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Early rural training key to keeping doctors in the bush
A bright young medical student leaves the big city to train in a small country town, where she falls in love with a sheep farmer and the charms of a simpler existence.
There will be a medical emergency, a strong sense of community and some wild chemistry between the protagonists at the annual country fair.
It could be a script for a TV rom-com.
Right?
“I’m not sure about that,” Dr Clare Hardie tells The West Australian from her home in the WA Wheatbelt.
“I spent my third year of university doing my Rural Clinical School placement in Northam in 2015 and yes, it’s true that I ended up meeting a fourth-generation farmer from Wandering at the Dowerin Machinery Field Day, which is an agricultural show.
“I was working out of a pop-up medical tent taking blood pressures and offering farmers free health checks when he walked over.
“He wasn’t one of my patients. We just met at the expo and I ended up marrying him.”
Almost a decade on, Dr Hardie still calls Wandering home, living there on a mixed cropping and sheep farm with husband Brendon and their two young sons, two and four.
It is a dream turn of events for the Wheatbelt town.
Australia is in the grips of a GP shortage, with the problem even more acute in remote and regional areas.
Dr Hardie, who works out of Narrogin Regional Hospital, is the only GP-obstetrician in the agricultural centre of 5000.
When she started, there were two others, but one retired and the other returned to Perth for family reasons shortly after she arrived.
Dr Hardie knows if she moves on, there will be nobody to replace her permanently.
Camera IconDr Clare Hardie cuddles one of her adorable new patients in Narrogin. Credit: Supplied
What’s more, relying entirely on locums would not only be costly, it would undermine the principle of continuity of care.
“Continuity of care is so important,” Dr Hardie says.
“If you see a woman throughout their pregnancy, you have automatic rapport in the birth suite — and they have trust in you — which makes the birth experience more positive.
“If you’re relying on locums, these women are relying on someone they have never seen before during the most special time in their life when their baby is being delivered.”
Interestingly, Dr Hardie had never lived outside of a city before her rural training stint in Northam nine years ago.
She grew up in suburban Brisbane and came to WA when she was accepted into medicine at the University of Notre Dame in Fremantle.
It was during her year-long rural immersion experience in Northam, during her third year of university, that she really fell in love with country practice — and Brendon, who was conveniently single when those sparks started flying at that sweet country fair.
“My university actually integrated rural medicine throughout the whole course so I did a Wheatbelt trip in my first year, and in my second year we went to the Kimberley and worked in remote communities,” Dr Hardie says.
After completing her year-long GP training in Northam, she had to return to Perth to do one more year of medical school, a 12-month internship, and another year as a resident doctor.
She then undertook 18 months of accelerated obstetrics training at King Edward Memorial Hospital, and Dr Hardie is grateful she was able to finish the rest of her training in Narrogin under a mentorship program.
“There was no way I could have done my specialist training in Perth without it being . . . accelerated,” Dr Hardie says.
“I had met Brendon and we were already putting off having children so I could get my training done.
“When I went to other hospitals to do my emergency training component, there wasn’t an accelerated program available.
“What KEMH offered was unique.
“They had a different attitude, which was ‘You’re going to work in a remote area so you are the first priority for training because we want to get you trained up and as skilled as we can so we can get you out into those communities that need you’.
“What is happening is a lot of doctors can’t leave the city because even though they might actually be happy to go rural, it is not being made easy for them because they are getting stuck on their specialist training program in the city, and during those years they’re likely to meet someone, get all settled there, they may end up starting their family there, and they are not going to uproot their family to move out to the country.
“The best time to get a doctor out into the country areas is before they even have kids and before they are settled in their life.”
Indeed, many Australian rural and remote towns are struggling to attract doctors, so much so that some have been forced to shut the doors of medical centres.
Other WA towns, like Quairading, were so desperate to lure medics they offered an $800,000 annual salary and a rent-free four-bedroom house to any doctor who would take the job.
However, attracting quality doctors to rural areas is about more than a good salary and a free house, Dr Hardie says.
She believes medical students would be more likely to settle in the bush if the training pathway was smoother, with lower wait times, and opportunities were created to do specialist training programs in country town settings, similar to how rural GP training already works.
Early rural immersion experiences are key, she says.
“There are a lot of rural doctors who want to come to Perth and train but they need to get in and out as quick as they can and yet they are being told they are in the same line as a city doctor to get their skills, and that is a problem, putting them in the same queue as people who plan to work in Perth their whole lives where they will have all the support of a tertiary hospital behind them,” Dr Hardie says.
“This is why we are not turning out GP-obstetricians anymore — we can’t even train them up.”
A first-of-its-kind Australian study has confirmed rural training in the early years is crucial to retaining country doctors.
Researchers followed 1220 medicine graduates from nine Australian universities and looked at where they ended up working five, eight and 10 years after graduation.
About 30 per cent of general practitioners — a specialty that gives doctors the opportunity to do most of their training in rural areas — were practicing in the country 10 years into their careers.
But only 10 per cent of other medical specialists, such as psychiatrists or paediatricians, and 15 per cent of surgical specialists, ended up in non-metropolitan areas a decade after graduation.
These specialists do most of their training in the city.
“This study reinforces the impact of rural training pathways on a doctor’s longer-term work location,” says the study’s lead author Dr Alexa Seal from the University of Notre Dame Australia’s Wagga Wagga clinical school.
“Specialist training needs to be expanded to support more rural training opportunities for doctors outside general practice because we know that rural exposure is associated with the likelihood of living rurally in the future.”
Data from the Australian Medical Association also highlights how rural and remote Australians often miss out on essential healthcare because of regional doctor shortages.
There were seven times fewer specialists in remote areas than in metropolitan areas, leaving patients with no choice but to travel extensively — often with significant financial and familial burden — to attend appointments.
The AMA found rural Australians also continued to have higher rates of hospitalisations, death and injury, and poorer access to primary health care than people living in major cities.
Dr Hardie admits life as a rural doctor can go from calm to completely crazy sometimes, but she has learnt to strike a healthy work-life balance overall, especially now she has a third baby on the way.
“We need to keep encouraging rural medicine because, in my opinion, it is a great lifestyle,” she tells The West Australian.
“My town takes me for whatever I can give, which at the moment is part-time.
“I plan to work more in the future, and I am lucky our community is so supportive because there have been times when the juggle with young kids while being on call has been difficult to manage, and I’ve had to bring the kids along with me.
“Just last week I was in the middle of delivering a baby who was already halfway out at 4.30pm but my kids had to be picked up from day care at 5.30pm.
“I put a call out for help and someone else drove the hour round-trip just to pick up my kids for me so I could continue delivering the baby. That’s small towns, and it feels special to be a part of one.”
One that all but sounds like a Hallmark movie setting.
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