Author: Allison Hempenstall
Reviewers: Jessica Tidswell, Rob Mitchell, Rob Zielinski
Jack (or Jill)-of-all-trades, master of none is a phrase often quoted in reference to rural generalists. As much as it’s a joke, there might be some truth to it!
Rural and remote medicine in Australia is unique. No other specialty provides access to beautiful locations and such interesting and diverse clinical medicine…although, as a trainee rural generalist working in the Torres Strait, I’m probably biased!
The Torres Strait is situated between the northern most tip of Queensland and the coastline of Papua New Guinea and is one of the most remote areas of Australia. There are at least fifteen inhabited islands each with their own primary healthcare centre situated across 150km of ocean.
Given that entry into specialist training programs is becoming more competitive than ever, more junior doctors are looking beyond the shiny lights of the city to specialise. So why go rural? Here are some benefits and challenges of practicing rural and remote medicine.
Fantastic clinical experience
Working in rural and remote locations you have the opportunity to do a little bit of everything. You can see a patient in the emergency department; review them on the wards the following day and a week later see them in your primary healthcare clinic. This continuity of care is one of the most rewarding parts of the job. Some rural doctors also have specialist skills in obstetrics or anesthetics and manage deliveries or retrieve patients from other locations. There is an abundance of clinical variety and as a doctor working in a remote location you have greater autonomy than in a structured, hierarchical based tertiary setting.
Here in the Torres we have an amazing mix of both communicable and non-communicable diseases. Not only do we see all sorts of weird and wonderful infectious diseases including melioidosis, tuberculosis and leprosy, but diabetes, heart disease and kidney disease are also a prevailing burden on the community. We often manage quite complex patients with specialists at the end of the phone for advice. Additionally, we are the only place in Australia that lies in such close proximity to a developing country: Papua New Guinea (PNG). Patients from PNG are only a short boat ride away from Australian shores and regularly present for medical assistance.
Being part of the community
Living and working in rural locations gives you the opportunity to be truly part of the community. There are always plenty of social activities to become involved in – local sporting clubs, volunteer groups or trivia nights. The local communities are always welcoming, friendly and will always say ‘hello’ to you in the grocery store!
A relaxed lifestyle
Quality of life is often quoted as a reason why people escape to the country. Many doctors that work in rural and remote environments enjoy going home to have lunch with their family each day and have more time to spend with their children. Rural and remote jobs across the country are more often then not located in stunning natural environments; the spectacular sunsets up here are the most magical you will see in the country! And there is always plenty to do outdoors – here in the Torres Straits most doctors own their own boat and go out fishing on a weekend!
Without a doubt limited resources are one of the most clinically challenging aspects of working rurally. Unlike a large hospital with round the clock imaging, intensive care units and specialists at your fingertips, rural hospitals don’t have these things. One needs to be more resourceful and relying on your clinical skills to manage patients. However you are never alone and there are always other doctors around in addition to phoning the nearest referral hospital for advice and help.
Where I currently work we have one doctor who is on call overnight for Thursday Island Hospital and all of the Torres Strait. The unique logistical challenges in providing healthcare and emergency medicine to the 4,000 people that live here is one of the most interesting parts of working in a place like this. Clinical decision-making is impacted significantly by weather and flying conditions if patients need to be retrieved from an outer island into Thursday Island Hospital.
Our fantastic nursing staff will manage the general, surgical and obstetric wards in addition to the emergency department. When they are concerned they will call the doctor for advice and guidance. Nursing staff who work in rural areas have a much greater clinical responsibility. Many outer island primary healthcare centres have only one healthcare worker and nurse, with a doctor visiting for one to two days every few weeks. They therefore have to be prepared for everything from minor cuts and sores to cardiac arrests and major trauma.
In many rural and remote locations, there are only a small group of doctors, which means that some (especially those with procedural advanced skills such as anaesthetics or obstetrics) are on call several times in a week. This can quickly lead to burnout if the doctor and supporting team don’t establish clear boundaries to protect themselves. Burnout is a common phenomenon in medicine and in particular in rural and remote settings. It’s important to be aware of this and have your own strategies to try and avoid it.
Maintaining professional boundaries
A challenge of working in rural and remote communities is maintaining professional boundaries. Often you’ll bump into patients at the local swimming pool and sometimes they might ask for some quick medical advice. Knowing your personal and professional boundaries is vital – not only for your sanity, but the safety of your patients.
Many people quote isolation as a reason why they don’t want to work rural or remote. These places can be thousands of kilometers from larger shopping facilities, specialty restaurants and fresh food. If you are lucky, some rural farming towns will have local fresh produce; but in other locations, food can be quite expensive.
Additionally, partners of doctors that move to rural and remote locations can at times find it challenging to find work if their sub-specialty skills are not required. There is also the added burden of finding work for the families of doctors in areas that already struggle to find employment for the local and Indigenous community.
Finally unless you’ve grown up in that rural location, often you’ll be moving away from your friends and some family. Keeping in touch with friends and family is easier than ever these days with smart phones. However it won’t be long until you meet friends in these wonderful towns you’ll keep for life.
Why not Jack or Jill?
The complete saying goes a Jack (or Jill)-of-all-trades, master of none, but often times better than a master of one. Overall, the benefits of rural medicine far outweigh the challenges. I would encourage all medical students and junior doctors to try at least a term working in a rural or remote setting to see what it’s like. Even if you dream of becoming a ‘super specialised specialist’, everyone can learn something from working rural or remote. Anyway, you never know, like me, you might just want to become a master of none!