The Doctor’s Dilemma Workshop   – Ms Veronika Rasic (@DocVei) FM Trainee

Support and Scribe: Dr Jo Scott-Jones (@opotikigp)

The workshop was designed to explore the dilemma that we need people to work in health in rural areas, but we have great difficulty in attracting them.

Question : What would make an ideal future practice from the point of view of a young doctor or medical student?

Question : What needs to be done to make rural practice attractive from the point of view of a young doctor or medical student?  

In attendance were around 15 experienced and knowledgeable senior doctors from NZ, UK, Canada, Slovenia, Australia and Veronika a Family Medicine trainee and Rok Petrovcic (@Rok5rovcic) a Medical Student from Croatia.

Process:

Because the expected audience of young doctors and medical students did not attend, the original plan for the workshop was modified.

Veronika and Rok were given an exercise to perform which was observed silently by every one else. They each had 2 minutes to talk to each other without being interrupted. Each sentence they said they had to begin with the phrase “My ideal rural practice will….” Once their two minutes was up they swopped over. This was repeated 3-4 times until the issues rasied were becoming repetitive and the information gained exhausted.

They then undertook a brief reflection on the process and how it felt as did the observers – the main feedback being it is hard to listen without interruption.

(In this context it is a good exercise to ensure that a minority relative powerless voice is heard within a group setting, it quickly can take you places you would not usually go without support, and it produces an exhaustive list of issues that probably reflects combined wisdom.)

Outcome:

The discussion was captured on a flip chart using a “mind map” technique – My ideal rural practice will…

The students and larger group then discussed what “the system” needs to do in order to recruit more health professionals into this ideal rural practice:

1. Start Early

Community role models have an early influence on career choice, be a great GP to your patients and you will inspire them – go into the primary schools and give talks,organise medical students to go into schools and give health or career talks.

It is most powerful when someone FROM that community can GO BACK and say “ I was once where you are now and it is possible to get to University, and to a health professional training” it is hard for kids to see unless they are shown it is possible.

2. Undergraduates

Show undergraduates it is attractive to work in rural areas.

There are many myths that propagate amongst undergraduates – partly supported by the specialist who are training them in hospital settings – that GPs are the “poor cousins,” they not experts, they work long hours, they are isolated, that emergency work is overwhelming, they are isolated.

Hold an undergraduate “myth busting” evening to expose and modify the perception of risk at an early stage in undergraduate years. Try and persuade senior doctors to use less negative language about GPs and about Rural practice.

Of course selecting for rural, training in rural, maintaining long periods of time in rural communities is great for undergraduate education and for rural recruitment.

There is a feeling that even once qualified junior doctors don’t feel they have been given all the skills and attributes to “cope” in a rural practice – make sure they have the opportunity to gain those skills, or better skill make sure every graduate feels they could work in a rural practice.

3. Make the workplace attractive.

Money makes the world go around.

It does cost more to live and work as a doctor in a rural area – there are greater locum costs, greater costs incurred in staffing, higher after hours work rosters to staff and pay for, greater costs getting away to education opportunities, and often a need to send children to boarding school because of lack of local facilities. A “rural premium” funding that gives a bonus to people working in a rural area can help make the job more attractive, it also shows the work is valued by the community.

Provide a junior doctor with a car and accommodation, at least for the first 6-12 months of work so they can find their feet and explore the community properly, it is a time when earning capacity os not great and this sort of incentive is highly prized.

Practices need to be well equipped.

It is satisfying to be able to provide comprehensive continuous care for a community. If the practice has access to some in-patient beds, and good diagnostic equipment like near patient laboratory services and an ultrasound scanner there will be fewer unnecessary transfers out of the rural community with the additional risk and costs that will occur. We know from work in Canada and Australia that small well equipped hospitals can be more cost efficient than larger centres.

Provide support.

Be a mentor to another doctor, older professionals can find this a sustaining role and younger colleagues are looking out for effective mentorship – if this can extend into private and personal aspects of life it can be even better to support a young professional through hard financial and personal decisions.

Support community initiatives.

An attractive community is a better place to work, a happy community is a better place to work, a resilient community is a better place to work. Engage in your community, support local initiatives that make the place you work more attractive, happy and resilient.

Gender Equity.

Make sure that maternity leave is provided for in a safe and comprehensive way within your system. Even if a junior doctor is not going to have a child, they need to know they could and it would be no problem, think about a crèche at work if the workplace is big enough. (In some countries it is still accepted practice to discriminate against women by asking about family planning during a job interview!)

Develop a clear career pathway for General Practice.

Young doctors want to see how they can advance in the career, often it seems that once you have become a GP you have reached the peak of the profession, the rest is experience. It is good to have something to strive for.

For Veronika and Rok, the students there it was good to hear the response of the experts and to understand that their ideal practices were achievable. The more senior people in the group felt the exercise was worthwhile for a variety of reasons, the two minute silence listening exercise was useful to observe, it was interesting that much of what the students had drawn out were issues that are on the agenda for the WONCA Working Party on Rural Practice.