Rural practice is basically about making sure your patients have good access to quality health care and illness prevention services. To support these you need a skilled workforce and adequate infrastructure.
The way the Victorian Department of Health, under successive state governments, talk of “Rural and Regional” as though they are almost the same thing is convenient, but deceptive and simplistic. In “Health” regional is effectively little different from metropolitan. It is only by regrouping these categories to reflect the reality that rural infrastructure, rural workforce and access to services can be focussed on for what they are. Critically under-resourced.
What’s it like to be a procedural rural GP these days? If you are by yourself, it can be all-consuming to an unhealthy degree.
First, infrastructure and the need for good country hospitals. What do we as a state want? A mega-freeway and level crossings fixed in marginal electorates, or for a re-allocation of only a tenth of the budgets for these things (half a billion would do it), decent rural health infrastructure?
The current infrastructure plans for Melbourne of both major parties are going to consign rural Victorians to run-down, leaking country hospitals for the next two decades or more. Because some money will be spent in the regional centres of Bendigo and Ballarat it all looks OK – but is it? Small communities are holding chook raffles just to keep their local hospitals’ roofs from leaking.
Let’s face it; if you don’t have the facilities you can’t attract skilled young doctors and nurses. They won’t come to rural facilities that are effectively nursing homes. They want to work in well resourced rural hospitals which can safely provide emergency, surgical, anaesthetic and obstetric services to their local communities.
If you want to support agriculture and tourism, and decentralise the state’s population to avoid Melbourne needing more and more freeways, infrastructure planning needs to support that strategy, and decentralise its priorities. The metro-centric infrastructure focus of the Kennett government finally brought it down, so in election terms, these things do matter.
Then there’s the question of the rural workforce and access to services. GP on-the ground services funded federally through Medicare are patchy across the state. In Queensland, a system of subsidies is far outstripping what is available in Victoria to get doctors to where people live. This makes it hard to attract doctors to these areas.
What’s it like to be a procedural rural GP these days? If you are by yourself, it can be all-consuming to an unhealthy degree. In a group practice, it is probably more manageable and rewarding. You get to do emergency Caesarean sections or anaesthetics in the middle of the night, or be confronted with whatever comes in to casualty. You know your own patients and you get to know the town’s visitors when they strike trouble.
Rural Clinical Schools and medical and nursing training-in-place, which is now happening all over the state, are great initiatives in the race to replace what is now an aging skilled (procedural) workforce. These trainees, however, will only return if the hospital infrastructure and work conditions are up to scratch.
With respect to access to illness prevention services, priorities such as diabetes, drugs and alcohol, and mental health, need more funding. They are starting to receive quite strong community, NGO and state and federal government funding, but more is needed.
The one major problem that local communities are currently almost helpless to combat is the obesity epidemic. Communities won’t often win against transnational corporations. Local empowerment in obesity prevention needs strong central government legislation. The “big food” (and soft-drink) companies are currently being allowed to run rampant with their advertisements and product inducements to children through both television and sponsorships. Available health evidence (eg. that having an ultra-processed food outlet within 500 metres of a school leads to increased obesity levels in that school) should be taken into account in state planning law.
The town I live in, Mansfield, recently raised a petition of 4000 signatures (equivalent to one per rate notice) to send a message to the McDonalds Corporation that they are not welcome, after they had made recent overtures to purchase land. Current state planning law around “convenience restaurants”, however, leaves communities like ours exposed, and in danger of being unable to control our own destiny. This situation can have its own health impacts, and itself lead to de-population.
Interestingly, the 2012 Parliament of Victoria Inquiry into Environmental Design and Public Health in Victoria recommended, inter alia, that the Planning Act be amended so that a “planning mechanism be developed that can be used by local councils to limit the supply of fast food outlets in communities”. It is time that happened.
So, more freeways, more level crossings, or, for a fraction (say, 10 per cent) of the cost, decent rural health services?
Dr Will Twycross, OAM, has been a procedural rural GP in Mansfield for almost thirty years and works at Mt Buller during the winter. He has previously worked in Kenya, India, England, Liberia and Papua-New Guinea. He has also been a shire councillor and recently chaired the $14M construction of Australia’s longest Rail Trail, between Mansfield and Tallarook.