Rural Emergency Medicine

Well a lot has been happening recently concerning Rural Healthcare (or maybe I'm just paying more attention) and I thought I would just shed some light. I do not claim to be an expert this area, and I certainly do not have all the facts, but I hope this post gives you a good snapshot of the current situation.

In part one, we will take a general look at the rural healthcare system as it stands. In part two, I'll take you through some of the issues I believe are particular pertinent to medical students and doctors. Which are part of the larger solution to Rural Healthcare.

The System
The healthcare situation in Rural Australia has long been dire. But it's not just Australia that is in trouble. Countries all over the world are finding that maldistribution of the workforce is one of the main issues limiting access to primary health care (World Health Organization 2006, 2010). Rural Australia has a widely dispersed population in a geographically and culturally varied region.

So what can we do about it?

Well the Australian solution for the past decade or so has been to send all the new incoming international doctors out to the bush. While in some cases this tactic has worked fine, there are many cases where both the doctor and the community are left short-changed. Dr Hambleton from the AMA noted,

''What we ask of our international colleagues is mind-boggling, because rural practice is challenging for any graduate, let alone someone unfamiliar to the country way of life,''.
In other words a flimsy band-aid solution at best.

Now here's a shocking statistic, 41% of the rural and remote Australian medical workforce in 2007 trained overseas (Australian Government Department of Health and Ageing 2008).

On the consumer-side of things, a recent report noted that, rural residents miss out on ~6 million GP visits, they would otherwise have, if they had the same access to health-care as their metropolitan counterparts. (Access to general practitioner services amongst Rural Australians, 2012).

Interestingly they also noted;
Parity is an insufficient goal and disadvantaged persons and underserved areas require greater access to health services than the well served metropolitan areas due to their greater poverty and poorer health status.

In other words, as the Australian and State governments have let the situation get so bad, they now need to invest more if they were to ensure health equality across Australia.

The most recent figures from the Australian Institute of Health and Welfare show there were 4600 excess deaths in rural Australia from 2004 until 2006, compared to major cities, and the most common causes were heart disease, circulatory disease, chronic obstructive pulmonary disease, motor vehicle accidents and suicide.

There are many other aspects of the Rural Healthcare situation that can be explored, which I will not cover here. However, if you are particularly interested in Mental Health and the Better Access program, you should check out Alison Fairleigh's blog which delves into these topics. Alternatively follow the #RuralMH discussions on twitter.

Education & Encouragement
The current solution to Rural Healthcare is not working, so it's time that the policy makers took another look and re-considered their approach. There are many things which could be altered to improve the situation, but two topics I'm going to cover are education and encouragement.

Student Diversification
Medical education is one area that has a chance of addressing the rural workforce shortages. Government policies were made a while back that encouraged medical schools to intake a certain proportion of rural students. The idea being, that these students would be more likely to return to their rural communities for professional practice. Medical Schools like JCU with higher rural intakes, have demonstrated that a larger number of their medical students end up in rural practice as Doctors.

The biggest issue here: Not all medical schools have been adhering to the rules.

Thankfully, some of the worst offenders have now begun putting in place entrance pathways that ensure there are a larger number of rural students within their course. From next year the University of Queensland which was previously one of the worst offenders, has set up a separate rural entry quota of 25% for its medical school. Meaning that rural applicants will only have to compete amongst themselves for those places (Med schools to ease rural student entry).

Stay tuned for more to come on these two areas in part 2.

Image: Adapted from Rural Southern Story County by cwwycoff1.

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