Australian Indigenous Doctor’s Association president Dr Simone Raye talks about the loss of holistic care, systemic racism and empathy.
Dr Simone Raye, the current president of the Australian Indigenous Doctor’s Association, is a jack of all trades, master of all.
Her journey to general practice was a “scenic” one, the route she most likes to take in all aspects of life.
Passing through “every department in the hospital system”, she was originally gunning to be an orthopaedic surgeon, but also worked in the ICU, general surgery, renal, respiratory, oncology, obstetrics and gynecology, and paediatric departments.
It was general practice that spoke to her as a place to incorporate her learnings into holistic care.
What does a day in the life of a GP in Darwin look like?
“Pretty good!” Dr Raye told The Medical Republic.
“I’m fortunate.
“The ethos of the practice that I work at is … not [like] one of those corporate clinics, so we do a lot of sports medicine, we do a lot of women’s health, we do a lot of kids’ health.
“We’re very community minded as well.
“There was a period of time when the [local] Aboriginal medical service had to close its books because it just couldn’t handle taking on any more clients at the time. So we covered the boarding students that came in from community.
“We also do a lot of LGBTQIA+ medicine – our practice is quite varied. That’s why I really like it.
“Also having an Aboriginal and Torres Strait Islander doctor, a lot of Aboriginal and Torres Strait Islander patients who, for whatever reason, choose not to go to the local AMS decide to come [here].
“I previously worked at a place that was more of a corporate-type structure and it just felt like you couldn’t always slow down and concentrate on the patient in front of you, that you were under the pump to get the numbers through.
“Whereas with the ethos of [my current] practice, we know that we have to see patients to earn money to keep the clinic open, but we do it in such a way that focuses on holistic care, so that we feel that we’re doing a good job and the patient [benefits].”
Is general practice losing its focus on holistic care?
“It is a bit,” Dr Raye told TMR.
“With the freeze on the Medicare rebate, when they do give us a raise it’s like a dollar … that’s not going to do anything.
“And the broader public doesn’t understand that you’ve got to pay for the premises, the insurance, for your equipment, your reception, your nurses and then you’ve got to pay your doctors.
“A lot of people whinge about paying to go and see the doctor, but they pay to see the hairdresser or get their car fixed.
“I don’t know why they don’t have their GP in that same category.”
As well as better public understanding, money should be funnelled into general practice rather than into concurrent, competing services like urgent care centres or immunisation clinics, added Dr Raye.
Dr Raye said she was perplexed by the “real disconnect” between acknowledging the importance of general practice and translating that into funding.
“I’ve recently attended a few meetings around scope of practice.
“We’re taking stuff out of the GP’s hands and that’s all well and good, but if we’re trying to talk about holistic care but you’re take chunks of care away from the GP, then how can they provide that holistic care?”
Dr Raye said that the new government initiatives – like expanding scope and UCCs – would probably work out to cost more if they “really sat down and did the maths”.
“With [the UCCs], it takes GPs out of the normal clinic because they get paid more to go and work in these acute care clinics, so why bother with chronic care and the preventative care that we should be doing?”
How did AIDA come to be?
In the early years of Dr Raye’s career in medicine – her studies began in 1988 – there was a grand total of around 13 Indigenous medical students, she told TMR.
“I think there were two dentists as well!”
In 1988-89, Dr Louis Peachey gathered this young group of Indigenous doctors in Newcastle.
“I think Louis’s original idea was to set up some sort of collegiate support from that [meeting], but we just didn’t have the numbers,” said Dr Raye.
“I then dropped out of medical school – lots of family stuff among other things – but I then came back in 1995.
“They did make me do first year again… all the same lectures. It was a bit like Groundhog Day, but it was alright.
“By the time I came back [to medicine], there were quite a few [Indigenous] students.
“We had a great support unit at Newcastle Uni, with our own office and liaison officer.
“Going forward a couple of years we even managed to employ some of our previous graduates to help with the new students coming through.”
Professor Pete O’Mara, Dr Mark Wenitong and Dr Peachey spearheaded the initial meetings, bringing together current and former students, including those that had dropped out, to decipher how best to support Indigenous medical students getting into, and staying in, university, said Dr Raye.
“We knew that financial support was a big one.”
After a couple of meetings in Salamander Bay, the then president of the Indigenous Physicians Association of Canada Dr Barry Lavallee invited himself to a meeting, bringing along a couple of his students.
“We managed to get hold of some more funding and, with assistance from Dr Lavallee, we then went across to the [Indigenous Physicians Association of Canada’s] sixth annual general meeting in Winnipeg.
“It all grew from there.”
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How can we keep Indigenous doctors in medicine?
Central to addressing inequity in the health system was increasing the number of Indigenous doctors, said Dr Raye.
Beyond funding and collegiate support, it’s about creating culturally safe spaces.
“One of the things we found among those that had left medicine was the bullying, harassment and racism in the system really created unsafe spaces.
“Sometimes we’ve lost trainees and students because of that, so we need to really improve these spaces.
“But it’s a work in progress.
“A lot of other female doctors [probably struggle] as well with these unsafe spaces, where it’s a bit of the ‘boys club’.
“We get the boys club, as well as the unsafe spaces for people who look different.”
Dr Raye said racism within Australia often went unacknowledged and could be somewhat hidden.
“The week after the [the Voice] referendum I went to a conference. There were so many really negative and derogatory comments that were made by other health professionals.
“You’re supposed to be our allies.
“But then there were a lot of good people there who stood up and deflected a lot of that negativity, which was fantastic to see. Because previously that hadn’t been happening, and we would be left to fend for ourselves.
“But, after the referendum, we can say that we do have allies.
“Over six million Australians voted yes. I need to hope that the person sitting next to me is one of them.”
While the referendum vote was unsuccessful, it “planted the seed of an idea”, said Dr Raye.
“Aboriginal people, we’ve been here for over 65,000 years. We’ll just keep moving. We didn’t get it that way, we’ll get it another way.
“In time things change.”
Are there any low-hanging fruit that could make general practice more sustainable and equitable?
Dr Raye said the Medicare rebate, which is stuck in the 1980s, needed to be brought into 2024.
She added that the public may also need to come to terms with contributing financially towards their healthcare.
“For a long time people have been bulk billed and subsidised,” she said
“Because they’re being asked to pay, [patients] are now putting the burden on the public hospital system.
“People should be encouraged not to go to the ED unless it is an emergency.”
It might be time to turn to Tiktok to educate patients, joked Dr Raye.
“I saw this really cute Tiktok the other day, it was from the US.
“They had a couple of nurses pretending to have a condition and then the headings ‘acute care’ or ‘the hospital’. Every time they’d go to go to the wrong one, they’d be ushered to the to the right one.”
How would you try to inspire the next generation of GPs?
“I talk with Indigenous medical students and junior doctors about being able to work on country and in community, and that it’s holistic care,” said Dr Raye.
“Previously, I had been the national chair of the Indigenous GP registrar network, so initially, I was just tunnel vision focused on GP land.
“You manage to find a bit of a better work-life balance and you have a lot more autonomy working as a GP. It’s the fact that there are so many different areas that you can specialise in within GP land, as well.”
The flexibility and breadth of general practice, particularly for rural generalists – from working with alcohol and other drugs to obstetrics and gynecology – was another major pull of the profession, said Dr Raye.
What does your work with AIDA involve now?
“I do a lot of advocacy, a lot of which is behind the scenes,” Dr Raye said.
“We’re working with DoHAC and the various colleges to increase the numbers of our trainees in those areas and helping in terms of retention as well.
“AMA and AIDA have a joint taskforce on Indigenous health looking at a lot of issues surrounding Aboriginal and Torres Strait Islander health across the country and looking into the policies and position papers.
“AIDA has designed its own cultural awareness and culture safety program. It’s written and delivered by Indigenous doctors,” said Dr Raye.
“We feel really strongly that one of the things we really need to do is improve the culture safety within our health spaces not only for our patients, but for our staff as well.”
Cultural safety spans beyond Indigenous health, added Dr Raye, and should include other often marginalised groups like culturally and linguistically diverse and LGBTQIA+ peoples.
“Cultural safety is different than cultural awareness and cultural competency.
“It’s an ongoing journey and we need to remember that we need to apply local context to cultural safety and that we need to not have fixed and rigid ideas around it.
“A lot of people think that when we talk about cultural safety, we’re just aiming at non-Indigenous people but [Indigenous doctors] attend courses as well, because we want to make sure that when we do go into other areas that we’re safe.
“It was a huge learning curve for me as well. We just need to remember that it’s a learning curve for everybody, but the underlying ethos is kindness and empathy.”
Wildcard question: Which icon, celebrity or inspiration would you love to invite to dinner?
“This is a bit of a hard one, and I’ve been thinking about it all day,” Dr Raye said.
“I thought about all the big names like Mandela and Maya Angelou, because she was always a hero of mine.
“Reading her books … she was such an important activist.
“But when it really comes down to it, I think I’d chose my grandmother. She was such an inspiration.
“My mum passed when I was quite young, so I didn’t really know her.
“But my grandmother stepped in after she passed. She was a bush midwife.
“I come from a long line of people who’ve worked in health: so my grandmother’s a bush midwife … and then my mum was a nurse’s aide.
“When I was a little kid, we’d go to the children’s hospital in Perth to visit kids who’d been sent down from the Kimberley.
“Part of why I wanted to be a doctor was because I always used to think, ‘why are there no Blak doctors for these kids?’
“When I got into medical school, [my grandmother] was so proud.
“By the time I graduated she had dementia, and so I don’t think she fully appreciated that I’d become a doctor.
“I’d be nice to have her [for dinner] when she was a bit younger and say, ‘hey, I did it!’”
This interview was edited for length and clarity.
