Everything’s coming up rural generalist … with apologies to Stephen Sondheim.
The peak body for medical school deans now recommends a rural-first training model, with metro-based training being the exception rather than the rule.
In a new position statement on thriving rural doctors, Medical Deans Australia and New Zealand outlined a series of 25 recommendations to turn Australia’s struggling rural health workforce around.
These ranged from medical schools working directly with rural communities on expansion strategies, governments investing in appropriate accommodation for students and accreditation bodies supporting alternative approaches to clinical supervision.
The overarching aim is creating a system that puts generalist skills at the forefront of being a doctor.
“Key to this is a flipped model of training where learning takes place in and for rural communities, with rotations to metropolitan or large regional hospitals if and when required … arguably, general practice and primary care is nowhere more important than in rural communities,” the position statement reads.
The deans’ association also advised the non-GP specialty colleges to consider how training could be restructured to allow more opportunities for rural doctors.
“Today’s rural trainees need to be tomorrow’s rural trainers if there is to be a sustainable pipeline to meet the needs of the community,” it said.
“Providing ongoing support to allow rural clinicians to participate in the full gamut of professional medical activity, and a place-based approach to managing training, workforce and succession planning, will create the circumstances in which rural doctors can thrive in long term careers.”
Rural generalism, which is on track to become a fully-fledged specialty in next one or two years, has been a steadily rising favourite among medical students.
According to the association, 7% of doctors in training listed rural generalism as their first preference of future specialty in 2023; a rise of more than two percentage points since 2021.
General practice, meanwhile, was first preference for around one in 10 students.
Some medical schools are already capitalising on the increased interest in rural generalism.
Flinders University has recently announced a new end-to-end rural medical program for South Australia, which will start accepting students in 2025.
The university runs a four-year graduate entry Clinical Sciences/Doctor of Medicine (MD) program, rather than the more traditional five or six-year Bachelor of Medicine/Bachelor of Surgery (MBBS) degree.
Around 50 students will make up the first cohort, with priority admission for rural-origin and First Nations applicants.
“We want to immerse our medical students in these regional areas for training so that they can see firsthand the wonderful aspects of living and working in a welcoming rural community,” deputy dean Professor Claire Drummond said.
“The [training program] offers diverse clinical training and experiences that will equip rural doctors with the skills to improve the health and wellbeing of local communities.”
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ACRRM, meanwhile, has reiterated its support for extended rural clinical placements as the AHPRA accreditation committee looks to put out new guidance on high quality clinical placements.
“There is extensive experience to demonstrate that extended periods of rural clinical placement during medical training strongly correlate with attracting and retaining rural doctors,” the college submission read.
One of the big barriers to these extended placements, though, is financial security: it isn’t exactly cheap to relocate.
“We would like to see reference to ensuring that financial considerations are not creating a barrier to potentially excellent rural doctors undertaking training in rural locations,” ACRRM said.
