Home : Rural Medicine    

Rural Medicine

Click underlined topics for further information.

The concept and practice of rural medicine as a separate discipline in Australia has met with considerable bio-resistance. However it is simply not feasible for rural residents to transport all their more complex medical problems to centres with specialist services. The RDAA, Australian College of Rural and Remote Medicine and National Rural Health Alliance have been the main proponents for recognition and support of rural medicine. The Council of Australian Governments finally recognised it as a medical specialty in 2006, mainly at the insistence of Queensland in the wake of the Bundaberg disaster. A number of advances have been made since 2011 as will be described. In particular there is growing commitment to training rural doctors as Rural Generalists.

Victoria is a small State but has considerable population living away from the metropolitan conglomerate at some hours remove from specialist and main ancillary services. Specialists are disinclined to live in rural areas. Ancillary services struggle to find recruits.

Whilst rural, in addition to the full range of disease, has higher rates of injury and mental illness, the ageing population is as everywhere developing an increasing mass of complex illness.

The Commonwealth is responsible for community medical practice. The State carries the Hospital Budget. Rural Hospitals are independent crown entities for whom the State can make certain rules. The State and Commonwealth both, often independently, fund community ancillary services. Rural Casualty is a grey area not fully accepted by either party. There is now joint carriage of responsibility through the Council of Health Ministers.

HoweverThis situation has resulted in a laisser-faire approach to Victorian rural health and in general has favoured attrition rather than maintenance of services. The loss of 4/5 of rural maternity units is an example. The determination of the local population and their doctor has usually been insufficient to prevent closure. In November 2011 the State released a Regional and Rural plan which is predicated upon a good supply of trained GPs, although there is a growing shortage of these in rural Victoria.

Whether supplying services to local hospitals, or simply in community practice, rural doctors continually adapt themselves to local necessity, taking on medical roles where these are absent. Through self directed education, if necessary overseas, they have developed skills in emergency, anaesthesia, obstetrics, surgery, complex medicine, mental health, paediatrics, aboriginal health, palliative care and so on. It is not realised that these specialist-level skills are constantly exercised.

Education for rural medicine has developed slowly, with the main impetus from rural doctors. Recognition of rural medicine only in 2006 after 20 years of lobbying, and final approval for the fellowship of the Australian College of Rural and Remote Medicine only in 2011. A substantial network of rural medical schools and regional training programs has established which permeate the whole of rural Victoria. The attrition of rural services has been immense, The State has commenced a program of training for rural generalists in 2012 but there will be further loss of services over the next 5 years until the situation stabilises. The cost in terms of transfer of patients for care has been immense and will continue to grow. As the population ages and the obesity epidemic spreads the demand for rural sub-specialist care will also grow.