Tell us about your journey into rural generalism. Why did you choose to be a Rural Generalist (RG), and why ACRRM?

I always wanted to be a GP. The community-based work, long-term therapeutic relationships, and focus on health promotion and disease prevention all really appeal to me. I chose to do an elective placement in Wilcannia in far west NSW during medical school to explore remote medicine. I found that I really enjoyed the mix of acute and chronic pathology that I was seeing and loved living and working in isolated communities. I decided to apply for general practice training through ACRRM during my internship with a view to working in small rural and remote towns in the future.

ACRRM was the natural choice for the highest standard of Rural Generalist training. The pathway is wholly tailored to rural practice but flexible enough to adapt to changing training needs. It is a rigorous training program but one which is directed from the start at producing world-class Rural Generalists.

2: What does it take to be a Rural Generalist and do the work you do?

One of the key things is to be keenly aware of your available resources and the limits of the services you can provide, both as a practitioner and a service. Know who you’ve got in your team to draw on in an emergency or otherwise sticky situation. Of course, you need to have a really broad range of knowledge and skills beyond the standard general practice toolkit, but the most critical thing is to know your community, your health service, and your own skills in order to function safely as a Rural Generalist.

3: What does a typical day at work entail? What challenges do you face working in a rural area?

A typical day will vary hugely depending on your stage of training and skillset. At the moment I’m working in emergency, so I can go from counselling someone with the sniffles, to leading a major trauma, to coordinating a retrieval, to suturing a simple laceration all within a couple of hours. When I make the move to more rural work later this year, I’ll be doing a combination of clinic-based work, seeing patients in the local nursing home, covering the emergency department, and reviewing inpatients in the hospital. It all varies day-to-day.

The tyranny of distance and the geographic isolation of some rural areas is probably the biggest challenge I’ve encountered so far. The time you spend with (for example) a critically unwell child preparing for and awaiting retrieval are some of the longest hours of your life, and situations like that really highlight the hard limits on the services you’re able to provide in rural environments. Fortunately, as a trainee, you always have someone to contact to talk through these situations, and again it’s important to know your network and who you can look to for support.

4. What AST are you considering? Why did you choose this AST?

I’m really interested in public health and research, and am considering Population Health for my AST. The cornerstone of the Population Health AST is a project which can be anything from development of a practical resource, health promotion project, or a research project. Some people do this while working in a public health-specific training post, but mostly it occurs in situ in the rural setting where you couple clinical work with your population health work.

The resource limitations and unique population health issues in rural areas mean that there’s a real demand for Rural Generalists with population health skills. Many of the social determinants of health are stacked against rural people and rural communities, and when coupled with difficulties accessing health services for many people, it’s easy to see why the disease burden in Australia increases with increasing remoteness. We need Rural Generalists who are equipped to confront this challenge, and I see population health AST as a starting point for that.

5: What advice would you give to medical students and junior doctors who are thinking about training as a Rural Generalist?

It’s really important for prospective RGs to understand what working as a Rural Generalist is actually like. It’s a very distinct profession from urban or regional general practice. The first step would be to do as many placements as you can in rural and remote areas. Most medical schools include an option or requirement for a rural rotation but try to get exposure to remote or very remote health services too, either through integrated or elective placements. Try to do a few in different environments and different states if you can.

Reach out to people who are doing the job that you want to do in the future. We all really want to see more Rural Generalists so most people are very receptive to talking about their career journey, which can give a lot of perspective on the reality of Rural Generalist training and practice and will better inform your choice to go into rural practice.

Finally, join ACRRM as a student member, do their online modules, and make sure you come to the Rural Medicine Australia (RMA) conference!