As the climate crisis worsens, energy prices increase, food supply becomes more vulnerable, and global security weakens, the pressures to keep people healthy are only intensifying.  

But there is hope, Dr McIver, Fellow of the Australian College of Rural and Remote Medicine (FACRRM) says, and it comes in the form of the Rural Generalist – adventurous types who are resilient, adaptable, can-do and aren’t afraid to “muck in and get blood on their boots”. 

That was the type of action a young Dr McIver was seeking when he graduated from Monash University in Melbourne in 2005. 

It was already a world away from home at Millaa Millaa in far north Queensland and lightyears from where he would eventually find his calling.  

“Monash University in the early 2000s was certainly not a place where you were exposed to Rural Generalist type roles,” he says.  

“I don’t ever recall that term being used, and I don’t remember that particular branch of clinical work being portrayed as a viable career choice.” 

Stints working in WA’s Kimberley region on a John Flynn Scholarship and as a doctor in training under the auspices of the Pre-Vocational General Practice Placements Program followed.  

“I took any opportunity I could to get out of the city and work in the bush,” Dr McIver says. 

“At that time, I had no particular interest in general practice, but I liked the idea of spending time in the Kimberley, roaring around in a Landcruiser for six months working in Indigenous communities in primary care, public health and emergency medicine.” 

A further six months in the emergency department at Alice Springs cemented the path he would follow.  

“That’s when the penny dropped; I liked the mixture of emergency medicine, primary care, public health and being in the bush and I’d met enough characters along the way who gave me some insight into what a career pathway that encompasses all of that might look like.” 

In 2008, Dr McIver started his ACRRM training in north Queensland, including an Advanced Specialised Training year in anaesthetics in Cairns, followed by a job as Senior Medical Officer in the Torres Strait, which he describes as ‘the formative period of my career’. 

Dealing with the problems faced by Papua New Guinean patients, in particular, while working in the Torres Strait was “like a punch to the face”. 

“I’m sure most Australians wouldn’t be aware that through the Torres Strait we share a busy, porous border with PNG where people move quite freely between the two states,” he explains. 

“You get this mix of genuine tropical health problems from this low resourced, developing country being serviced with the resources of one of the wealthiest countries in the world.  

“In terms of key indicators like per capita GDP, life expectancy and child mortality, the differences between PNG and Australia are further apart than any two countries that share a border anywhere in the world.” 

Dr McIver left the Torres Strait in 2011 to take up a job with the World Health Organisation in the South Pacific. While the focus of his work and PhD was on the devastating health impacts of natural disasters and climate change in Pacific Island countries, it quickly became clear that these island communities had another health crisis on their hands: too few doctors overall, and almost none in rural and outer-island communities. 

“It seemed that no matter where I travelled, the conversations with various Pacific governments followed the same pattern. The health needs were greatest in the rural communities and outer islands, but the very small number of doctors in each country were concentrated in the urban areas. Even more concerning was the fact that opportunities for Pacific Island doctors to train as Rural Generalists were almost non-existent. We realised there were opportunities to adapt the Australian Rural Generalist training model to Pacific Island countries, and that’s how Rocketship was born.”

Rocketship Pacific Ltd is an international health non-profit organisation focused on improving health in Pacific Island countries through stronger primary care. It stands for ‘Remote Opportunities for Clinical Knowledge, Education, Training and Support for Health in the Pacific.  

After several years working in Fiji, Vanuatu and across the Pacific region, Dr McIver moved to Switzerland to take up a consultancy contract at the headquarters of the World Health Organization. He then switched to Médecins Sans Frontières (Doctors Without Borders) and has been working at their Geneva headquarters for the last four years. 

But relentless travel while working in hostile environments, surviving war zones and near kidnappings, eventually took its toll, leaving Dr McIver emotionally exhausted and financially bereft despite the joy of starting a new relationship and working his dream job. 

Dr McIvor has written about his career, promoting the concept of rural generalism in his book Life & Death Decisions. 

Described as “part rollicking medical memoir, part analysis of global health crises”, Life & Death Decisions is Dr McIver’s telling of the pressures on those who administer primary care in some of the toughest places on the planet. 

“The focus of the book isn’t on me, it’s on our communities and our profession – an explanation of what Rural Generalists do. These are stories that I think all Australians should be aware of,’ says Dr McIver. 

“The title of the book is not just about the decisions doctors and other health professionals take every day, but what our patients face when they live remotely. 

“I’m very upfront about this in the book - working for Doctors Without Borders doesn’t pay very well,” he says. 

“I had financial commitments and mortgages that I couldn’t maintain. 

“I was broke and became suicidally depressed and stayed pretty close to a very dark precipice from about 2017-2019. 

“It was a nasty combination of financial stress, relationship stress, social isolation and professional frustration. It was extremely difficult to find a balance between my core clinical role as a Rural Generalist and my work with MSF, which was more focused on public health and infectious diseases.” 

By 2020, the “ship started to right”, Dr McIver explains. 

“After some long and tough periods of hardcore clinical work, spending many months apart from my partner, I was finally able to drag myself out of debt. Then when the Virtual Rural Generalist Service was established in western New South Wales in early 2020, I jumped at the chance to join the team. The timing was almost miraculous – definitely for me, but also for the community, as within weeks the Covid pandemic hit and telemedicine services became more important than ever before.’ 

As the world’s health system felt the strain from the pandemic, Dr McIver began to piece the threads of his life and the chapters of his book together. 

He is still based in Geneva, where he is the Tropical Diseases & Planetary Health Advisor at MSF Operational Centre Geneva, but he remains committed to his role in western New South Wales through the Virtual Rural Generalist Service and will return to Australia to catch up with family and hospital work and promote my book. 

“I’m using my experience as a Rural Generalist to shine a light on the work we do as doctors and the challenges we face as a society, particularly in regard to health, from climate change impacts, health system inequities, pandemics and antibiotic resistance,” he says.