General practice

Dr Michael Livingston Rural generalist based in Ravensthorpe , WA .

There ’ s a fix for the challenges of care in isolated towns .

When it comes to rural communities , we rely on parachuting in GPs , typically IMGs .

These IMGs may not have much or any rural Australian experience . They usually haven ’ t passed their fellowship exams , and some are wedged into a job vastly exceeding their clinical capabilities and training .

This leads to learned helplessness , where the care model has to shift to a heavy reliance on expensive Royal Flying Doctor Service retrieval by air ($ 20,000 a flight ), or in WA at least , St John Ambulance road transfers ($ 4000 one way ).

Then there is the social isolation faced by doctors and the fatigue and eternal on-call self-flagellation demanded by a system that doesn ’ t care for your mental or physical wellbeing , culminating in the final result of burnout or leaving .

This scenario has played out all over Australia for far too long .

In WA , where I work , police cannot attend to a scene unless they can ‘ two-up ’ ( arrive with two officers ) to deal with issues that will confront them .

Nurses have to check in when leaving a site and returning home .

But doctors have zero protection systems , zero welfare systems , and whether they kill themselves driving or are murdered , as they are on their own , it is on them .

Is this appealing in any way ?

Rural generalists

Rural generalists are part of the

fix : the ‘ Swiss Army knife ’ doctors who can be inserted into the most rural , remote or challenging jobs and not only maintain the patients ’ wellbeing but also thrive , leading to improved care , extended skills and better outcomes for rural and remote communities .

The limiting factor is that these clinicians are very few and very far between , especially here in WA . We are not training enough of them .

In WA , you will not hear a single mention of rural generalists .

In the past seven years , I have never seen a single government document or email that acknowledges or respects this role .

Rural and remote hospitals that used to support advanced skills — theatres for surgery , wellstocked EDs , obstetric and labour wards — have been cut down .

So our ability to offer the necessary out-of-the-city care is throttled .

By the time a rural generalist makes it through the training , there will be no locations where their advanced skills can be used . Who makes these decisions ? It is the WA Country Health Service under the influence of colleges such the Australasian College for Emergency Medicine , the Royal Australasian College of Surgeons and RANZCOG .

The colleges

The irony is that , although

these colleges influence policy

Our lived experience doing these jobs is always ignored . In the local emergency meetings , we are never invited .

decisions , they never seem to be able to supply their own specialists to come out permanently to these rural and remote roles .

Telehealth , sure , but never on the ground unless it is a halfday trip for some ‘ teaching ’.

What reeks of arrogance is that their own trainees do not have to prove any similar rural experience in these jobs yet are there to tell us how to do them .

It adds to the further subservience

and belittling of general practice .

Instead , the state budget focuses on making the same mistakes under the illusion that , if we repeat them with even more money , this will fix issues such as ramping or the lack of medical resources in rural communities . It won ’ t . I have seen these policies being applied and failing . It is entirely predictable . The lack of any shock is the blessing of being remote and watching all

Dr Michael Livingston .

this from the periphery — probably the only blessing .

If you need examples , take the sudden interest in urgent care centres . In WA , St John Ambulance was awarded $ 28 million to establish and run them in Perth . Why ? What did this achieve ? Has it reduced ED ramping ? Why was a non-GP organisation given the money to provide this service ?

There are plenty of practices in metro areas that , with $ 28 million , could have provided better , more comprehensive after-hours / weekend coverage with that same funding .

If Prime Minister Anthony Albanese wants to repeat the same model around the rest of the country with federal money , let him look back at the history of this . It just doesn ’ t work .

A solution

When it comes to emergencies ,

in some rural parts , there is support from Sandpiper Australia : a not-for-profit entity that ensures rural clinicians have access to a standardised bag and the necessary equipment to deal with emergencies .

It is an idea sparked by the tragic death of a 14-year-old boy back in 2001 in Scotland , where appropriately skilled GPs are

now called to attend the scene of high-impact injuries — farming accidents , car traumas and so on .

We know the most important moments with severe injury are not when arriving at the statebased trauma unit but the first 30 minutes , the first hour .

We call the first 30 minutes the ‘ platinum 30 ’, realising that , if we get there and institute management early , we prevent further harm down the next 24 hours and preserve brain function , reduce organ dysfunction and damage , and support the individual .

Dr Tim Leeuwenburg , a GP on Kangaroo Island in SA , has been instrumental in bringing this to Australia , with another rural GP , Dr Scott Lewis , also based in SA .

Yet in WA , in one of the biggest land masses in Australia littered with geographically isolated towns and cities , we do not have anything like it .

Instead , we pour money into services that have yet to show they can stop the rural deaths from harm or injury .

The service providers go uncontested , and the state has never asked the question .

Our voice is drowned out by the jumpsuits ( Royal Flying Doctor Service / St John Ambulance ), who make it appear like they and only they know the ‘ solution ’, which is more money .

Again , not one of them has ‘ boots on the ground ’ covering these towns as we do as rural generalists .

I have 14 years of emergency medicine experience at senior consultant level , yet I am sidelined in a major emergency as it is deemed the St John Ambulance volunteers with minimal clinical skills , along with the community paramedic , are the best equipped to provide immediate care for the most vulnerable and injured . Really ? The narrative portrayed is that GPs are somehow bumbling , incompetent doctors best kept shackled to outdated EDs while valuable time , blood and reversal of injury are lost as we are left addicted to a model the rest of the world has got rid of .

Our lived experience doing these jobs is always ignored . In the local emergency meetings , we are never invited . It appears that discussing disaster response with the nursing staff is deemed sufficient .

This is how far down the ladder we have come in these communities , and health outcomes are worse .

Everyone wants a fix for rural health .

But the fix is just to plough