Training our future rural medical workforce

To the Editor: The editorial by Wearne and Wakerman on the subject of rural training and its relationship to rural practice is timely.1

There is widespread belief that the rural problem lies in small country centres, and it is generally not realised that most of the regional centres, in New South Wales at least, are seriously short of both general practitioners and specialists. The statistics are highly unreliable, as many people, such as me, are listed as GPs even though we do not practise.

It seems likely that improved selection processes and the undergraduate rural training initiatives will increase student interest in rural practice. Many students express intent to practice in a rural or regional centre, but are later deflected from this by the necessity for training after graduation. Several large centres are not primary allocation centres, so a student who trained there may never get back. (The Australian Medical Students’ Association study puts the figure for rural internships as 9% of the total.)2 All too often, regional centres are understaffed, and junior staff lack adequate supervision and educational possibilities. Their negative experience is highly visible to students.

The allocation of registrars and senior resident medical officers, who supervise or make time for consultants to supervise, rests between the major hospitals and the various colleges. Regional hospitals are often low on their priority list when shortages occur. Yet there are regional hospitals that rate very highly in the quality of the training experience they provide. Regional hospitals that do not enjoy this reputation need to take active steps to improve their training and supervision or their plight will worsen.

Training packages also need to be developed for those who express an interest in rural practice so they can plan their future. This must be a collaborative process between the different seconding agencies: without such a process, much of the impetus of the undergraduate initiatives will be lost.