Rural & Remote Medicine: a Specialty

1. Rural & Remote Medicine:a Specialty Professor Ian Wronski Immediate Past-President ACRRM Executive Dean, Faculty of Medicine, Health and Molecular Sciences, JCU

2. The Rural and Remote Medical Workforce • 4000 rural and remote doctors • Middle aged workforce • 70% male • 30% Female Source ARRWAG, 2004

3. Practice Style • Private office practice 80% ¾ Owners/partners ¼ salaried by the practice½ involved in hospital care especially A&E • Registrar 9% ½ salaried • Hospital only 5% • Community team 3% • Locum < 1% • Fly in Fly out 1% • Other 1% Source Reality Bites ARRWAG

4. Workforce Source ARRWAG, 2004

5. Procedural activity Source RDAA Viable Models report

6. Workforce Shortages • Workforce shortages in all health professions • Particularly in rural and remote practice • Shortages exacerbated by international competition for health professionals • Difficulties in attracting and retaining health staff to regional areas

7. Current Government Initiatives • Educational Programs • Students • RAMUS • Medical school intakes • NRHN • JFSS • RCS/UDRH • RMBS(100 pa) +234 • Interns • RRAPP • Registrars • GPET Regionalised RTP • ERT Framework • Rural Doctors • Procedural medicine

8. What do we know about going Rural? - the Evidence • Rural origin 2.5X (1.68 to 3.9) • Rural schooling 2.5X (2.2 to 5.42) • Rural spouse 3.5X • Rural undergraduate 2.05X (0.7 to 3.0) plus anecdotal - seem to want to stay on • Rural Intern 3X(Peach et al, Ballarat 2004) • Rural Training 2.5X(Rural Stocktake, Jack Best) • Rural upskilling/support - Stay longer (Hays et al, Wilkinson et al)`

9. The Argument for Rural and Remote Medicine as a Specialty • Meets three core criteria for recognition as a specialty

10. 1. Improve Safety of Health Care • By ensuring dedicated education and training targeted at the realities of rural and remote practice • Provide appropriately benchmarked guidelines for managing clinical risk in rural practice • Foster further growth in research into safe clinical care

11. 2. Improve the Standards of Health Care • Provide an adequately trained workforce • Increase understanding and focus on service needs of rural communities • New models of care and complementary training, accreditation and professional support structures • Consolidate acceptance of rural standards by professional organisations responsible for safety (e.g. clinical privileges) • Provide support and clear points of articulation for entry and exit to other specialties (e.g. general practice into RRM) • Assist other specialties to deliver appropriate support and education to their rural and remote colleagues • Advance more effective medical service models within resource and distance constraints

12. 3. Result in More Cost Effective Health Care • Create most effective rural medical workforce service models • Reduce costs of unnecessary retrieval, referral and transportation for patients • Facilitate resource and administrative sharing amongst training programs and allow for streamlining of training time and arrangements • Create clear and facilitated career paths and continuity of education from undergraduate to postgraduate practice – organisational and professional efficiencies • Assist to recruit doctors by improving status and attractiveness of rural career • Provide impetus for continued growth of intellectual and service infrastructure in rural areas

13. Community Benefits • Better rural doctor recruitment, retention and support • Better targeted training for medical services that rural communities want and need • Opportunity to nurture better inter-specialty teamwork models • Sustaining rural communities themselves by maintaining and retaining rural doctors • More medical services available at home communities

14. Benefits of specialisation • Identity and recognition (retention) • Specialist Rebates (complexity) • Infrastructure support • G/S • Access to MRI referral etc • More Rural Doctors (recruitment) • Career pathways for rural students • Mentoring and teaching next generation of rural doctors • Opens up alternative pathways to doctors interested in rural medicine, but not attracted to standard GP training

15. What’s missing? • Recognition  some recent developments • VR (Partway with PDP) • Specialist (AMC process under way) • Rural Training Pathway enabled and integrated (Part way with GPET enhanced rural training framework)

16. ACRRM • ACRRM • 1700 members • FACRRM – 1330 (generalists) • Advocacy • PDP - unified • For VR • Procedural • Radiology • Education - Filling the gaps • Telederm, Ultrasound, Anaesthetics, Surgery, Obstetrics • Population health (Collaboratives) • RRMEO

17. The Future – what it could it look like • A different educational pathway with flexibility and rural focus • The same infrastructure • Targeted selection to a different cohort • Targeted incentives to learn not just be there

18. Future • Recognition and specialisation • Simpler pathway to RRM - choice • Further development/refinement of standards • Further development of assessment incl exam • Educational gaps addressed e.g. procedural • Increasing rural infrastructure incl Regional Training Providers, Rural Clinical Schools University departments of Rural Health and rural teaching practices • CPMC and College collaboration

19. Future workforce • Important determinant of other factors Workforce Lifestyle Family • Ground work done and infrastructure in place • Wave of students coming • Attract and keep • Nourish and keep them up to date • RECOGNISE and REWARD