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.

Dr Skye Kinder was the 2017 Victorian Junior Doctor of the Year, the 2019 Victorian Young Australian of the Year, and is on the Australian Financial Review’s 100 Women of Influence list. She is a Board Member of the Rural Doctors Association of Victoria and the Postgraduate Medical Council of Victoria, a Near-Peer Mentor and Clinical Tutor at St Vincent’s Clinical School in Melbourne, and a psychiatry registrar at St Vincent’s Hospital.



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.


2 thoughts on “Rural passion, city training: balancing two worlds

  1. Erin Hawkey says:

    Beautiful narrative, Skye.

    I’m hearing everything you’re saying and nodding furiously.

    I found myself waiting, breath held, for the next paragraph…

    So, please, tell me the next installment is ready for the next edition – and details the multitude of reasons urban, tertiary-hospital-based specialty training models are not fit for purpose anymore…

    Not because *now* the rural community is more demanding, or because patients have greater need of service(s) than in decades past – but because we (as a medical workforce) are different.

    Our demographics, our expectations as workers and expectations of our families.

    I don’t have a wife. I AM the wife.

    Medicine’s nostalgic yearning for the golden age of the ‘medicine man’ in ye olde country community are obsolete. That model wasn’t even sustainable in the 80s.

    Patients age with their chronic conditions, surviving longer with severe disease(s).

    We as a workforce demand a different life. So do our families.

    Specialty training models, as they stand, are not fit for purpose.

    Then again, neither is general practice training at present… hence the insanity of the current race to put together a *sustainable* national rural generalist (RG) pathway.

    It will be fascinating to see what happens if (ever the optimist, I want to write ‘when’) RG is perceived as equally appealing (in lifestyle, pay, conditions and prestige) by trainees when compared with other speciality pathways… THEN specialty training will change and allow (again, the optimist in me wants to write, ‘require’) trainees to invest their SOCIAL CAPITAL into regional and rural areas during their training… because they will be BASED rurally if that is what they are offered and when they are rotated to bigger centers, they will likewise be supported by a relocation allowance and their family will be able to remain where they live. Their families will be supported. Their lives will be balanced. They will be content. They will feel (and BE) supported as champions of a funded and fruitful rural health system. They will live their lives immersed in their professions AND their communities. They will educate. They will advocate. They will thrive.

    Imagine that.

    Ahhh, the serenity.

  2. Dr Neil Edward Hucker says:

    Thank you Skye for your personal sharing.
    As a Melbourne suburban boy I thoroughly enjoyed my rural first year residency
    and found myself inevitably drawn to conversations with the weekly visiting psychiatrist.
    After surmounting the biased medical zeitgeist that one was either mad or medically inadequate to
    be a Psychiatrist and being supported by wonderful psychiatric mentors I have never veered from the
    love of the work and the conviction of how important it is.
    I returned to a rural psychiatric hospital (luckily the perfect model for psychiatric care) , for a year to test my conviction and then returned to Melbourne
    to complete training. I was lucky to train in the Golden age of Melbourne Public psychiatry during the 70’s.
    During the 80’s I moved into the mountains to re-invent the wheel and spent many years practising “rural Psychiatry”. The sequential gaining of the GP’s Trust evolved and not having a then urban psychoanalytic impassive role meant that I could be myself and still practice “‘renovation psychotherapy” for those personalities that wanted it.
    Like rural general practice, the breadth of psychiatric problems I had to deal with kept the creative spark alive.
    It was clear that a wholistically trained psychiatrist had an enormous amount to offer.
    The only problem was to create a psychiatrist role that could meld into the community and not bat an eyelid,
    If i was rostered on to play golf with a patient or their relative.
    So keep up the promotion of rural practice which may become more attractive as trainees get sick of the urban
    rat race.

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