Madeleine J. Cox1
Volume 10, Number 4: 436-438
Received 05 05 2022; Rev-request 09 05 2022; Rev-recd 16 08 2022; Accepted 31 08 2022
Australia is a large country, with significant healthcare issues affecting its regional country towns. These issues include isolation, poor access to resources, and shortages of doctors. Unique to Australia, is the specialization program of rural generalism, which is in urgent need of increased recruitment rates of junior doctors. Through a medical student experience reflection of my placement in Deniliquin, a small country town in Australia, I explore the facilitators and barriers associated with junior doctors entering the rural generalist pathway. Through the recognition of the current barriers associated with a rural generalist career, I aim to promote change in the developmental strategies for the rural generalist training program and thus, promote the implementation of adequate healthcare resources within rural Australia.
Keywords: Family medicine; General practitioner; Rural health (Source: MeSH-NLM).
Australia is an exceptional country, with most of its population living on the Eastern Seaboard in highly urbanized, developed capital cities such as Sydney, Melbourne, and Brisbane. However, more than seven million Australian’s live inland in some of the flattest, driest, and inhabitable regions on Earth.1 This poses unique challenges to Australia’s regional country towns, as they battle issues such as isolation, substandard health resources, and poor welfare. Despite Australia’s world-class healthcare system, unfortunately individuals living in regional Australia, have health comparable to that of low- and middle-income countries.2 Government strategies have aimed to improve this through lackluster funding, empty promises, and ill-considered pathway strategies.3,4
The Australian Government is desperate to train more rural generalists. Through a reflection of my time, experiences, and observations during my placement in the small regional town of Deniliquin, I discuss the facilitators and barriers preventing junior doctors from entering this highly needed career pathway. Through recognition of these challenges, perhaps it will initiate change in the way we implement healthcare strategies for regional Australians.
To contextualize, Deniliquin is a small regional town of 8000 people in New South Wales (Figure 1), with a dozen primary care physicians and a single 41-bed hospital facility, which includes general medical, day surgery and maternity beds, as well as a 24-hour Emergency Department.Figure 1.
Map of Australia depicting the location of Deniliquin in relation to the large metropolitan capital cities.
Through a medical student experience of rural generalism, I have been enlightened on numerous facilitators to enter a rural generalist career pathway. Firstly, working as a rural generalist enables experiences in interesting and diverse medical cases that present to both clinic and emergency departments in a rural center.
For many junior doctors, this is a very attractive component of the job and can persuade an individual to initiate a career in rural generalism. The rural generalist career is also adaptable to any stage of life, allowing doctors even mid-way through their career to easily switch to this medical pathway. Another strong facilitator for a career in rural healthcare is the high demand for doctors ‘out bush’, which enables easy employment in any desired location.
During my own experience in Deniliquin, it was evident that the rural Australian landscape is a strong motive for many junior doctors to move from the busy urbanized cities to the lush green expanses of the countryside.
The perfect tranquil scenes that I experienced in Deniliquin was mesmerizing to wake up to. Dozens of kangaroos would sit outside my window at breakfast, the calm Edward River flowing during my drive to work, and the tall scribbly gumtrees towering above me during my walk to the clinic (Figure 2). Most Importantly, the charisma of every rural community was unique and vivacious. During my stay in Deniliquin, I attended street fairs, the country show, and even a salami festival. At every event everyone in the town attended and knew each other. It was a humbling and wonderful experience. The strong community spirit of small country towns is the reason as to way many junior doctors endeavor to work in rural healthcare.Figure 2.
Deniliquin – the Dirt Road I Took Each Day from My Accommodation to the Hospital.
Despite the desperate need to employ more doctors in a rural healthcare setting, there are significant drawbacks preventing junior doctors from committing to a career in rural generalism. Even though the many marketing strategies promote rural generalism as a highly accommodating and adaptable career, during my placement I came to discover that this is not the case. As described above, rural generalist days are long, with most days being double- and triple-booked. One may think that, most doctors have this issue. However, ‘out in the sticks’, if you are not in clinic, you are either rounding on hospital patients, assessing patients in emergency, or on-call for emergency obstetrics and trauma. Rural generalists do more than work overtime-they work a dangerous amount. With days, weeks, and months like these, I have learnt that, for rural generalists, planning a personal life outside of work is almost impossible – no matter the seniority. Rural generalist doctors moving to the regional communities would have to give up any personal time due to high levels of workload and uncertainty of working hours. These doctors take up a great responsibility, placing the healthcare of the community above their own lives and their own families. From my experience, work-life balance in rural generalism does not exist and is becoming increasingly more obvious.
Packing your bags and starting your new life in a beautiful town like Deniliquin may sound ideal, how, but, these beautiful landscapes come at a great cost. This cost is the isolation faced by living hundreds-to-thousands of kilometers away from family, friends, transportation, and healthcare resources. Everyone considering a career path in rural generalism must consider if all these barriers and costs are suitable to their current lifestyle. More importantly, the main consideration that a junior doctor must make upon deciding a career in rural healthcare is the health and wellbeing of themselves and their household dependents.
As described earlier, small country-towns are tight knit with a strong sense of community. Nevertheless, this comes with the crucial issue of a lack of privacy. This is exceptionally challenging as a healthcare professional. The predominant issue is separating a privately bound patient-doctor relationships from personal friendships. This is difficult in small country-towns and leads to many clinicians becoming exhausted and lonely. Hence, another barrier preventing junior doctors from entering a rural generalist career.
My placement in Deniliquin has made me realize the reality of the rural generalist pathway. It is one of the most rewarding, yet challenging careers available, and different from any other specialty in medicine. Through a medical student experience, I was able to appreciate the facilitators and barriers for junior doctors considering to specialize in rural generalism. Strategies to overcome these barriers include greater support for interested doctors through flexible rotations, structured training schemes, housing packages, monetary bonuses, and improved healthcare infrastructure in these regions. Using management frameworks like overseas expatriate modelling, may make rural generalism more desirable, and encourage many junior doctors to begin a career in rural medicine.
Australia is one of the largest countries in the world, with many of its residents living in regional and remote towns. Healthcare services and resources across most of Australia are phenomenal due to well thought out government led funding. However, there is difficulty accessing these services in rural towns. There is a critical need to provide more healthcare staff rurally, this includes a specialty of rural generalism. A specialized career in rural generalism is one that includes family medicine with added skills to care for regional and remote communities. Unfortunately, there are several barriers that prevent many junior doctors from deciding to continue a career in rural medicine. Through my experience in a small country town called Deniliquin, I discuss the facilitators and barriers including work-life balance, isolation, and privacy concerns. This reflective article exposes the need to improve Australian rural healthcare networks and provide solutions to overcome these barriers to encourage more doctors to specialize in rural healthcare.
I would like to thank Dr. Rachel James and the team at Deniliquin Medical Clinic for their generosity, warmth and hospitality.
The Authors have no funding, financial relationships or conflicts of interest to disclose.
Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing: MJC.
1. Pain CF, Pillans BJ, Roach IC, Worrall L, Wilford JR. Old, flat and red–Australia’s distinctive landscape. Shaping a nation: A geology of Australia. 2012: 227–75.
2. Larkins S, Evans R. Greater support for generalism in rural and regional Australia. Aust fam Physician. 2014;43(7):487–90.
3. Dymmott A, Brebner C, George S, Campbell N, Milte R, O’Connor J et al. South Australian Allied Health Rural Generalist Pathway Evaluation: Phase 2.
4. Nielsen I, Hulcombe J, Davis S, Moore R, McDonald A, Bianchini D et al. The road travelled and road ahead for allied health rural generalist pathways. In 14th National Rural Health Conference 2017 (pp. 26–29).
Madeleine J. Cox, 1 BMedSc, BSci(Hons), MD. University of New South Wales, Sydney, Australia.
About the Author: MJ Cox is a medical intern passionate about women’s health with publications and internationally recognized prizes in the field of PCOS.
Correspondence: Madeleine J. Cox. Address: NSW 2052, Sydney, Australia. Email: email@example.com
Editor: Francisco J. Bonilla-Escobar; Student Editors: Moez Bashir, Amaan Javed, André Yvan Zolo; Copyeditor: Sebastian Diebel; Proofreader: Leah Komer; Layout Editor: Cesare Mercalli; Process: Peer-reviewed
Cite as Cox MJ. Barriers for Junior Doctors to Specialize in Rural Generalism – A Medical Student Experience. Int J Med Stud. 2022 Oct-Dec; 10(4):436-38.
Copyright © 2022 Madeleine J. Cox
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Medical Students, VOLUME 10, NUMBER 4, September 2022