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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)

    • 1700 members
    • FACRRM – 1330 (generalists)
  • Advocacy
  • PDP - unified
    • For VR
    • Procedural
    • Radiology
  • Education - Filling the gaps
    • Telederm, Ultrasound, Anaesthetics, Surgery, Obstetrics
    • Population health (Collaboratives)
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