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AS a rural-origin doctor, I am the subject of many debates. I have been surveyed more times than I can count, and the career choices that I make contribute to scrutinised statistics, impacting political folly and funding.
For there exists a subconscious and, occasionally, even overt expectation that rural-origin doctors must and will solve the rural health workforce maldistribution.
We are expected to remedy a crisis that predominates as a result of decades of inadequate funding and poor planning. One that is still on many levels controlled from the comfort of our capital cities, and discussions about which we may have difficult or inadequate access to contribute.
It is often expected that our dedication to our communities alone will enable us to overcome all odds, including the many varied and formidable barriers to training that we continue to face.
We are the saviours of rural Australia, and any deviation represents a failure of our participation in medicine. In exchange for accessing the privilege of medicine through quotas and scholarship support, we sign an unwritten contract as well as, in many cases, a written one.
And although I too hope that I make a meaningful contribution towards closing our rural gap, the expectations that I have experienced as a rural-origin doctor have often been as unrealistic as my goals to meet them.
It is simply not practical to expect the goodwill of the individual to sustain our rural communities, nor is it even really possible.
What we need instead is acceptance of the inconvenient truth: that rural-origin doctors are people too. People who have their own wants and needs. People whose inherent value should not be determined by government agenda. People who, even at the most selfless and successful of times, remain limited by a broken system.
Rural-origin medical students and doctors bring with them a wealth of diversity and lived experience, and we should continue our concerted efforts to recruit them. But, even more importantly, we should begin to listen to them, to their struggles and to their solutions.
So, while many are describing this year as a watershed for rural health, with potential for real and sustained growth and gain, I encourage you to cast a thought and maybe an ear to our rural-origin doctors, a cohort of colleagues so often discussed, frequently studied, but seldom heard.
It’s time to challenge the notion that our crisis will be solved by simply adding more unheard voices into the rural doctor population. Instead we must embrace rural-origin doctors not as the solution, but as the medium through which the problem can finally, truly be understood.
Only then can we expect real change to begin.
Dr Skye Kinder is a rural-origin doctor and Victoria’s Junior Doctor of the Year for 2017. She was recently appointed to the Board of the Rural Doctors Association of Victoria and is an active member of the Rural Doctors Association of Australia Residents and Registrars Rural Special Interest Group. Follow @skyekinder on Twitter.
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If we just rely on school leaving scores that is definitely unfair, the children from affluent suburbs in high ranking private schools are incredibly advantaged in that system. They have many peers with the same aspirations leading to improved marks, schools that are excellent at coaching students to get high mark and live in a culture where academic expectations are high.
There is inequity in every system and favouring rural students, while not without its own inequities, probably has more positive than negative impacts on equity overall.
Medical student selection needs to be about producing the medical workforce Australia needs. Selecting medical students from as wide a range of backgrounds as possible is likely to make our medical workforce more fit for purpose.
The rural student advantage needs to stop. Currently, city born-and-bred students ( their parents life choice- not theirs) are discriminated against for medical school entry. The scores for rural students are significantly lower yet a city student would have a ‘snowflakes chance in hell’ of getting an interview at somewhere like JCU despite a genuine interest in working rural. It is simply not fair- these students work hard and miss out because rural students are provided with significant advantage. Large regional cities are classified as rural when there is absolutely no educational disadvantage.The rural background is also being rorted by people who own rural property but don’t actually live there.If you work hard in the city you will be eclipsed by a rural peer who did not have to achieve at the same level. Students who have got into medical school on this basis and pushed a higher achieving city studet out- absolutely need to go rural- otherwise it is even more unfair!!!
Skye Kinder and Wayne Shipley are both right. I am the last of a breed of the old school, obstetrics, anaesthetics and surgery. The younger brigade are not as we were. The on-call does not enthuse them. And, I am not from the country. They will not pay us more to be out here, as they think we earn enough, and some of us do. The problems are deeper than money. There is the perennial problem of the spouse and her/him getting a suitable job out here. The Government does not know how to solve the problem, and when a decent program arrives that seems to help they dump it. The ‘PGPPP’ was dumped as it was not paying for itself. But it exposed a lot of young graduates to rural medicine and a number of them returned after getting their rural ticket. Very soon numbers of young graduates will be without an intern year, and this program may have to make a comeback. Bean counters in Canberra may not readily accept this.
It’s easy, there only needs to be one policy, we have enough Med student and doctors in Australia to do it, it is simply underpaid. Just like the trades that get paid double or triple to go out rurally to support the mining industry, start paying double and triple for rural docs and the crisis will disappear and we won’t have to bully rural origin docs or international docs to go out there. It is that simple , but no one wants to simply pay more? It deserves that pay so let’s do it! We could then save money by getting rid of the hundreds of people involved in trying to encourage docs to go out there by some romantic outdated notion of rural medicine. It hasn’t worked in decades why will it start now when we have an even more city addicted medical workforce.
Really interesting post, certainly we must accept that people make choices. Against that:
1. we know that rural-origin doctors who attend rural medical schools are more likely to stay working in rural. So there is a statistical argument here – it is not that everyone who is in that category ends up in rural, but rather that it is just more likely.
2. Government policy has designated a certain proportion of places in all medical schools for rural-origin students. What should government policy be for students who fill those places who would not otherwise be accepted into medicine?
I agree that rural doctors (those who choose) to work rurally are expected to overcome all obstacles; Interestingly, my superdoctor skills do not enable me to attend a short course in my capital city that is not televised, as I would have to leave home the day before and travel home the day after (due to the plane timetables) and thus miss 3 days work (and miss home life and miss supervising the family and the grandmother for whom I am carer).
I cannot even use my superdoctor skills to get the city to videoconf us here instead of phoning – all our phones can have secure teleconf apps, but the Sydney city hospital IT dept cannot set up the older subspecialist with a computer-camera, and the younger doctors do not want to breach a (misunderstood) rule about teleconf on their personal devices. Rurally, we are teleconferencing increasingly to the more remoter areas. It will be useful and highly valued when the city IT and specialists and subspecialists and trainees start this more. We did have one successful immunology consult for an inpatient which avoided his transfer to the city by plane, so maybe seeing this as a money saving method might get others on board?