Retirement at last! A twice-retired general practitioner reflects on rural practice | 
MJA 1999; 171: 627-628
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On completing many years as a senior lecturer in physiology at the
University of Tasmania Medical School, I retired at the statutory age
of 65. At the age of 74, after a retirement spent mostly doing rural
locums, I was asked to undertake full-time general practice in
Swansea, a small town (population about 450) on the east coast of
Tasmania (see Map). The Journal published an article I wrote then on my
observations of rural practice and my local community.1 Now that I have
retired again (at age 78), I offer some further observations on rural
practice and its special demands -- especially on an older GP.
Swansea Nevertheless, Swansea has suffered financial recessions, and the employment opportunities for young people are not good, although there has been some improvement lately, largely tourism-based. There is a relatively large older, retired population, dependent largely on social security payments.
The practice Thus I found myself, geriatric by any standards, looking after a resident population with many people in my own age group. Indeed, while I was at Swansea I had three centenarians in my care at one time or another! The doctor's house was close to most homes in the centre of the town, and I covered most house calls, plus visits to the nursing centre, on foot. To reach the wider Swansea area, with its scattered houses on widely spaced access roads, I had to drive, and the lack of conspicuous house numbering meant that on some dark nights I got completely lost! Outside the town area, the practice extended along a five- to 20-km-wide coastal strip, about 50 km long. The nearest practices, also solo, like Swansea, were at Triabunna and Bicheno (see Map). These were too distant to give cover for house calls from Swansea, but patients from these two practices usually came to Swansea when their own doctors were away. Bicheno patients needing hospitalisation usually went to the Launceston General Hospital, while those from Triabunna went to the Royal Hobart Hospital. Private hospitals in Launceston and Hobart were also used. From the Swansea practice, I usually referred non-urgent cases to Hobart consultants, whom I knew well because of my university background, but I occasionally referred patients to Launceston consultants. Coles Bay, to the north-east, was in a kind of no-man's land, being served by either the Swansea or Bicheno practices as convenient, but most of the trauma patients came to Swansea because of the x-ray and casualty treatment facilities. The practice routine consisted of daily surgery consultations, referrals, emergencies, telephone calls, and being continuously on call -- all common to rural practices wherever they be. We acquired a fax machine and equipment was installed for receiving medical educational material by satellite from the Rural Health Education Foundation, while the work of Nerilie Gilson and her staff of the Tasmanian Rural Doctors Coordinating Unit greatly facilitated my contacts with locums and attendance at conferences and seminars. Also, the local Lions Club donated a diagnostic electrocardiogram machine. As I got older, the ability to keep up to date was very important to me, and I dreaded getting into a rut. However, close liaison with colleagues, especially with Hobart consultants and hospitals, helped in many ways. Then there was the support of the Glamorgan Ambulance Service and the nursing staff of the May Shaw Nursing Centre. I find it difficult to express how much their support meant to me. Even so, there were times when I felt like a one-man E.R. (TV series set in an emergency room), such as when I was suturing a head injury in casualty, while a patient with a suspected heart attack was on a stretcher in the corridor outside having an ECG, and an ambulance was radioing in with another casualty, wanting advice on how best to handle it! We coped. Originally, my wife and I thought we would be working full time in Swansea for about a year, after which it was confidently expected that a younger doctor would be found to take over the practice. Four-and-a-half years later I was still there, still working full time! When it became obvious, after a couple of years, that no replacement was in sight, we sold our house in Hobart and bought one in Swansea. It was only about 400 metres from the nursing centre, virtually on Schouten Beach, with an unobstructed view east across about 17 km of Great Oyster Bay to the pink granite hills of the Freycinet National Park, Schouten Island, and south-east to the open sea and Maria Island. We rapidly learned to appreciate the ever-changing patterns of light, clouds and sea, the sounds of the surf ranging from calm sunny days to overcast, stormy ones, and the beautiful flight of the seabirds. During our time in Swansea three final-year medical students were attached to the practice, two of whom stayed with us. They were all most welcome, for they brought youth and the latest teaching from the medical school and Royal Hobart Hospital. With the help of a qualified nursing sister, Jane Dick, we grew from virtually nothing to a thriving practice in a year. With so much going for it, we found it hard to understand why there was so little interest from doctors in taking over the practice. We also found that our case was not unique -- it is terribly hard to attract doctors to many rural areas, despite the many attractions.
Retirement again Retirement means gardening, building a fence, putting up trellises, playing bridge and mah-jong, joining Probus (an organisation for retired professionals), indulging in photography, running a model electric train layout, enjoying membership of the Australian Medical Association and the Australian College of Rural and Remote Medicine, and taking part in as many social activities as we can fit in. To those older people contemplating full-time solo rural practice I would say that if you are fit and well, maybe. If you have any conditions needing frequent or quick access to medical care and absence from the practice, then no, definitely not. If you do decide to take it on, do so with your eyes wide open. Seek the opinion of your medical and financial advisers. Be very clear about the practice and about ancillary help and accommodation, and set a deadline for finishing. Swansea was the highlight of our lives, but we wouldn't have been able to take it on without the help and support of relatives and friends and of the Swansea community. I miss the rough-and-tumble and the drama of rural practice, but I don't miss being called out for emergencies at all hours of the day and night! William G Flux
©MJA 1999
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