Rural practice: A mission much more than possible
WAGPET CEO Adj Prof Janice Bell on rural medicine in WA.
I read the cover story in the March edition of Medicus with some interest. It was a timely examination of an issue that is very close to my heart. The headline asked the question: Rural Practice: Mission Impossible? This is my response.
Over the past decade, WA has been developing a Rural Practice Pathway for doctors interested in country practice. This pathway is open to GPs and specialists working in community or hospital settings, across public and private practice and represents a unique collaboration between the WA Country Health Service, WAGPET, Rural Health West, Rural Clinical School of WA and WA Primary Health Alliance. Each of these agencies has a strong rural focus and recognises the importance of collaborating to overcome the traditional barriers for doctors seeking to work in rural areas.
Given our dispersed rural population, the only viable procedural model for rural services is a shared care model. Specialists and advanced skill GPs work closely together as a team to provide local services in areas like obstetrics, anaesthetics and emergency medicine.
The GPs make up the backbone of these services. For example, almost 85 per cent of emergency services in rural WA are provided by GPs with advanced skills.
The success of the approach to establish an effective pathway to rural practice is measurable and we no longer need to rely on anecdotes to determine the state of affairs in the country. Rural workforce and service performance data over the last decade has shown continual improvement against population growth and demand.
• the number of GPs (headcount) has grown from 556 in 2006 to 934 in 2016 (68 per cent) – a faster growth than population, which over the same period has grown by 14 per cent to 536,000 people.
• the turnover rate for these doctors has fallen.
• the number of procedural doctors has kept pace with the activity growth in our rural hospitals.
• there has been a 25 per cent increase in resident rural specialists, most working within a shared care model.
This represents good news for our rural communities and is on the back of an extraordinary effort from several quarters, not least the rural doctors themselves who have invested time, effort and energy to ensure rural practice is a much more attractive proposition for the next generation of doctors.
The data clearly shows that rural WA has more doctors than ever before; they are staying longer and are better supported in their clinical practice.
As the training body for general practice in WA, WAGPET is proud to be a part of a broad effort that has focussed on more education and training in country settings, well supported by supervisors and training practices and placements in hospitals and general practice.
While on the right path, we have not reached the end of the required effort and much work is underway. There are still too few GPs for many of our rural communities’ needs.
In my view, we need to:
• continue to build an integrated medical education and training system that is not so hospital based, but supports safe and sustainable service models in rural WA.
• seek MBS items for Telehealth consults by GPs into rural communities. It is odd that a specialist can do a consult with patients through Telehealth and receive a Medicare item and yet a GP cannot. As a state with the least Medicare spend per person and one of the most geographically isolated, surely this
is a good way to improve access to GPs in rural communities.
• Establish more training places to meet growing number of medical graduates.
• Expand procedural training places in obstetrics and endoscopic procedures.
Far from mission impossible, rural practice is a mission well on track, thanks to our extraordinary collective action.