A new innovation in GP training may offer hope to the New England by allowing GP registrars, or trainee doctors, to work in short-staffed communities and be supervised remotely.
The Royal Australian College of General Practice (RACGP) is running a pilot project to test the system that enables GP registrars to work in rural and remote communities as doctors, while offsite supervisors, using phone and videoconferencing, supported the registrars with teaching and real time assistance.
In 2022, the RACGP pilot project enabled registrars to work on Norfolk Island and Walgett at an Aboriginal Medical Service, where they have been making a positive impact. Remote GP supervisor, Dr Debbie Hough, said the training program has exciting potential.
“It is a pleasure to be involved in mentoring passionate, young GPs to work in areas where a sustainable medical workforce has previously been difficult.”
“Remote supervision may enable registrars to be exposed to amazing rural communities and increase the likelihood that they may choose to settle long-term,” she said.
West Armidale Medical Centre to be included in new project
Last year The Healthy Communities Foundation bought the West Armidale Medical Centre, intending to recruit replacement GPs to continue after the retirement of doctors Maree Puxty and Terry Bohler. Despite allowing 12 months for transition, recruitment efforts to attract new doctors to the smaller practice have failed. From August, the West Armidale Medical Centre will be added to the remote supervision project trial.
Healthy Communities Foundation CEO, Mark Burdack said the biggest problem in rural Australia now is that all the older doctors are retiring.
“So, to become a new doctor in a rural practice, you need a senior doctor to supervise you.”
“And we are losing those [senior doctors], or the ones that are there are tending to patients and can’t provide supervision,” Mr Burdack said.
“Trainees are capable of independent practice but require support for their advanced training.”
The Foundation turned to the RACGP remote training project to make West Armidale Medical Centre a virtual training site, keeping the centre open and helping to build a local GP workforce. The project will see registrars and international medical graduates working at the practice from August this year. From February 3 until the new project starts, the medical centre will continue to operate with a combination of telehealth or telehealth via videoconferencing with local nursing support on site.
Helping patients get appointments
While some will be uncomfortable with either the telehealth services or remotely trained registrars, the ability for some to get an appointment when they need it will make a big difference, particularly for those patients who have lost their GP to retirement or resignation.
Emergency Services worker Allie* is one of those patients. When trauma associated with her work as a first responder left Allie with Post Traumatic Stress Disorder (PTSD), she found she needed continuing regular support, monitoring, and crisis assistance from her GP who has mental health advanced training.
Reduced numbers of general practitioners in Armidale and across the region means Allie struggles to get the regular medical appointments she needs, which in turn means prolonged and delayed treatment. Despite loving where she lives, Allie is considering leaving the region and believes the shortage of doctors puts the entire community at risk.
RACGP President Dr Nicole Higgins said the remote supervision concept is to enable registrars to train where there is no on-site supervisor, and improve the availability of doctors where they are needed.
“Research shows GPs who train in rural and remote communities are more likely to stay on working and living there,” she said.
The project team’s Senior Medical Advisor and Rural Generalist Dr Jill Benson AO said the team found that the impact of poor access to supervised training threatens the sustainability of medical services. Overloaded GPs running their own clinical practice often lack the time or enthusiasm to supervise a GP in training, with many close to burnout.
“The key to providing a sustainable GP workforce in rural and remote areas is the provision of timely and effective remote training supervision,” Dr Benson said.
The RACGP is planning to roll out the program more widely and identify a further 10 to 20 remote communities that have had difficulty attracting or retaining a GP that could be suitable for remote registrar training.
What local doctors think
Tamworth GP Dr Ian Kamerman said long established training schemes like the Australian College of Rural and Remote Medicine’s Remote Vocational Training Scheme had previously trained rural GPs.
He thought that the RACGP while project was, “not a particularly new thing; it is great that RACGP now have a formal policy as to how it should be done.”
He thought that there were few locations where remote supervision was needed.
“It is unusual for a doctor these days to go to a place where there are no other doctors that are able to supervise.”
“The provision of remote supervision will benefit a small number of rural doctors who can’t otherwise access training, but it could make a huge difference to that community,” Dr Kammerman said.
Chair of the New England Division of General Practice Dr Vicki Howell said the RACGP project has promise but wondered if it could successfully attract doctors to the region.
She said that attracting medical graduates to GP training and Rural medicine has been difficult.
“Less than 50 per cent of available training places in NSW have been filled. There has been a progressive loss of registrar numbers state-wide, but it’s a nation-wide issue.”
She said the loss of registrar numbers has disproportionately impacted rural areas with most trainees not choosing rural placement.
“I have heard that of 40 training positions in the New England, there were 8 registrars available to take up those positions,” Dr Howell said.
As for the RACGP project, Dr Howell was cautiously optimistic. “There are fewer and fewer supervisors left in rural centres. So, I think it is a potential immediate solution.”
Political will
A Senate inquiry in 2022 found that communities in rural and remote regions have less access to healthcare and poorer health outcomes, with a greater reliance on GPs that need to provide a wider scope of services than their city colleagues. A report for that inquiry from Deloitte Access Economics found that that demand for medical services in regional Australia would outstrip supply for most of this decade.
Minister for Health and Aged Care Mark Butler told The New England Times the Federal Government has committed $183 million to attract and retain more health workers to rural and regional Australia through improving training, incentive programs, and supporting development of innovative models of multidisciplinary care.
“Premiers, chief ministers and our government have made it clear that this issue is in the national interest, especially in rural and regional communities.”
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