Dr Dan Manahan is medical superintendent of Stanthorpe Hospital in south-east Queensland and the medical director of the state’s Rural Generalist Pathway. The Pathway is a training program for junior doctors who want to pursue a career in rural generalist medicine, including advanced training in anaesthetics, obstetrics or surgery.
My main position is as a rural generalist clinician, which means I have a broad variety of roles at Stanthorpe Hospital, including seeing patients in the emergency department and in the general practice-type outpatients department, as well as inpatients, including maternity and cancer patients.
I’m what we call the old-style rural generalist. We’re not much different to doctors who come through the current Rural Generalist Pathway, except they have had a supported training pathway and we had to cobble together our own training. After my internship, I worked in Emerald in central Queensland for a year. The hours were long, but the work was fascinating and the patients were very appreciative. After that, I decided I wanted a career as a rural practitioner, but there was no clear path to achieving it, unlike in other specialties. I had some good mentors who helped me find the training I needed, so I trained in general practice procedural areas, including surgery, anaesthetics and obstetrics. If there had been a clear pathway like there is now, I would have jumped on it.
Rural practice in Queensland has changed. When I worked in Emerald in 1990 we had two doctors to manage more than 300 deliveries a year. When I moved to Stanthorpe in 1996, I was the only doctor at the hospital, which had 120 births a year. I’d work 30 days on and have five days off. The work was satisfying, but it was fatiguing and unsustainable. Over the past 16 years at Stanthorpe Hospital, we’ve gone from just one doctor to the four doctors and two interns we have now. That’s close to being the right number. My team in Stanthorpe tell me that life isn’t too bad — that it is sustainable. It’s not perfect yet, but a one-in-four roster is a lot better than 30 days on and five days off.
If rural hospitals and rural practices don’t provide an attractive and sustainable working environment, they won’t have a medical workforce. If you have to be on call every night or every second night in a town where there’s a lot of after-hours work, you are going to burn out quickly. The Rural Generalist Pathway is a key part of the process of making rural practice both attractive and sustainable. When I was training, some doctors who wanted to be procedural rural doctors gave up because it was too difficult to get the training they needed. We didn’t have enough rural doctors and I never had to compete for a position — I was always the only applicant. Some people are born to become rural practitioners. It is in their make-up and nothing will stop them. But for that group of people who would like to become rural doctors and don’t know how to negotiate it, rural generalist pathways will mean this group will come forward and achieve their goal.
The medical team at Stanthorpe Hospital is made up of rural generalists who want to be here. They weren’t sent here; they asked to come. They have the skill base needed to provide a hospital-based general practice, emergency care and a maternity service, and they are really keen to work with the local GPs. One of the successes in Stanthorpe has been the GP community, who have supported the hospital by participating in our services. I would have been long gone if it wasn’t for those GPs.
The doctor who taught me the most was Dr Jim Baker, who was a rural obstetrician who visited Emerald and nearby towns. Jim, who died a few years ago, was a great mentor for me in terms of rural practice and his work ethic.
I find karaoke is a good tool for training medical students. We’ve been training medical students at Stanthorpe Hospital since 1996, and we now have four students who stay for 12 months in their third year. We’ve had high-performing students who we’ve taken aside and said: “You can do a case presentation or you can skip this one and you’ll get an A grade if you do a karaoke song in the tea room instead.” I’ve had a couple of students take up that offer — one sang Dancing Queen and one sang Staying Alive, and they were X Factor material.
The best advice I have for young medical colleagues is to spend time with your family and don’t become a victim of your work. Over the years, dozens of older rural doctors have told me they regret the amount of time they missed with their family when their children were growing up. I’ve dedicated myself to trying to avoid that regret. Even though I worked long hours early on, I think I have been really involved in my kids’ lives. My kids would probably say I’ve been too involved.
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