We sat down with Dr Overweel to find out more about his journey to rural generalism, including some great advice for future RGs. 

Tell us about your journey into rural generalism.

I first heard about ACRRM during Orientation Week at Flinders University. I signed up to hear from all the colleges to get an idea of what my options were as a naïve student.

I then decided to do a rural rotation in the Riverland of South Australia, where I had previously worked as a paramedic. It was great because I already had strong community roots and knew a bunch of people.

After that year, I went back into working in tertiary centres and it was at that point that I realised I wasn’t cut out for the hospital system. To me, it was like I was playing hot potato with my patients where I never got the opportunity to take ownership of their medical issues. This was very different to my experience working with Rural Generalists the year before in the Riverland, and it definitely put rural generalism on my radar.

I’ve now been living and working rurally on and off since 2015 and I love it. Once you get into the country lifestyle, you tend to stick around. 

Did your decision to do an Advanced Specialised Training (AST) in Emergency Medicine come from your background in paramedics?

Paramedics certainly has a lot of similarities to working in the Emergency Department (ED). My wife is a local paramedic, so she brings me a lot of my work. 

But ultimately for me, choosing the Emergency Medicine AST was a family decision because of the flexibility it allows with my roster. In ED, there are set shifts which you hand over after each one. Where I work, there’s no on call or follow up. 

When I was a medical student, I was thinking of doing anaesthetics or working in the Intensive Care Unit (ICU), but I have young kids and I want to be around for them. So, I chose to focus on emergency medicine to allow me to still build on those skills and to meet that interest, but to also allow me to have a bit more agency over how much time I get to spend with my kids, without the on calls.  

I believe you should choose an AST based on what stage of life you’re currently in. If I didn’t have kids, I probably would have cracked on with a different option. But being only 33 and on my fourth career, it’s unlikely that I will be doing the exact same thing in 10 years’ time, and that’s what I love about rural generalism. 

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

To be a Rural Generalist, you need to be flexible in how you do things. You might not always get the same team, or the same medical equipment and so you must be able to do things on the fly. 

You also must be willing to extend your scope and take ownership and responsibility for the situations you’re in because you’ll inevitably get all sorts of patients and presentations. It happens a lot in the ED especially, where you are stitching up a hand or a face and you have to say to them “Look, normally you would have this done by a plastic surgeon and we would send you to Adelaide”, and they will say, “Nup, not going to Adelaide for that, you do it”. And so, you have to do it because you can’t leave it untreated - which provides a unique opportunity to expand and develop your skills. 

The other side of that is that you must know when to call it or when to ask for help, and you have to know that early; especially for deteriorating patients in a rural area. Sometimes the best-case scenario is a four to five hour wait for a medical retrieval. You have to be ahead of the curve and know that you won’t be able to fix everyone, because you’ll end up behind the eight ball.   

Also, as an RG, you must be willing to be a doctor at all hours of the day, regardless of where you are. There's no anonymity in a country town, and even if you don’t know who people are, there is a good chance they know who you are.

Which then leads to knowing when to build in time to leave town. I know a lot of rural doctors who don’t, but for me and my family, we make sure we plan three to four visits a year to see family and friends across the state and elsewhere so that we can unplug. Otherwise, you run the risk of burnout – which is already high working in ED, but when you add the rural nature, the risk is even higher.

What does a typical day at work entail?  

There is no typical day for me, every day is different. 

Right now, I have hospital inpatients in the morning, then go into clinic in the afternoons. Sometimes I have someone in clinic who needs to be an inpatient, so I will admit them in my lunch break or after my consulting day.  

One of my days, at least, I am on call for admissions from the regional hospital or from Adelaide, which at times involves a lot of phone calls.  

And because I work in ED, there are at least two shifts a week where I’m on the floor in the hospital. In a way, it looks like an ED everywhere else, but ED in the country can also be quite different. In my particular setting, we don’t have an ICU or High Dependency Unit, so any patient who is severely unwell lands in ED for us to look after, which can be challenging.

You’re also a Registrar Liaison Officer (RLO) at ACRRM, what does that involve?

This is what I do on my “days off”. I really enjoy being an RLO because it’s informal and I get to meet loads of registrars from across the state and offer advice based on my experiences.

It can be quite daunting for new registrars to enter into private practice after being in the public system. They will ask for advice on what they’re entitled to and what is reasonable to ask for in contract negotiations. Things like percentage of billings, what they should get paid, that kind of thing.

I also see a lot of imposter syndrome when registrars first start because their career up until now has been under the supervision of another more senior doctor. Now, all of the sudden, they have their own patients. I can offer peer support on that front because I went through that same feeling. 

I also have a passion for education and how it’s delivered because of my background as a lecturer at Flinders University for Paramedics and my graduate Diploma in Clinical Education, which I think adds a lot of different experience to the role.  

Why did you choose ACRRM for your Fellowship training? 

I was looking at my options right before College-led Training (CLT) was introduced. ACRRM had been running its own education program through the Independent Pathway for many years, so I knew it would be in a better position to run with CLT, whereas other colleges were essentially outsourcing their education. I knew it would be a big jump for them to suddenly deliver an education program.

Also, I find that most colleges cater to the bulk of their membership, and the bulk of other college’s membership is not rural. If you want to be supported in your training in rural areas, there really is only one college dedicated to that, and that’s ACRRM. 

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

First – just do it. 

There’s this old joke in medical school – choosing a medical specialty is not so much a career choice, but rather like the sorting hat in Harry Potter where your personality governs what house you end up in.

To choose a specialty, I think, is more about knowing yourself and knowing whether you’re cut out for it. If you’re someone who enjoys a challenge, working in different environments, and extending your scope of practice, then rural generalism is absolutely worth a consideration for you.

If you’re someone who likes to have your three conditions that you’re really interested in and three drugs you like to prescribe, then maybe it’s not so much your jam. 

The flip side to that is that in general practice, you do attract the work that you like. If you’re someone with a special interest in women’s health, then guess what? You’ll see a lot of people for women’s health. If you have a special interest in sports medicine, guess what? You’ll probably sign up with the local sport club and see heaps of sports medicine patients. 

I like to say to students, when you experience general practice in your rotations, you’re experiencing what general practice is like for the GP you’re working with. It’s not necessarily what general practice will be like for you. You can make it what you like. 
 
It’s like any job – there will always be things that you don’t like about it, patients you don’t like seeing – that’s just being a doctor. But you will carve out a niche or cohort that lets you do more of what you like to do. 

My advice for anyone going rural is to find a way to engage with your local community. For me, I did a season of outdoor soccer to develop a network within the town. 

Also, look into the subcultures of the regions you’re thinking of training in. If you enjoy surfing, choose a coastal town, if you love camping and fishing, then choose somewhere like where I am in the Riverlands. If you choose your rural area based on your lifestyle interests, rather than going rural because it’s rural, you’ll likely stick around because you live somewhere that aligns with your interests. 

When you find a local interest, you’ll also spend more time in town, and when you spend more time in town, it will start to feel more like home rather than being away from home.

 

Discover more about ACRRM Fellowship here.