Queensland’s Rural Generalist Pathway is leading the way for rural training
Dr Jack Sloss has found the ideal job in rural medicine — one that provides the occasional adrenalin rush of acute medicine with the backdrop of general practice and the chance to be part of patients’ lives.
He is one of the first graduates of Queensland’s Rural Generalist Pathway (RGP), which began in 2007 to help address the state’s rural medical workforce crisis and the loss of procedural skills in rural communities.
Dr Sloss heard about plans for the RGP when he was still a medical student, and he knew immediately that was what he wanted to do.
“Being a rural generalist meant I would be able to do a variety of medicine in a rural community, including obstetrics as my advanced skill, and the pathway would support my training”, he says.
Dr Sloss, who was a shearer before studying medicine in his mid-30s, was intent on a career as a rural doctor from the day he set foot in medical school at the University of Queensland.
After completing his general practitioner and advanced skills training in obstetrics through the RGP and his Fellowship of the Australian College of Rural and Remote Medicine last year, Dr Sloss is now based at Thursday Island, where his work reflects the varied role of a rural generalist.
For three days a week he travels around the outer islands, working as a GP and focusing on chronic disease management in Torres Strait Islander people. For the rest of the week, he is based at Thursday Island Hospital, providing obstetrics cover and on-call services in emergency and obstetrics.
The 5-year RGP combines with the Australian General Practice Training program to produce an end point of advanced rural medical training. Each RGP trainee trains in an advanced skill, such as anaesthetics or obstetrics.
Many RGP trainees hold Queensland Health scholarships, with the pathway providing a way to integrate return-of-service obligations with training needs.
Queensland Health’s principal rural medical adviser, Dr Denis Lennox, who is widely seen as the architect of the program, says it was developed to produce doctors who have the skills needed to work in both primary and secondary care in rural towns.
A key plank of the program is to provide a supported pathway for rural doctors that can begin when they graduate from medical school.
“The tracks to rural practice in Queensland before the Rural Generalist Pathway tended to be disjointed”, Dr Lennox says. “There were fantastic initiatives such as rural clinical schools, but they weren’t connected into anything after undergraduate training, and most graduates were streaming into urban specialist settings.”
Another problem prior to the RGP was that students didn’t apply for rural training until 1–2 years after they had finished their medical degree and if they wanted to commit to rural medicine, they needed to move many times to complete the training they needed. “So we looked at all those experiences that represented a minefield for students and junior doctors to negotiate and produced a clear training pathway, with as few relocations as possible.”
Dr Lennox says the RGP has also meant that rural generalists have professional status equivalent to that of a medical specialist, with remuneration to match. This recognition — both professional and monetary — has helped ensure the popularity of the pathway, he says.
The training program
Doctors can join Queensland’s Rural Generalist Pathway as early as their intern year. They do a variety of term rotations and intensive skills workshops in their first and second postgraduate years.
In their third year, trainees begin advanced skills training in a discipline of their choice, such as obstetrics, emergency medicine, surgery or anaesthetics.
In years 4 and 5, trainees work under supervision in rural communities in one of three roles: as a senior medical officer; as a medical officer or medical superintendent with right of private practice; or as a private practitioner and visiting medical officer at a rural hospital.
At the end of training, doctors are recognised as rural generalists and achieve Fellowship of the Australian College of Rural and Remote Medicine, or Fellowship in Advanced Rural General Practice, both of which certify their advanced specialised skill(s).
Dr Sloss says a misconception about rural generalists is that they have to be all things to all people, like the previous generation of rural doctors who often worked 80-hour weeks, had little time off and had to cover all procedural areas.
He says the RGP has addressed this issue by training a workforce that hopes to provide several doctors in a rural town, each with an advanced skill, ensuring there are enough doctors with the required skills to provide work−life balance for all. “The RGP is suggesting that you can have a balanced lifestyle if there are two or three of you in the town”, Dr Sloss says.
Professor Tarun Sen Gupta, co-director of Queensland’s RGP, agrees that the new generation of rural generalists show that rural doctors don’t have to be “10-foot tall and bullet proof”.
“In the previous generation, rural doctors did work extraordinary hours and needed all the procedural skills”, he says. “While there are people who still do that, there is a range of skill sets that can meet the needs of rural communities and the pathway is providing that.”
The Queensland Rural Generalist Pathway has proved so popular since it began five years ago that there have been more candidates than available training positions in each intake.
So how would a medical student or doctor stand out to the selection panel?
Dr Sloss says candidates “need to show they enjoy the bush and rural and remote people, and that they want to be part of people’s ongoing lives”.
RGP medical director Dr Dan Manahan says aspiring rural generalists should show they are team players. “Rural practice is a team sport”, he says. “To get the best outcomes for your patients, you have to be able to work in resource-poor and time-poor teams, and our evolving rural workforce is learning to do this.”
Leading the way
Queensland’s Rural Generalist Pathway is a role model for other states and territories, which are also battling to ensure that their rural and remote communities not only have enough doctors but also doctors with the necessary skills.
New South Wales, Victoria, South Australia and Western Australia are either investigating their own version of a rural generalist pathway to suit their jurisdiction, or have already started recruiting advanced trainees to start next year. The Northern Territory had its first intake of rural generalist trainees this year.
State and territory support for rural generalism coincides with a recent Senate Committee report into the rural medical workforce, which supported efforts to increase the number of rural generalists through the development of training pathways.
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