Rural health a highway, not a pipeline

IN rural health we spend a lot of time talking about career pipelines, but a wise man once told me that rural health is actually more like a highway. Now, in my final year of medical school, I understand what he meant.

I’m a rural-background student and I’m passionate about rural health. In just those few words many of you will have already conjured up an image of who I am and what you expect my story will be.

If you live in Victoria like I do, then you’re probably picturing that I’m from a small town, maybe a farming community. I probably want to be a rural GP, and I’m probably completely unwavering on my journey from the bush to medical school and back to the bush again.

Except I’m not. I’m from a large regional centre, I haven’t decided on a specialty, and I’ve definitely been unsure of how my passion for rural health will fit into my career. And that’s okay.

But over the years I have noticed that in some instances, it doesn’t feel okay. And never has this been truer than in my final year.

Like most other final-year medical students in Victoria, I have started the process of applying for internships. I have applied to a mixture of country and city hospitals and, in the current climate, I’ll be happy just to get a job at all.

Yet I have been expected to justify my decision to rural and metropolitan peers alike. I’ve fielded months of endless questions: “are you applying for city jobs as well?”; “aren’t you supposed to be interested in rural health?”; “don’t you want to work with rural patients any more?”

And while this experience has been a silent one, it has not been a solitary one. At the end of our degrees, many of my friends and peers are being presented with a binary career decision: join the rural health pipeline, or don’t.

But the reduction of rural health to a single career trajectory undermines the inherent diversity of the sphere.

The rural health sphere spans seven states and territories and encompasses a variety of communities, industries and landscapes (geographical, political and otherwise). It encompasses the work of rural GPs, rural generalists and rural specialists. It encompasses the work of locums, telemedicine providers and fly-in fly-out doctors. It even encompasses the work of many tertiary and quaternary service providers.

The breadth of health professionals who make important and meaningful contributions to the lives of rural patients should not be underestimated or forgotten.

In fact, the Australian Medical Students’ Association Rural Health Committee has long argued that the nomenclature of a rural career “pipeline” is doing more harm in rural health than good.

By their very nature, pipelines are inflexible. They focus on the production of a single outcome, often at the exclusion of all others. They lead to binary decision-making: are you in or are you out?

Ultimately they deter passionate students and junior doctors who might not be quite so unwavering in their career choices, and they inhibit others for whom the pipeline is simply not a good fit.

So instead of talking about a rural career pipeline, we should focus our discussions around the many and varied rural career pathways that are too often overlooked. Flexible pathways, inclusive pathways, non-binary pathways. We should be as embracing as we are diverse.

For some people their career in rural health is a simple drive from start to finish. For others, it’s a series of on-ramps and off-ramps, roundabouts, detours and empty tanks of petrol.

For me rural health is a highway, and I’m enjoying the ride.

Skye Kinder is co-chair of the Australian Medical Students’ Association Rural Health Committee. She is in her final year of study at the University of Melbourne, and has just learned that she will be interning in her hometown of Bendigo next year.

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