THE EXPANDING ROLE OF THE RURAL GENERALIST IN AUSTRALIA – A SYSTEMATIC REVIEW

1. THE EXPANDING ROLE OF THE RURAL GENERALISTIN AUSTRALIA – A SYSTEMATIC REVIEW Chater B., Murray R., White C., Erikson L., Du Rietz M., Sheedy V., Pashen D. Australian College of Rural and Remote Medicine APHCRI Stream Six http://www.anu.edu.au/aphcri/Spokes_Research_Program/Stream_Six.php

2. Australian College of Rural and Remote Medicine

3. Aim of our systematic review • To define generalist practice in Australian Rural and Remote context • To identify the factors which promote or inhibit generalism and generalist practice in rural and remote health • To investigate the policy arrangements which impact on generalist practice • To recommend policy options that could increase the quality and quantity of rural generalists Australian College of Rural and Remote Medicine

4. Methods • Systematic review of the literature (grey and black) • Consultation with policy makers - state and federal • Consultation with communities and the profession Australian College of Rural and Remote Medicine

5. Australian College of Rural and Remote Medicine

6. Medical Generalist roles in rural and remote areas • Rural generalist offer acceptable, sustainable and cost effective primary health care, anaesthetics, obstetrics, emergency and procedural skills Australian College of Rural and Remote Medicine

7. Funding Rural Generalism • Primary health care is equity producing and ‘generalist’ services are cost effective and sustainable for rural communities. • Perverse incentives favouring specialist and sub-specialist practice undermine generalist career choices Australian College of Rural and Remote Medicine

8. Quality and safety in rural health care • Heath outcomes in small rural hospitals - notably in obstetrics - are equivalent to those in major centres, particularly compared with ‘travel-out’ alternatives. Australian College of Rural and Remote Medicine

9. Service models and regulatory framework • Generalist workforce, viable service models and regulatory frameworks are linked. • Models of delegated practice should be explored for both mid-level providers and for specialist substitution by generalists Australian College of Rural and Remote Medicine

10. Conclusion from the review • The international literature supports the efficacy and safety of rural medical generalist practice. Australian College of Rural and Remote Medicine

11. Policy options to support rural medical generalist practice • Support for increasing teaching capacity • Regional planning • Incentives for generalist training and practice • Clearly articulated generalist training pathways • Infrastructure support • Integrated practice models Australian College of Rural and Remote Medicine

12. Education and training for generalism • Rural and regional recruitment and medical training along the rural ‘pipeline’ enhances retention in rural areas and generalist career choices. • Regionally planned medical workforce production is a key policy goal. • Access to hospitals for training and professional development is a critical challenge Australian College of Rural and Remote Medicine

13. Key issues within the medical education sector that have been identified as enablers of generalism include: 1. Medical student selection and admission policies 2. Generalist curricula 3. Generalist representation on medical school faculty 4. Generalist involvement in learning experiences at teaching hospitals (urban and rural) and in the community 5. Exposure to the broad scope of rural generalist experience at medical school, in prevocational and vocational levels 6. Vertical integration of generalist training; 7. Multidisciplinary focus 8. Need for generalists to have a greater teaching role 9. Recognition for medical generalism as a discipline Australian College of Rural and Remote Medicine

14. Some issues to consider • Live in/Fly out training • Addressing spouse’s preferences • Career planning • Integration of initiatives • Vertically • Regionally • Recognition of prior learning • Vocational recognition for generalist skills • Infrastructure – accommodation, consulting space, IT • Aging trainers • The future of generalist specialists • Emergency medicine • Physicians • Surgeons Australian College of Rural and Remote Medicine

15. Australian College of Rural and Remote Medicine

16. Generalism Jack of all trades Master of none But oft times better Than master of one Australian College of Rural and Remote Medicine

17. Contacts • ACRRM Ph: 1800 223 226 Fax: 07 3105 8299 • Contact Assoc Prof Bruce Chater : chater@attglobal.net Ph.+61 419674164 Assoc Prof Dennis Pashen: dennis.pashen@jcu.edu.au. Ph. +61 418 771 441 • Research Group also included . • Vicki Sheedy ACRRM –Principle Research Officer • Col White (Health Workforce Queensland) – Data Research • Lars Erickson (UQ) – Librarian, Literature Review. • Richard Murray ACRRM/JCU - Researcher http://www.anu.edu.au/aphcri/Spokes_Research_Program/Stream_Six.php Australian College of Rural and Remote Medicine

18. Australian College of Rural and Remote Medicine