Access to Healthcare in Underserved Areas

In the wake of modernisation, many of us enjoy the perks of urban living, including easy access to healthcare facilities. However, the same cannot be said for our fellow citizens living in rural or remote regions of Australia and New Zealand where isolated communities lack adequate healthcare and suffer the consequences. Considerable health disparities result from the failure to prevent and treat easily curable diseases.

The speciality of Rural and Remote Medicine plays an indispensable role in bridging this divide, providing much-needed healthcare services to populations which are often overlooked.

Tackling The Distance

One of the significant challenges of remote medicine is the sheer distance between medical facilities and patients. Physicians specialising in rural and remote medicine are trained to overcome this hurdle, ensuring timely medical care for those who need it most.

• Remote doctors often travel to reach patients, defying tough terrains and harsh weather conditions.
• They also embrace modern communication technologies to provide telemedicine services, where patients are diagnosed and treated over the phone or via video consultations.

Broad-Spectrum Care

A distinctive characteristic of rural and remote medicine is its broad approach to healthcare. Due to the limited number of doctors in these areas, they have developed the skills to treat a wide range of conditions.

• Instead of focusing on a particular specialty, remote physicians are akin to 'medical generalists'.
• They are skilled in numerous areas of medicine – from paediatrics to geriatrics, from public health to emergency medicine.
  

The two Australian colleges which train primary care physicians have developed programs to address these challenges. These are the Australian College of Rural and Remote Medicine and the Royal Australian College of General Practitioners.

The Australian College of Rural and Remote Medicine

The Australian College of Rural and Remote Medicine (ACRRM) is a specialist medical college accredited by the Australian Medical Council (AMC) for setting professional medical standards for training, assessment, certification and continuing professional development in the specialty of general practice.  It is the only College in Australia dedicated to rural and remote medicine, and plays an important role in supporting junior doctors and medical students considering a career in rural medicine.

It is committed to delivering sustainable, high-quality health services to rural and remote communities by providing:

• Quality education programs
• Innovative support, and
• Strong representation for doctors who serve those communities.

Recognition of Rural and Remote Medicine as a Medical Specialty

The process of creating the speciality of Rural and Remote Medicine was a lengthy path obstructed by many hurdles, mainly political. Its story starts in 1987, with the formation of the Rural Doctors Association of New South Wales followed in 1991 by its national counterpart, the Rural Doctors Association of Australia (RDAA).

In 1991, the RDAA was instrumental in convening the first National Rural Health Conference (NRHC), the recommendations from which, led to establishment of the original Rural Health Training Units, the National Rural Health Alliance (NRHA), and to Government support for a dedicated rural medical training program.

In 1992 the RDAA procured a Government grant to develop a rural medical training pathway to incorporate advanced curricula in the specialist fields of anaesthesia, surgery and obstetrics. Following negotiations to secure a 'Faculty of Rural Medicine' and a 'Fellowship of the Faculty of Rural Medicine' within the RACGP, RDAA in a plebiscite, agreed to hand over its advanced skills curricula to the RACGP to form the basis for a discrete rural training pathway incorporating these skills.

A series of decisions by the RACGP Council however overturned this approach and resulted in the disillusionment and resignation of many rural RACGP members, eventually including eight of the ten RACGP Rural Faculty board members. In particular, the title, 'Faculty of Rural Medicine' was rejected in favour of 'Rural Faculty' and the proposed dedicated Rural Fellowship training pathway was replaced with a 'Graduate Diploma of Rural General Practice', a 12-month "add-on" qualification on top of the generic RACGP Fellowship.

In 1995 a second national plebiscite of rural medical practitioners voted by a ratio of 2:1 to establish a separate college to foster Rural and Remote Medicine as a distinct model of medical practice. The Australian College of Rural and Remote Medicine (ACRRM) was incorporated in March 1997.

The ACRRM Primary Curriculum in Rural and Remote Medicine (Edition 1) was published in 1998. Fellowship criteria were advertised to foundation members in 1998 and, in the same year, ACRRM's rural training pathways and the commencement of a continuing development program in Rural and Remote Medicine were established.

In 2005, the College applied through the newly established Australian Medical Council (AMC) process, for recognition of Rural and Remote Medicine as a medical specialty. The then Commonwealth Minister for Health and Ageing, Hon Tony Abbott MP, determined that the application would not be accepted and that the College was to be supported to prepare its programs for accreditation within the specialty of general practice. The Commonwealth Government provided financial assistance to the College to further develop its programs to meet AMC accreditation standards.

In 2007, following a comprehensive assessment process, the College was awarded provisional AMC accreditation as a medical college within the discipline of general practice and recognised in Medicare legislation which permitted payment of general practitioners for their services.

In 2011, after further extensive assessment, the College was awarded full AMC accreditation and in 2012 gained membership of the Australian Council of Presidents Medical Colleges. The ACRRM became the first Australian medical college to be fully assessed and accredited under the newly-established and substantively more rigorous AMC accreditation framework. It was also the first to be accredited as one of two colleges setting practice and education standards within the same specialty.

Since that time, the College has maintained its full AMC accreditation status.

The ACRRM is thus the professional home of Rural Generalist Medicine and the ACRRM Fellowship (FACRRM) is designed to describe the professional standards for excellence in Rural Generalist practice. The College is committed to building a thriving workforce of Rural Generalists across rural and remote Australia. These specialist general practitioners are trained to bring a broad set of advanced skilled services to people living rural and remote communities.

Rural Generalist Medicine

Rural Generalist Medicine is the provision of a broad scope of medical care by a doctor in the rural context that encompasses the following:

• Comprehensive primary care for individuals, families and communities
• Hospital in-patient care and/or related secondary medical care in the institutional, home or ambulatory setting
• Emergency care
• Extended and evolving service in one or more areas of focused cognitive and/or procedural practice as required to sustain needed health services locally among a network of colleagues
• A population health approach that is relevant to the community

The Rural Generalist Medical Practitioner

A Rural Generalist medical practitioner is a General Practitioner who has specific expertise in providing medical care for rural and remote or isolated communities. The Rural Generalist medical practitioner works as part of a multi-professional and multi-disciplinary team of colleagues, both local and distant, to provide services within a ‘system of care’ that is aligned and responsive to community needs. This requires an understanding of the diverse needs of rural communities which includes applying a population approach, providing safe primary, secondary and emergency care, culturally engaged Aboriginal and Torres Strait Islander peoples’ health care as required, and providing specialised medical care in at least one additional discipline. 

The Royal Australasian College of General Practitioners

The Royal Australian College of General Practitioners (RACGP) is the voice of over 40,000 general practitioners (GPs) in the growing cities and throughout rural and remote Australia and internationally. It is the professional body for GPs in Australia and is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP develops resources and guidelines, advocates for GPs on issues that affect their practice, and develops standards that general practices use to ensure high quality healthcare.

There are nine faculties within the RACGP, representing different geographical regions and special interest groups.

• Six geographical faculties serve the needs of members practising in their respective regions; Western Australia, Victoria, Queensland, Tasmania, South Australia & Northern Territory and New South Wales & Australian Capital Territory.
• RACGP Rural supports and advocates for GPs working in rural and remote communities across Australia.
• RACGP Aboriginal and Torres Strait Islander Health was formed as part of the RACGP's commitment to raising awareness of Aboriginal and Torres Strait Islander health needs, and therefore to help 'close the gap'.
• RACGP Specific Interests was established in 2008 to recognise the additional interest and expertise held by GPs in selected areas of general practice. RACGP Specific Interests facilitates GP members practising in these areas to promote the area of specific interest and to share and develop related knowledge and materials.

The RACGP Rural Generalist (RG)Fellowship

The Rural Generalist Fellowship is awarded in addition to the vocational Fellowship of the RACGP (FRACGP). It recognises the uniquely diverse set of skills and knowledge required to work in rural general practice and is a four-year FTE program which is completed in addition to the FRACGP.

The RG Fellowship is available to: 

• Registrars in the Australian General Practice Training (AGPT) program, Fellowship Support Program (FSP) and the Remote Vocational Training Scheme (RVTS) 
• Practicing GPs who have already been admitted as FRACGP (this may take a further 2 years of training unless prior experience is recognised.)

Fellowship in Advanced Rural General Practice (FARGP)

This is a 6 year training program which combines the standard 3 year FRACP training with a further 3 years of training in emergency medicine and rural medicine.

Opportunities in Rural and Remote Medicine

GPs who hold relevant qualifications and experience in rural and remote medicine are highly sought after for permanent and locum positions across all states in Australia and at rural hospitals in New Zealand. This field is not only crucial for healthcare accessibility in underserved regions but also a testament to the resilience and versatility of its physicians.

As we continue our dialogue about rural and remote medicine, we look to the very individuals who keep this sector alive – you, the General Practitioners and Rural Medicine Physicians who tirelessly cover miles and expand your professional skills to maintain the health and well-being of our remote communities.

We are here to support your career growth, providing opportunities which resonate with your skills while contributing to the broader goal of enhancing rural and remote healthcare. If you are a physician passionate about remote healthcare, I invite you to pour your dedication and skills into the rural and remote areas of Australia and New Zealand. Why not take the next step and explore the career possibilities available to you today? Contact us now, and together we can bridge the gap to your successful career.