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Rural health needs more than doctor-based health reform

Why is there so much focus on encouraging more doctors to work in the bush rather than a holistic approach that recognises the need for other health professionals as well?

That’s a question that’s been bothering Shannon Nott, a medical student who is Co-Chair of the National Rural Health Students’ Network, in the wake of a recent Federal announcement of more funding for GP training.

He writes:

“The health status of rural and remote Australians is simply not good enough.  For too long now, we have waved the white flag when it comes to addressing the health inequities that exists in outback Australia.  We have reached a stage with new health reforms and debates taking place, where we can battle the problems in the bush and not mask them with temporary quick fixes.

I am a medical student from the University of New South Wales and also Co-Chair of Australia’s largest multi-disciplinary health student body – The National Rural Health Students Network.  For years we have been pounding at the door for equity in terms of the health workforce and health outcomes of Australia’s rural and remote peoples and it seems now that the wheels are beginning to turn in this area of dire need.

What we need in order to turn around the discrepancies in health service across this country is one simple thing – equity.  Let’s cut away the fat when we talk about workforce reform and look at what is really needed – the most optimal health service delivery for rural and remote Australians that will improve their status.

That is it, it isn’t about doctors or nurses or paramedics, it is about providing better service delivery for rural and remote Australians.  It has been long recognised that an inter-professional team working synergistically results in better outcomes for the patient.

So then, I ask ‘Why do we seem to only focus on doctors when we speak about health reform?’

It is undoubtedly obvious that doctors form an integral aspect to the health team and efforts to improve doctor numbers in the bush are needed, but we will continue to see overworked, overburdened doctors in the bush if we do not start looking to provide them with the support they need.

Now is a time for us to look at health holistically and recognise the vital role that ALL health professionals play in the management of patients.  We know through programs introduced for medical students and young doctors what works in terms of attracting them to the bush, so it is now time for us to start looking toward providing similar incentives for their poorer cousins allied health and nursing.

I am not saying that medical incentives are at a point which is perfect, but they are miles ahead of those offered to allied health and nursing students.

We know that by providing students with positive rural or remote placements at university, they are more likely to return to the bush upon graduation.  So let’s start providing all students with positive placements.  This involves not only financially supporting all students through such placements but also providing logistical support as well when getting students out to such areas.  This includes helping students plan and select appropriate rural placements but also by providing them with community contacts to which lie the responsibility of integrating these students into the community.

We also need to start looking outside the box when it comes to the provision of incentives for medical, nursing and allied health professionals entering rural or remote practice.

At the moment much of this revolves around financial remuneration, which is important, however we cannot forget the non-monetary incentives that many young professionals seek.  These include ensuring access to continuing professional development, adequate infrastructure in the health workplace, access to assured leave and most importantly access to professional support.

So let’s get serious about improving health outcomes for rural Australians and start promoting rural practice to all health professionals.

It is time to get fair dinkum about rural and remote health and it is time to begin listening to the future health workforce and address their needs to ensure that rural and remote Australia are viable workplaces for the next generation.”

Comments 6

  1. BackOfBourkeBoy says:

    Note for forwarding Shannon Nott please:

    Shannon, there is a large untapped group travelling round the country, namely the grey nomads, who would willingly (I hope) give of their time and professional competence to assist in the bush. I suspect that all that has to be done is to provide them with facilities to volunteer their services (maybe in exchange for board and lodging). Ad mittedly they would cover only 6 months of the year but, in terms of a major preventive effort, that may be adequate.

  2. Raymond Bange says:

    Shannon Nott is absolutely correct about the fixation on hospitals and medical practitioners in the reform debate, and I’m pleased to see him raise the issue of interprofessional practice in rural and remote Australia.

    Readers of Croakey may recall my own observations on health care reform last June 2009 (Paramedics forgotten in our health care debate http://bit.ly/ctnXzN) and the concern I expressed about a too narrowly-focussed view of health care.

    As for incentives being offered, the allied health professions and nursing at least get something in the way of scholarships and clinical training support.

    Paramedic students get virtually nothing and are excluded from the eligibility list of the various Scholarship Schemes managed by Services for Australian Rural and Remote Allied Health (SARRAH) To verify this inexplicable situation, just look at the eligibility criteria for ARRHPS (http://bit.ly/dg3sWd) or for RAHUS (http://bit.ly/d2Aki7) or
    ACHPSS (http://bit.ly/9XxwFd).

    It is well past time that governments recognised the benefits that could be gained by properly integrating paramedic practice with the primary health care system and better utilising the skills of these qualified practitioners to provide a true interprofessional approach to care.

    But that will only happen if EMS is funded nationally with paramedics registered under an independent national regulatory scheme. That cannot come too soon for the sake of everyone, and particularly those living in rural and remote Australia.

  3. Fiona says:

    Speaking of registration, @ Raymond, it is interesting to see who gets included in registration in the next round – occupational therapists, Chinese medicine practitioners, and podiatrists I believe are in there, while speech pathologists are not – interesting given to money sent our way with the Helping Children with Autism package… Just not deadly enough, I suppose. Because there’s no risk in having to decide whether a patient is safe to eat and drink.

  4. Raymond Bange says:

    Fiona, I appreciate the point you are making and the priorities that seem at times a little awry.
    When it comes to registration, the question of risk is one of the criteria listed under the 1995 AHMAC guidelines for assessing the regulatory requirements of currently unregulated health occupations.

    However, one might question the generality of application of these guidelines and the extent to which the various criteria (such as risk) are weighted in any assessment, as well as the objectivity and appropriatness of other regulatory controls.

    In some cases, such as EMS, the risks are demonstrably high, with patients receiving interventions and powerful medications that would qualify for a Medicare rebate if performed in a clinic or hospital by a registered practitioner with a provider number. The fact that intubation and other invasive procedures are often performed under emergency and adverse physical conditions only adds to the risks and underscores the high level of professional skill and judgement required of the attending paramedic.

    Unfortunately, as Shannon has outlined, the importance of interprofessional practice has not been fully recognised in health care and the established silos of practice still hold great sway within the policy arena.

  5. Stephj says:

    Raymond,
    Whilst I agree with you I would like to clarify one point you made.
    You wrote”As for incentives being offered, the allied health professions and nursing at least get something in the way of scholarships and clinical training support”.

    I was part of a delegation invited to Parliment House last year by Warren Snowden MP to discuss the inequities that exist with scholarships and opportunities between medical, nursing and allied health students.

    Whilst there are scholarships available for Allied Health through SARRAH, there is not a national scholarship scheme for nursing students to undertake a rural or remote placement.

    There is some money available through some of the states and territories but only approx $500 per placement. These are not available in all states and territories though.
    Many nursing students are not even offered a rural or remote placement, most students have to organise the placements themselves – that is find the placment location, arrange accommodation, and travel etc etc and usually nursing students have to fund these placements themselves.

    CRANAplus (Council of Remote Area Nurses + Allied Health) offer three scholarships of $1000 each on an annual basis for students who have undertaken a remote placement and they also administer another three scholarships for a S.A. based nursing agency.

    This is – as far as we know – just about all that is available for rural and remote placements for nursing students. If anyone knows of any more I would love to hear about it.

    I think it is really important though that we work as a team and not single out one profession as being more hard done by than the other. A multidisciplinary approach is what is needed if we want to get things changed.

    Stephanie Jeremy
    Senior Nursing Representative
    National Rural Health Student Network

  6. Raymond Bange says:

    Stephanie,
    Thank you for highlighting yet another anomalous situation regarding support for rural and remote health education and placements.

    I agree that interprofessional practice and interprofessional education are goals to be sought and a much more holistic approach needs to be taken in developing policies that will provide support across areas of need. I feel that some are worthy of special attention because of the nature and depth of that need – such as indigenous health workers – nand to a degree I discern some affirmative actio in those areas.

    It’s clear that nursing, medical and allied health students are at least recognised as belonging to discrete health care professional groups when it comes to discussing policy initiatives. Nursing stands apart as a strong profession and special arrangements do apply even if not specifically covering rural and remote aspects.

    My reason for nominating paramedics is that they are not even recognised by government (and thus administrative organisations such as SARRAH) as health professionals or allied health professionals, despite their obvious health care functions and critical clinical interventions. So unless one mentions them specifically by name, how will the situation ever change? It’s a catch 22 situation.

    For example, health care really begins with the patient and not at the hospital door. Effective triaging by paramedics and referral to suitable avenues of care during the initial atages of crisis care could have a substantial impact on the Emergency Department loads of hospitals and help allieviate overcrowding and other demands.

    To me as a policy and systems analyst, recognising paramedics as part of the interprofessional team, alongside other health professionals, would facilitate the provision of a seamless continuum of care with significant outcome benefits..

    But the evidence from my reading of several hundred submissions produced during the current health care reform debate is that EMS and paramedics simply haven’t registered to any significant degree on the policy radar. They fall between the policy cracks despite the public perception of them as Australia’s most trusted professionals.

    I certainly support any moves to have a more balanced view of health care reform with consideration of rural and remote incentives across the full range of major health care disciplines. I hope that others will do likewise.

    Ray Bange
    Principal, Probity Consultants International

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The Conversation
The Health Wrap
TOO MUCH of a Good Thing
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
CroakeyNews
Cultural determinants of health
Digital platforms
Elections and budgets
Federal Budget 2019-20
Federal Budget 2020-21
Federal Budget 2021-22
Global health and climate change
2019-20 climate bushfire emergency
asylum seeker and refugee health
Climate emergency
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Ebola
extreme weather events
flooding 2011
global health
NHS
NZ Election 2017
WHO
health
Healthcare and health reform
abortion
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aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
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Equally Well
euthanasia
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general practice
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Health Care Homes
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Medicare Locals
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MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
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Pregnancy and childbirth
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TGA
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Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
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transport
vaccination
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Web 2.0
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Royal Commission
Social determinants of health
discrimination
education
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17