there is no simple or neat answer to this quest. To even begin to address it, aimed at delivering more equitable health care, demands we embrace the volatile, complex, uncertain and often ambiguous worlds of health, people, geography and workforce. Surprisingly, you might think, in the past two decades we have always found doctors who want to ﬁnd the meaning of medicine in a rural place, to make a difference for those who need their care the most, and to enjoy all that country life has to offer.

They don’t always make it through the system. They must confront a multitude of seen and unseen barriers, some of which are set by the profession, some by the context. Nearly all of these barriers can be ameliorated, if not eliminated, and nearly all of these doctors can be better accompanied and supported on their medical journey to places where they are needed most. Incivility. The tone and language with which some doctors speak of general practitioners – and how some general practitioners speak to and of each other – was a complete shock to me when I joined the medical fraternity after a career in many other like professions. If we could change this language and thought, we could see a sea change in attitude towards

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GOING BUSH | THE BEST MEDICINE

“

Research has shown rural doctors are mostly robust in character, resilient, risk-adaptable and enjoy taking responsibility. These are not qualities writ loud in medical school selection processes, medical education programs, or even fellowship training programs. – Dr Janice Bell

what is undoubtedly the hardest craft within our profession. As they say, ridicule is the guardian of the truth, here played out through cheap quips that, over time, bite hard. They sublimate eventually into a simple eyebrow raise, shared amongst the cognoscenti and viewed with surprise by our new peers. Inequity. While it is often claimed rural doctors earn so much more than city doctors, it is not always so. The experience and expertise of a rural doctor is cherry picked by the funders, favouring their procedural and hospital-based skills over the preventive, early intervention and masterly diagnostic. Ironically, these latter services are those that need critical, life-changing and hardto-acquire craft skills that keep patients and

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communities well and away from avoidable procedural- and hospital-based care. This inequity is seen most prominently in the profound, chronic, bipartisan under-funding of primary care and it digs deep into both the pockets and eventually the respect of our rural doctors with extraordinary non-procedural expertise. Individuality. Research has shown rural doctors are mostly robust in character, resilient, risk-adaptable and enjoy taking responsibility. These are not qualities writ loud in medical school selection processes, medical education programs, or even fellowship training programs. Nor are they qualities to be taken for granted – set and forget – as if they unerringly can withstand long periods of exhaustion, fatigue or isolation.

At WAGPET we have seen this clearly with our rural generalist registrars, in particular. They are typically their own harshest critic and our most uncompromising participants when it comes to the service we provide, and there is no doubt we must – and do – pivot to provide bespoke support where needed, and to address and help meet their similar yet different needs in fulﬁlling their evolving career intentions. Mentorship. For more than two decades I have lauded the success of the rural clinical schools in recognising and rewarding scholarship and supervision previously provided in silence by our rural doctors for the next generation of their peers. It was a trail that WAGPET subsequently followed, and despite dire prognostications from

GOING BUSH | WA GENERAL PRACTICE EDUCATION & TRAINING

the naysayers, WAGPET has never had a problem recruiting enough passionate, capable, inspirational mentors, educators and supervisors for our registrars. They are not perfect, any more than you and me, but they are not less perfect than those undertaking the same role in our city locations. Infrastructure. It might surprise you, then, to learn it is not so much the lack of interest in rural practice, or the ability to access safe quality training while delivering safe quality care, that threatens our delivery on Kim Snowball’s challenge. It is infrastructure. The most obvious infrastructure is a house, child or after school care, communication means, and in some places a vehicle and a licence to drive it. To that list, we can expand to partner support and professional and fatigue leave. But infrastructure is where all of the above barriers – incivility, inequity, individuality and mentorship – play out in policy and procedure. Some infrastructure cannot be found at any price, including housing and child care. For instance, despite much advocacy, a house will not be provided if a GP registrar works parttime in the local hospital and part-time in an Aboriginal medical service. In other areas, the local shires or government and the mining industries set their own priorities and thus set limitations around child-care access for doctors, though they sympathise, of course, and keep begging us for more doctors. Some missing infrastructure is medical. The lack of operating theatres, other skilled health GOING BUSH | THE BEST MEDICINE

GP REGISTRAR DISTRIBUTION 2010-2022 South West

644

Peel

392

Kimberley

373

Great Southern

299

Mid West

257

Central Wheatbelt

121

Goldﬁelds

Pilbara

workers, and specialist equipment leaves patients and their most competent doctors adrift, much more than it should. Credentialing can exacerbate this inability to deliver services for which rural doctors are proven competent. A GP anaesthetist can intubate a three-month old with bronchiolitis but be relegated to merely delivering consent form signatures for a routine grommets list, while the ‘real’ anaesthetist is ﬂown from Perth for the morning. The lack of a permanent contract, the lack of an equitable job-to-be-done industrial agreement, leaves many rural doctors dependent on lucrative but uncertain locum contracts, subject to the ‘real’ specialist being unavailable. The lack of recognition that if not trained for rural practice almost any other specialist is less competent, that being able to deliver a baby and support it during its ﬁrst few hours, weeks, months, years of its life is undoubtedly better health care is deeply troubling to me.

WHAT HAS CHANGED SINCE 2007? Not much. Certainly not enough. There is more awareness, more funds, more distributional KPIs for all of us, but not – in my view – a true grasping of the nettle, the recognition starting from each community of what is needed in an affordable and accessible way, and how we must pivot towards them and away from our organisational egos. It still perplexes me how we can get in the way, when ostensibly we all want the same outcome – doctors with the right attitude and aptitude for some of the most vulnerable, grateful and amazing communities in WA. I think our best hope lies the new generation of rural doctors – they often see things more clearly, more directly, more locally, and mostly from the community perspective more than their own. They who know how their journey could have been improved and thus lost fewer colleagues along the way. Maybe they will plant the seeds of trees that others may shade under, even in our most inhospitable places.

TWO DECADES OF GROWING RURAL GPS Two decades. A mission to support doctors to work and train where they are needed most. Over 1200 fellowed GPs out working in our communities, all who have undertaken their training with Western Australian General Practice and Education (WAGPET). 50 5 0|

GP registrar Dr Dikshy Garg

GO G GOING OIIN NG BU B BUSH U US SH S H | W WA A GE G GENERAL ENE NERA R AL PR P PRACTICE R AC ACTI TI C CE EE EDUCATION DUCA DU CAT TIIO ON N&T TRAINING R AIIN RA NIN ING

WAGPET has a timeline scrawled along our ofﬁce wall of our milestones and achievements over 20 years in delivering the Australian General Practice Training (AGPT) program. Small beginnings – just three GP registrars – to today’s 634 doctors-in-training to become a GP. All are learning on the job, in WA general practice facilities, hospitals and specialist clinics. More than one-third of these doctors-in-training have chosen a rural career while hundreds of others have spent some part of their training in a rural or remote setting. ACHIEVEMENTS BEYOND THE DATA You can map achievements by looking at data, trends and KPIs set and met. However, progress in numbers is not even half the story. Over years, our organisation has forged a strong connection between those we serve (communities), those we train (GP registrars) and those mentors and educators who partner with us in the registrar’s workplace (GP supervisors and their teams). They have kept our job very real. Each understanding there is shared ownership in embracing the true purpose. For us that has been about training doctors who ﬁnd the meaning of medicine in a rural place. Twenty years of experience teaches you a lot about GP training and education. You grow better at helping GP registrars navigate their career in those crucial early years and supporting those that have the passion and tenacity to be a great rural doctor. You become adept at tackling the barriers and at working across and with organisations with a similar, or on occasion, competing priorities, programs and vision. You build relationships that endure in communities that understand what they need in health services. We have learned valuable lessons along the way.

GP registrar Dr Callum Lamont

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RURAL AT THE CENTRE

CULTURAL MEANING

Our focus has been to put rural at the centre of all that we do. WAGPET regional medical educators and program training advisors support and case manage every GP registrar’s training journey. Once fellowed, those doctors become the mentors, the educators and the leaders for the next generation of rural doctors. We have established an organisational structure that embraces this as a philosophy and the results are evidenced.

WAGPET Board director and Kuprun and Noongar Aboriginal elder, Mr Malcom Champion, makes sure Aboriginal health outcomes are intrinsic to our strategic and operational plan and all decision-making.

Applications to train rurally in WA are growing each year and demand for rural training places in 2022 outstripped training positions available.

Clinical Lead for Aboriginal Health Dr Kim Isaacs and a team of Cultural Mentors from across the State have ensured cultural competency is at the core of the WAGPET education and assessment framework. The Aboriginal Health Team, through dedication and commitment over two decades, have built a culture at WAGPET that constantly strives to improve the health outcomes of Aboriginal people in our community and for our registrars to provide and practise culturally safe care. WAGPET is also proud of the many

250

200

150

100

GP registrar Dr Priyanka Kumar

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

TOTAL OF AGPT RURAL PLACEMENTS IN WESTERN AUSTRALIA 2010 – 2022

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2021

2022

TOTAL

GOING BUSH | WA GENERAL PRACTICE EDUCATION & TRAINING

“

GP registrar Dr Simarpreet Kaur

Aboriginal and Torres Strait Islander registrars who have succeeded to Fellowship. From 2023, WAGPET as the custodian and deliverer of the AGPT program in WA will hand this responsibility and contract to the GP colleges, Australian College of Rural and Remote Medicine (ACRRM) and Royal Australian College of General Practitioners.

WAGPET SNAPSHOT GPs who complete AGPT training at a rural or remote location are 43 times more likely to still be working rurally As of 30 November 2021, GP registrars represented 14.6% of the WA rural GP workforce 58% increase in number of registrars training in Aboriginal Medical Services since 2018 78% of all non-hospital GP training in 2021 was being undertaken in areas of need (outer metro and MMM2-7).

GP training will ﬂourish if it takes along with it the humility, the learnings, the capable and passionate people who know how WA ticks and a lens that stays contextually relevant to our communities.

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The faculty was formed on 26 April 1992 and today RACGP Rural provides advocacy, education, training and support for rural GPs. This anniversary demonstrates the RACGP’s long-term commitment to prioritising rural and remote health care and advocating for rural GPs and their communities.

COLLEGE SUPPORT FOR RURAL GPS Representing four-out-of-ﬁve rural GPs, the most of any organisation in Australia, the RACGP is celebrating the 30th anniversary of its Rural Faculty in 2022, by continuing to champion the role of rural GPs.

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GPs in rural and remote areas have faced some enormous challenges over the past few years and more than ever, doctors practising outside major cities need different and more robust forms of support. Two years into the COVID-19 pandemic, the need for well-trained and supported GPs has never been more critical. The RACGP remains committed to a world-class health care system for all Australians, regardless of their postcode. Improving access to high-quality general practice in rural and remote communities is critical to the health and wellbeing of rural people, and we know GP training must meet the unique needs of rural patients. From February 2023, Australian general practice training will return to the colleges, which means future GPs will be trained by the RACGP and the Australian College of Rural and Remote Medicine (ACRRM). The RACGP has more than 40,000 members, 22,500 of whom belong to our dedicated RACGP Rural Faculty. “Almost 10,000 of our members practise in rural, regional and remote locations, so we’re well placed to educate a future general practice workforce that ensures healthcare equity.” Dr Michael Clements says. The shift back to college-led training is an opportunity to create a nationally consistent, locally delivered, ﬁt-for-purpose training program for the next generation of GPs. The RACGP will build on the successes of the existing training model led by the regional training organisations, but also make a range of improvements, particularly in the area of rural generalism. The RACGP’s Rural Generalist Fellowship will be launched in the second half of 2022.

GOING BUSH | THE ROYAL AUSTRALIAN COLLEGE OF GENERAL PRACTITIONERS

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I am very proud of each and every service that rural and remote GPs provide every day in their communities. GPs make sacriﬁces and bring so much value. – Dr Michael Clements, Chair, RACGP Rural Dr Prue Plowright in Derby (left)

The RACGP training model will ensure superior education and, importantly, support the equitable distribution of GPs, including mobility across jurisdictions and ensuring that training aligns with community needs. A pillar of the model is prioritising Aboriginal and Torres Strait Islander health and the needs of everyone living in rural and remote Australia. The RACGP model focuses on developing conﬁdent, capable, independent rural generalists (RGs) and rural GPs to meet the needs of communities in regional, rural and remote locations. RGs tend to work in larger regional centres with hospitals and a patient catchment large enough to employ their specialised procedural skills, while most rural and remote GOING BUSH | THE BEST MEDICINE

communities are served by GPs employing additional skills without the support of nearby secondary and tertiary care services.

Generalist Anaesthesia (DRGA), which will supersede the Joint Consultative Committee on Anaesthesia (JCCA) from 2023.

Post-Fellowship, the RACGP will further support these RGs and rural GPs by continuing to lobby government to increase Workforce Incentive Programs with payments for additional skills. We’ll also push to ensure these doctors are appropriately compensated for their additional skills through access to the relevant speciality MBS items.

The diploma is designed to recognise the role GPs with additional training in anaesthesia play in many rural and remote communities.

The RACGP collaborates closely with other professional bodies on standards and training in rural general practice. Our Rural Faculty has been working with the Australian and New Zealand College of Anaesthetists (ANZCA) and ACRRM in developing a Diploma of Rural

The RACGP training model has a strong community focus and is built on the solid foundation of high-quality medical educators, training managers, supervisors and training sites. Its ultimate aim is to improve universal access to high-quality medical services for people in every corner of the country. Visit the RACGP website to ﬁnd out more about the transition to college-led training.

UNLIMITED PLACES ON THE ACRRM FELLOWSHIP PROGRAM Choosing an ACRRM Fellowship puts you on the path to becoming a Rural Generalist.

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GOING BUSH | AUSTRALIAN COLLEGE OF RURAL & REMOTE MEDICINE

We achieve this through the breadth and depth of our competency-based, skillsfocused curriculum, developed by rural doctors for rural doctors. ACRRM supports you on that journey with a rural and remote-centric curriculum, training you in the specialised skills and knowledge to competently and conﬁdently deliver humancentred healthcare. ACRRM Fellowship is a four-year program with the rural context embedded from day one. As the home of rural generalism, we deliver a program providing a broad range of knowledge and skills to produce safe, conﬁdent and independent Rural Generalists who provide their communities with excellent health care.

Fellowship is made up of three years Core Generalist Training and a minimum of 12 months Advanced Specialised Training where registrars must meet training, education and assessment requirements across their choice of Aboriginal and Torres Strait Islander health, anaesthetics, emergency medicine, mental health, obstetrics and gynaecology, paediatrics, surgery, palliative care and more. There are many paths to choose to reach your Fellowship, from fully government-funded to self-funded.

Rural Generalist Dr Michael Flynn

Lead the way – we’ve got your back.

To ﬁnd out more – visit the ACRRM website at www.acrrm.org.au, or phone 1800 223 226. *Subject to eligibility requirements. https://www.acrrm.org.au/home

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CHOOSE THE COLLEGE EXPERIENCED IN COLLEGE-LED TRAINING ACRRM is excited to be provided the opportunity to directly deliver training to registrars on the fully government-funded Australian General Practice Training Program from 2023. We are the only GP college with the experience to directly deliver training to registrars. For more than 15 years, we have directly delivered the Independent Pathway program, and in 2021 we became the only college chosen to deliver the government-funded Rural Generalist Training Scheme. We have

the curriculum, education, training and assessment programs in place, and we have our footprint in the regions, with teams of training ofﬁcers, medical educators, supervisors and training posts. We are committed to ensuring the ACRRM Fellowship Program remains high quality and continues to address the future needs of rural doctors and their communities. If you are planning a career as a Rural Generalist, you can be conﬁdent in our proven track record in setting professional standards for practice, lifelong education, and support and advocacy, for specialist General Practitioners and Rural Generalists.

Find out more about college-led training on the ACRRM website. https://www.acrrm.org.au/about-us/ about-the-college/college-led-training Dr Oscar Whitehead

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GOING BUSH | AUSTRALIAN COLLEGE OF RURAL & REMOTE MEDICINE

ACRRM – YOUR HOME OF PROFESSIONAL DEVELOPMENT As a college specialising in rural generalism, we are proud of our comprehensive professional development program which is speciﬁcally designed to meet the needs of all general practitioners, regardless of whether you are in rural or urban practice. ACRRM’s professional development framework and activities help to ensure you are able to maintain and enhance your skills throughout your career, through a range of clinical, management and professional skills. The ACRRM professional development portfolio is designed to allow self-reporting

within a flexible framework to facilitate the recognition of day-to-day practice-based learning as well as traditional educational opportunities such as workshops, conferences, and meetings. The objectives of the program are to: Provide a continuing professional development (CPD) home that meets all requirements Provide a flexible framework of activities Recognise and respond to the scope and diversity of professional standards required of rural and remote GPs Support members to fulfil their commitments to other professional bodies through crossaccreditation and communication.

Find out more about the ACRRM Home of CPD at: https://www.acrrm.org.au/pdp Find out more about courses here: https://www.acrrm.org.au/courses

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ACRRM’s CPD home is supported by Australia’s most comprehensive course catalogue specifically aimed at rural and remote general practice. Held across Australia, and online, our worldclass courses provide Rural Generalists with the confidence and skills to deliver exceptional care to their communities. Content is developed and designed by people who understand the context in which you practice. Face-to-face courses are back – and delivered in a peer-to-peer learning environment where you not only learn new skills, but can network with colleagues, sharing experiences. Our purpose-built online learning platform provides the opportunity to participate in more than 100 courses from anywhere in the world, at any time. And our extensive database of externally provided activities are accredited, providing you surety they are fit for purpose.

Thanks to the sponsors who have made Going Bush possible

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