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Rural Medicine

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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.

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.

This 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.

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.

Education for rural medicine has developed slowly, with the main impetus from rural doctors. It is still in early days, with dedicated pathways recognized only in 2006 and a rural fellowship only in 2007. A substantial network of rural medical schools and regional training programs is being established in Victoria

Victoria has a choice of whether to continue a process of centralization of services, or to develop the support of rural doctors able to manage commoner medical conditions, to preserve the viability and vitality of its rural sector. The RDAV, Country Womens Association, and Victorian Farmers Federation, combined to issue a joint statement about rural medical services in 2006.