Rural passion, city training: balancing two worlds

AS A psychiatry trainee, I spend a lot of time thinking. Reflecting, analysing, understanding, formulating. Usually about patients, but sometimes about myself.

They say that great clinicians balance two very different worlds: both the science of medicine and also the art. And nowhere is that truer, I believe, than in psychiatry. As a psychiatrist, you traverse between the worlds of neurobiology and psychology, you balance the DSM-5 with psychoanalysis, and you create systems but also challenge them.

And when I think back about my own life, I realise that I have always been balancing two worlds, in one way or another.

Growing up in central Victoria, I attended a low socio-economic school community. The first in my immediate family to go to university, becoming a doctor wasn’t supposed to be a dream shared by people like me.

And on my first day of undergraduate orientation, having been accepted through rural entry schemes, a classmate told me in no uncertain terms that I didn’t deserve to be there. He said that I had taken someone else’s place.

Surrounded by our country’s elite young people, this feeling of not belonging became a regular occurrence.

I spent my university years, all eight of them, being reminded that I was different. Sometimes in overt ways, when a peer would openly and comfortably state that rural entry students weren’t as smart or capable as other students. Other times in simple ways, when my colleagues would share stories of international holidays that I could never afford.

But as a medical student I found my place – my sometimes small, but always significant place – in rural health.

People who gathered around me and welcomed me as one of their own. People who encouraged me, supported me and helped me to achieve things that I never thought possible on my own. People who, in many ways, were just like me.

I had finally found a place where I belonged, and no one could ever take that away from me. Or so I thought, until I became a specialty registrar.

Because despite growing up in a regional area, studying at a Rural Clinical School, working as an intern in my hometown, and loving my rural health community so dearly, I am currently completing my specialty training at a tertiary centre in Melbourne.

As a profession, we spend a lot of time talking about the rural workforce maldistribution and the loss of specialty trainees from our regions to the capital cities. I guess I’m part of that statistic.

But what I have come to realise through this process is that I am yet again balancing two worlds.

During the day, I work with psychiatry colleagues in the city, passionate about mental health service delivery and good psychiatric care but largely not of rural origin. Meanwhile, in the evenings, I teleconference into meetings with rural generalist colleagues who share my passion for our regions but who have not experienced the trials and tribulations specific to a psychiatry registrar.

As each day passes, the lack of specialist access in rural areas begins to make more sense to me because balancing two worlds is exhausting.

In rural health we often acknowledge the profound social isolation that comes with geography, and I would never seek to minimise the sacrifices that our rural doctors make because they are large and I am grateful. But seldom do we consider the different but still isolating experience of the city-based registrar with a passion for rural health.

Knowing in your heart that you are trying to be part of the solution, while also unintentionally being part of the problem.

Feeling the weight of two worlds on your shoulders.

So to all the other registrars across our country, who have a passion for rural health but training posts in our cities, I don’t know where you are, but I am here. And I hope we get to meet each other one day.

And find our sometimes small but always significant place, together.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.