Academic journal article Australian Health Review

Looking after Health Care in the Bush

Academic journal article Australian Health Review

Looking after Health Care in the Bush

Article excerpt

LOOKING AFTER health care in rural Australia involves providing adequate services to meet the urgent and non-urgent needs of rural patients in a timely, cost-effective and safe manner. The very provision of these services requires an appropriate workforce and facilities in rural areas. This provides challenges for clinicians, administrators and medical educators.

While preventive medicine has made some significant gains globally in reducing the need for acute care and hospitalisation in some areas of medicine such as infectious disease and asthma, these demands have been replaced by an increase in trauma, chronic disease and mental illness1 which, with an ageing population, eventually means presentations at an older age which can require hospitalisation.

Rural patients have always had to deal with a relative undersupply of health practitioners. Rural people have coped valiantly with this. The legendary stoicism of rural people has been shown by Schrapnel2 and Davies to be a prominent feature of the rural personality. This both allowed them to cope with lack of services and to suffer in silence while their health status fell below the Australian average.3 Rural Australians use fewer Medicare services and see the doctor less per annum than the Australian average.

Measures to address this

The issues of rural health care were first addressed in the 1970s by the Country Towns Country Doctors Conference.4 In 1979 the Medical Board of Queensland appointed the Thompson Committee to enquire into the future training needs for medical practice, especially rural practice, in Queensland. The Thompson Report,5 published in 1981, led to the radical changes in medical courses in Australia over the past 20 years. In the early 1980s, inspired by WWAMI (University of Washington School of Medicine is a regional medical school resource for Washington state, Wyoming, Alaska, Montana and Idaho the WWAMI states) and the work of Rosenblatt and Muscovice in the United States,6 and fired by industrial disputes in New South Wales and Queensland, Rural Doctors Associations were established and moved to address these issues through better terms and conditions and better education. In 1991 the First National Rural Health Conference was held in Toowoomba and the national rural health strategy proposed.

From this and subsequent decisions came a raft of government policies, listed below:

Educational programs

* High school student recruitment

* Rural Australia Medical Undergraduate Scholarship (RAMUS)

* Rural Undergraduate Support Committee (RUSC) 25% rural origin medical student target

* National Rural Health Network of rural student clubs

* John Flynn Scholarship Scheme QPSS)

* Rural Clinical Schools/University Departments of Rural Health

* Rural Medical Bonded (RMB) Scholars (lOOpa)

* Bonded Medical Places (BMP) (500pa)

* Rural scholarships including state bonded scholarships and cadetship schemes

Interns

Rural and Remote Area Placement Program/Prevocational General Practice Placement Program

Registrars

* Australian General Practice Training - Regionalised through Regional Training Providers

* General Practice Registrars Rural Incentives Payments Scheme

* Enhanced Rural Training Framework

* Rural generalist pathway (Qld)

Rural doctors

* Rural and Remote Procedural General Practitioners Program

* Practice Incentives Program incentives including Procedural Medicine incentives

* Retention grants

Communities

* Multipurpose Health Service

* Regional Health Service

Effectiveness of existing programs

These policies have been effective in creating interest in and support for rural practice. Recruitment and exposure programs such as RAMUS (providing scholarships to students of rural origin), JFSS (providing exposure to rural practice) and RMB/BMP scholarships providing extra funded places for medical students, have been heavily subscribed. …

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