Specialist rural outreach needs more support

INCREASING support for specialist outreach programs could be a feasible way of improving health outcomes in regional and rural communities, new research has found.

The authors of a Perspective published in the MJA analysed data from the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of Australian doctors.

Internationally, it was the first research of its kind and aimed to look at the rate of participation and the pattern of service, including the analysis of factors that influence that supply.

The authors found that 19% of the 4596 specialists surveyed provided rural or regional outreach services, many doing so as a way to grow and diversify their main practice.

Although there is a subsidy program, the Rural Health Outreach Fund, which covers the cost of some doctors travelling to remote areas, the authors found that less than a fifth of specialists (19%) were funded by this program.

Many specialists were participating in rural outreach programs through public hospital systems, but there were some specialists who were travelling without any financial support, funding their rural trips themselves – something which lead author Dr Belinda O’Sullivan was keen to understand more about.

“If you’re funding yourself, how far will you travel and how often?” she queried in an MJA podcast.

Specialists who traveled rurally tended to visit only one town and it was often to maintain a pre-existing connection to the region, the authors found; however, the relationship wasn’t necessarily related to a childhood rural background.

“We don’t know the nature of that connection, it may be that they have had family holidays in a particular location, or they have parents who have retired in the region or they merely had some exposure in their undergraduate medical training,” Dr O’Sullivan told MJA InSight.

The largest group doing rural outreach was mid-career specialists, aged 45–64 years, and the study noted that more support may be needed for doctors in other stages of their careers, such as those building their practice and those approaching retirement.

Registrar Dr Erin Vaughan agreed that there would need to be significant support for her to do an outreach program at the conclusion of her training. She has been working for one day a month in Griffith, New South Wales, as part of her nephrology work at the Royal Prince Alfred hospital in Sydney, and has enjoyed learning about medicine in a rural community and diversifying her experience.

It has inspired her to continue doing rural outreach, but she is not sure how she’d go about it or what support would be available.

“It’s hard for us to know how to get out there. It’s quite daunting to go out there alone without the support of senior colleagues,” she told MJA InSight.

The Perspective authors wrote: “One option, facilitated by how common outreach work is, could be to increase outreach work within vocational training, especially through the Commonwealth Government Specialist Training Program, linking emerging specialists with experienced providers”.

Another group less likely to participate in rural outreach were female doctors (15% v 20% of male doctors). According to Dr Sullivan, one reason for this may be the burden of regular travel.

“One option is to think about telehealth and other systems to help with that burden; however, there’s not a lot of evidence to suggest telehealth would wholly replace face-to-face,” she said.

Training and increased support was also flagged by the president of the Rural Doctors Association of Australia and rural GP, Dr Ewen McPhee.

He told MJA InSight that there should be more incentives to increase regional specialist training, including the development of rural training hubs and an intern placement program.

He said that there were a range of specialists who visited his community, including a cardiologist, a plastic surgeon, an endocrinologist, a gastroenterologist, a psychologist, gynaecologists, obstetricians and general surgeons; however, the area was still lacking in many services.

“I believe that psychiatry remains significantly under-represented as does population health, chronic disease management (GPs) and Aboriginal and Torres Strait Islander health,” he said.

He noted that more training for rural generalists would also help, giving them an extended scope of clinical practice within the region.

Dr O’Sullivan said that an integrated combination of local workforce, rural outreach and telehealth was the answer to better health services in rural and remote areas.

“That’s not just going to happen on its own, it’s going to take motivated regional centres to sit down and look at their population and health profile … to make sure that as much care can be provided locally, reducing the need for patients to travel.”

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