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Community Medicine

As well as the many towns that have hospitals, there are a number without hospitals and in all locations GPs have to manage illness without the depth of services and specialists that exists in the metropolitan zones. Rural Practices are often de facto casualty departments, carrying a full range of emergency equipment Rural small businesses and self-employed farmers are particularly vulnerable to the economic aspects of sickness in themselves, their families and their aged relatives, especially at crucial times in the farming cycle. Having medical capacity within the community is a major priority for them.

Rural doctors aim to manage illness within the community, whether in hospital or otherwise. It is necessary to have a high degree of skill to know the range of possibilities in any given condition and to manage it accordingly without unnecessary referral.

Such skills steadily increase the longer the doctor stays on in the rural location. GPs graduating from the Regional Training Programs gain these skills through supervised casualty and rural experience. RDAV is concerned about recent placement of limited registration practitioners into rural practices without formal on-site arrangements for supervision and mentoring. This is not allowed for Australian Graduates who remain in hospital until they are fully registered. The RDAV also considers that all rural doctors without GP fellowships should remain in formally mentored situations under College-approved conditions until Fellowship is attained.

Studies have confirmed that rural GP consultations are more complex and that rural practice is more expensive to run. The Federal Government has in the past instituted a number of initiatives and programs to support rural practice to overcome these problems. There is widespread concern that lately this focus has been diminishing and that rural practice is receiving support equivalent to many regional towns, especially because of the new Australia Standard Geographical Classification, which bears no relation to medical realities and the need to keep small rural hospitals open.

The complexity of rural medicine has been recognized in 2006 by the COAG heads of State and by the Australian Medical Council in 2007. Both the curriculum-based ACRRM and RACGP fellowships are now recognised as specialist qualifications within the speciality of General Practice. The Fellowship of Australian Rural General Practice FARGP is not accredited as a fellowship by the AMC. It comprises the standard RACGP fellowship with an added diploma examination in the philosophy of rural practice, and a year’s specialised experience in a personally chosen field, which may or may not be in procedural training. It is therefore well-suited to inner regional practice and does supply some proceduralists to rural hospitals, but currently lacks skills experience for the wider range of acute and chronic conditions dealt with in rural practice.