For many doctors working in rural and regional WA, it’s more than a job – it really is a way of life, as Marnie McKimmie explains.
It is the teamwork, trust and terrain that captures the hearts of doctors such as Rural Doctors’ Association WA president Dr Brittney Wicksteed. They channel their energy into addressing inequalities in rural and remote healthcare.
“Seeing the skills of the rural generalist doctors in action is quite awe-inspiring – no matter what comes through the door, the team come together to deliver excellent patient care and are able to innovate,” said Kalgoorlie-born Dr Wicksteed, who has just finished a stint working in the Kimberley.
“One of the delights is getting to know entire families through continuity of care and being able to work across different settings – the patients are a real highlight of working rurally.”
Yet the number of doctors putting up their hands to take on this challenging work – in regions with known poorer health outcomes and higher levels of socio-economic disadvantage continues to fall far short of demand.
Efforts to address workforce shortages are now focusing on finding a “grow our own” solution. This includes a new push to get in early to “ignite the fire” among rural and remote high school students considering a future in medicine by allowing them to “dip their toes in”.
“We know that medical students from rural backgrounds with rural medical mentors are more likely to return and work rurally once they graduate,” Dr Wicksteed said.
“There are programs aimed at medical students and junior doctors to entice them to work rurally – it makes sense to appeal to high school students as well.”
Dr Wicksteed has called for the innovative Year 11 and 12 Health and Medical Specialist Program run at Manea Senior College in Bunbury, that does just that, to be rolled out across the State’s regional high schools.
She believes it could be a key to building a permanent local workforce in the regions.
Launched in 2013 and now receiving 80 applications a year, the Manea program introduces high school students to a range of health and medical fields and immerses them by placing them in health workplaces for short stints. This allows the teenagers to observe, help out and perform simple skills where appropriate. Guest speakers from all areas of the industry also share their wealth of experience, “both gritty and inspiring”.
“There’s the saying that ‘You can’t be what you can’t see’, and this is the case for country kids and their ability to aspire to careers such as medicine,” Dr Wicksteed said.
“For high school students who don’t have health professionals in their family networks, aspiring to study medicine is extremely daunting and may feel like an unrealistic aim.
“Having some familiarity with the environment, positive experiences and mentors can mean all the difference. This Manea program also gives them the opportunity to experience other rural/regional areas, including Kimberley trips.
“Being from a non-medical family myself, I did not know any doctors socially.”
Already set on a future working in the country, junior doctor Travis Papalia from Mt Barker/Collie says he is evidence that the “ignite the fire” strategy works.
Now based at Sir Charles Gairdner Hospital and planning to return to rural regions through a Rural Generalist Pathway, he said in his final years of high school he had settled on becoming a physiotherapist until a mentorship and participating in the Health and Medical Specialist program at Manea Senior College triggered a change in mind and a decision to pursue medicine.
“The experience of seeing these health professionals I shadowed impacting on the lives of those around them, it made me feel like, ‘Yeah, that’s what I want to be doing for the rest of my life’,”
he said.
“I support this program wholeheartedly. Up until year 11, I wanted to be a range of different things, as all kids do. I wanted to be a chef because my parents watched cooking shows. Later on, an engineer because my older brother was studying that. A sport teacher because my PE teachers were awesome. Then a software developer, because of video games.
“The key point is that I wanted to do these things at the time because I had the exposure to know just enough about them that I thought ‘Hey, I could do that!’
“This Health and Medical Specialist program offers students like me, who don’t come from medical families, that exposure. It lets you dip your toes in, so that instead of spending years at university doing a degree you thought you’d like at 17, you’re studying to work in a job you’ve at least, in part, experienced and understood its essence.”
Manea’s program teacher Peter Thompson said the high school had been fortunate to have formed an invaluable partnership with the Rural Clinical School of WA.
“Their medical students mentor our students, teaching them simple clinical skills such as donning/doffing PPE, wound care, bedside observations, applying a backslab or setting up drip lines. They also act as our patients in an annual simulated emergency, giving our students opportunity to put their first responder skills into practice.
“Staff at Broome Hospital and Bidyadanga Clinic, Bunbury Health Campus and numerous medical practices around Bunbury are also very supportive.
“Manea alumni also visit as guest speakers and teach clinical skills to current students and they have made themselves available to give advice to our Year 12s about to sit UCAT (University Clinical Aptitude Test) exams or medical interviews.
“We often hear in the news about rural or remote centres that are desperate for staff. We do sow the seeds of returning to the regions, or going remote, but find most of our students are already keen to do so, saying it was always their intention to return.”
Dr Papalia is one of them.
“Ideally, I’ll be working in the country for many years,” he said. “After growing up in the country, I want to offer the same experiences I had to my future children and return to being a part of a small country town. Similarly, as a health professional, I look forward to being able to contribute in my own way to the community I live in.
“I think often people are focusing on what they might lose moving to a regional area rather than what there is for them to gain.”
Dr Wicksteed says increased support is needed for those who commit to rural and remote healthcare, as the job can at times be both “disheartening and upsetting”. Working in rural EDs where the incidence of alcohol-related presentations and family and domestic violence presentations were high, rarely a day went by without seeing people impacted by these.
“This is difficult to stomach when the underlying factors leading to these social issues are impossible to tackle as an individual,” she said.
Looking ahead at expected pressures that will add to an already heavy workload, Dr Wicksteed says it remains to be seen just how long COVID-19 will disrupt the delivery of rural and remote healthcare in the months and years to come.
“The great fear is how the pressures on retrieval of unwell patients will translate to patients getting the care they need, whether they are presenting with acute coronary syndromes, psychotic illnesses, major trauma or sepsis.”
Dr Wicksteed believes key changes are needed to support rural and remote doctors:
- Improve access to safe, healthy and family-friendly communities
Provide safe and appropriate housing and childcare and employment and educational opportunities for partners and family members. - Improve access to upskilling
and education for doctorsSet up networks that ensure skilled and experienced rural generalist doctors have access to high enough caseloads to ensure they remain accredited in their skills. - Invest in the multidisciplinary team
Increase efforts to attract, train and retain other health professionals rurally (nurses, midwives, physiotherapists, dietitians).
Encourage consultant specialists to live and work rurally, or deliver rural care. - Invest in the future healthcare workforce
Capture the interest of high school students and demonstrating the types of enriching health careers they can have outside of the metro area. - Make GP great again
Address shortages caused by fewer new graduates interested in pursuing general practice as a career. Start with a full review of Medicare billing.
Invest in the National Rural Generalist Pathway to deliver more rural generalist doctors to the bush to help support local doctors. - National Credentialing
Simplify recruitment and allow movement across state borders to deliver essential care.