And other stories from the annual ACRRM and RDAA conference.
How to “fix” rural medicine is anyone’s guess, but the clinicians, researchers and medical students at the joint ACCRM-RDAA conference last week are keen to make a start.
It would appear, too, that the government is ready to listen – the new government has just made good on its election promise to reinstate the 50% fee loading for bulk billed video psychiatry consults in rural Australia.
Hosted in Canberra last week, Rural Medicine Australia 2022 was billed as the country’s largest family reunion.
Here’s a selection of the talks in brief.
Topic: Extended rural placements deliver sevenfold return
Who: Associate Professor Aaron Hollins, James Cook University
James Cook University has the distinction of being Australia’s first rural medical school and supplies an impressive portion of the country’s rural GPs and generalists.
Over the first 15 years of its existence, 33% of JCU students have gone on to be GPs, 11% are now rural generalists and an additional 10% are generalist specialists of some description.
One of the unique opportunities offered for final-year students at the Queensland university is a competitive “extended” rural placement of either 20 weeks or 40 weeks at an MMM4 location or above.
Using a social return-on-investment methodology, JCU researchers calculated the total value of the scheme to the rural medical workforce and the students themselves at just over $700,000.
The costs to the medical school in terms of accommodation and travel expenses, as well as the personal cost to the students was valued at $93,000 – a return-on-investment of $7.60 for every dollar put into the program.
“Three-quarters of the people who did extended placements are either working or intending to work in MMM4 to 7,” researcher Associate Professor Aaron Hollins told delegates.
“When we looked [a year later, in] 2019 at where their practice location was, 40% of them were already working in MMM4 to 7.”
“That may seem a little bit less than what you’d expect, but remember that we’re looking at extended placements from 2012 to 2018, and some [students] will still be interns in MMM1 and 2 hospitals [as of 2019].”
Topic: Everyone has a different view on conflict in GP training
Who: Dr Samia Toukhsati, General Practice Supervisors Australia
Practice managers, supervisors and GP registrars can have wildly different perceptions on how conflict is managed during training, according to GP Supervisors Australia researcher Dr Samia Toukhsati.
Across both rural and metro settings, more than 80% of registrars reported that conflict was not easy to resolve, while between 60% and 80% of practice managers felt it was easy to resolve.
GP supervisors were in the middle, with 40% and 20% feeling that conflict was easy to resolve in metro and rural settings respectively.
“Registrars … [mostly] said that it was the attitude of the supervisor that is the primary cause of conflict that they experience,” Dr Toukhsati told delegates.
The important takeaway, Dr Toukhsati said, is that conflict resolution is in the eye of the beholder.
“Registrars are likely to be needing to resolve conflict with multiple people, so not just the supervisor but possibly the practice manager,” she said.
“Even knowing to whom a conflict should be taken to can be challenging and certainly, they recorded having difficulty with working within a hierarchy and feeling powerless.”
Topic: Telehealth, but it’s GPs doing dermatology
Speaker: Dr Scott Temple, GP
A year and a half ago the regional Queensland city of Mackay has just one dermatologist per million people, with no public outpatient clinic.
The average wait to treatment for people with chronic inflammatory skin disorders was about 12 years, which – as Mackay GP Dr Scott Temple pointed out – is a rather long time to live with what can be a very debilitating condition.
Dr Temple, with the help of a Brisbane-based dermatologist, set up a GP-led outpatient dermatology clinic in June last year, which runs once a week and sees up to 18 patients.
“I triage the patients and … take a history, physical examination, investigations, take photos, and then email it all to the dermatologist,” he told delegates.
“Then at about 2 in the afternoon we just discuss over video conference about how to manage these cases.”
For the first three weeks, the dermatologist was visiting patients in Mackay weekly – from there, the visits dropped to once a month for seven months.
Now, the dermatologist is only expected to visit three times each year.
“As [my experience] has increased, the dermatologist has had to come less,” Dr Temple said.
