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Rural & Remote Medicine: a Specialty. Professor Ian Wronski Immediate Past-President ACRRM Executive Dean, Faculty of Medicine, Health and Molecular Sciences, JCU. The Rural and Remote Medical Workforce. 4000 rural and remote doctors Middle aged workforce 70% male 30% Female.

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Rural remote medicine a specialty

Rural & Remote Medicine:a Specialty

Professor Ian Wronski

Immediate Past-President ACRRM

Executive Dean, Faculty of Medicine, Health and Molecular Sciences, JCU

The rural and remote medical workforce
The Rural and Remote Medical Workforce

  • 4000 rural and remote doctors

  • Middle aged workforce

    • 70% male

    • 30% Female

Source ARRWAG, 2004

Practice style
Practice Style

  • Private office practice 80% ¾ Owners/partners ¼ salaried by the practice½ involved in hospital care especially A&E

  • Registrar 9% ½ salaried

  • Hospital only 5%

  • Community team 3%

  • Locum < 1%

  • Fly in Fly out 1%

  • Other 1%

Source Reality Bites ARRWAG


Source ARRWAG, 2004

Procedural activity
Procedural activity

Source RDAA Viable Models report

Workforce shortages
Workforce Shortages

  • Workforce shortages in all health professions

  • Particularly in rural and remote practice

  • Shortages exacerbated by international competition for health professionals

  • Difficulties in attracting and retaining health staff to regional areas

Current government initiatives
Current Government Initiatives

  • Educational Programs

    • Students

    • RAMUS

    • Medical school intakes

    • NRHN

    • JFSS

    • RCS/UDRH

    • RMBS(100 pa) +234

  • Interns

    • RRAPP

  • Registrars

    • GPET Regionalised RTP

    • ERT Framework

  • Rural Doctors

    • Procedural medicine

What do we know about going rural the evidence
What do we know about going Rural? - the Evidence

  • Rural origin 2.5X (1.68 to 3.9)

  • Rural schooling 2.5X (2.2 to 5.42)

  • Rural spouse 3.5X

  • Rural undergraduate 2.05X (0.7 to 3.0)

    plus anecdotal - seem to want to stay on

  • Rural Intern 3X(Peach et al, Ballarat 2004)

  • Rural Training 2.5X(Rural Stocktake, Jack Best)

  • Rural upskilling/support - Stay longer (Hays et al, Wilkinson et al)`

The argument for rural and remote medicine as a specialty
The Argument for Rural and Remote Medicine as a Specialty

  • Meets three core criteria for recognition as a specialty

1 improve safety of health care
1. Improve Safety of Health Care

  • By ensuring dedicated education and training targeted at the realities of rural and remote practice

  • Provide appropriately benchmarked guidelines for managing clinical risk in rural practice

  • Foster further growth in research into safe clinical care

2 improve the standards of health care
2. Improve the Standards of Health Care

  • Provide an adequately trained workforce

  • Increase understanding and focus on service needs of rural communities

  • New models of care and complementary training, accreditation and professional support structures

  • Consolidate acceptance of rural standards by professional organisations responsible for safety (e.g. clinical privileges)

  • Provide support and clear points of articulation for entry and exit to other specialties (e.g. general practice into RRM)

  • Assist other specialties to deliver appropriate support and education to their rural and remote colleagues

  • Advance more effective medical service models within resource and distance constraints

3 result in more cost effective health care
3. Result in More Cost Effective Health Care

  • Create most effective rural medical workforce service models

  • Reduce costs of unnecessary retrieval, referral and transportation for patients

  • Facilitate resource and administrative sharing amongst training programs and allow for streamlining of training time and arrangements

  • Create clear and facilitated career paths and continuity of education from undergraduate to postgraduate practice – organisational and professional efficiencies

  • Assist to recruit doctors by improving status and attractiveness of rural career

  • Provide impetus for continued growth of intellectual and service infrastructure in rural areas

Community benefits
Community Benefits

  • Better rural doctor recruitment, retention and support

  • Better targeted training for medical services that rural communities want and need

  • Opportunity to nurture better inter-specialty teamwork models

  • Sustaining rural communities themselves by maintaining and retaining rural doctors

  • More medical services available at home communities

Benefits of specialisation
Benefits of specialisation

  • Identity and recognition (retention)

  • Specialist Rebates (complexity)

    • Infrastructure support

    • G/S

    • Access to MRI referral etc

  • More Rural Doctors (recruitment)

  • Career pathways for rural students

  • Mentoring and teaching next generation of rural doctors

  • Opens up alternative pathways to doctors interested in rural medicine, but not attracted to standard GP training

What s missing
What’s missing?

  • Recognition

     some recent developments

    • VR (Partway with PDP)

    • Specialist (AMC process under way)

  • Rural Training Pathway enabled and integrated

    (Part way with GPET enhanced rural training framework)

  • Acrrm

    • ACRRM

      • 1700 members

      • FACRRM – 1330 (generalists)

    • Advocacy

    • PDP - unified

      • For VR

      • Procedural

      • Radiology

    • Education - Filling the gaps

      • Telederm, Ultrasound, Anaesthetics, Surgery, Obstetrics

      • Population health (Collaboratives)

    • RRMEO

    The future what it could it look like
    The Future – what it could it look like

    • A different educational pathway with flexibility and rural focus

    • The same infrastructure

    • Targeted selection to a different cohort

    • Targeted incentives to learn not just be there


    • Recognition and specialisation

    • Simpler pathway to RRM - choice

    • Further development/refinement of standards

    • Further development of assessment incl exam

    • Educational gaps addressed e.g. procedural

    • Increasing rural infrastructure incl Regional Training Providers, Rural Clinical Schools University departments of Rural Health and rural teaching practices

    • CPMC and College collaboration

    Future workforce
    Future workforce

    • Important determinant of other factors

      Workforce Lifestyle Family

    • Ground work done and infrastructure in place

    • Wave of students coming

    • Attract and keep

    • Nourish and keep them up to date