Reflections of a Rural Generalist

Transforming maternity care 

When I arrived in East Arnhem Region, NT, I quickly noticed that most women birthing in our small district hospital received care a plane flight away from the hospital or in one of the region's many Aboriginal Community Controlled Health Organisations (ACCHOs). It made sense to place a GP obstetrician where the women were, but convincing the decision-makers of the value of this approach wasn’t easy. However, after some initial scepticism, I was given the green light. I took on two shifts a week at the ACCHO alongside my hospital work.

Not long after, an incredible midwife invited me to her monthly outreach visits to remote communities. Together, with a travelling sonographer, local health workers, and clinic staff, we provided comprehensive, multidisciplinary care for women in their own communities.

Once we had strengthened antenatal and postnatal care, we tackled the ‘women’s business’ waitlist. This list, held in clinics, consisted of women referred to a specialist obstetrician or gynaecologist who visited just four days per year, often less. I reviewed referrals, recalled women who could receive care from a GP obstetrician with advanced skills, and expedited specialist consultations where necessary. As a result, many women received care much sooner.

I also facilitated urgent investigations and direct specialist admissions, eliminating unnecessary consults and reducing the number of trips women had to make away from their communities. This significantly shortened wait times and reduced disruptions to their families and lives.

On several occasions, specialists contacted me with unexpected test results from inpatient stays. Rather than delivering sensitive news over the phone, I was able to discuss results with women in person at my next visit, overcoming language and cultural barriers.

From an antenatal perspective, our multidisciplinary approach improved continuity of care across the region. Some key outcomes included: 

• A single GP obstetrician overseeing results, making decisions alongside women and midwives. 
• Early identification of high-risk pregnancies and timely specialist referrals. 
• Prevention of premature births in the community by ensuring timely transfers to regional and tertiary hospitals. (Born-before-arrival cases dropped from 31 to 3 in the first year.) 
• Increased engagement in care by placing women at the centre of decision-making. 

The impact was so significant that the state’s Chief Midwife noted a dramatic improvement in care quality. This is the power of rural generalism—one RG joining a care team for just two days a week had an enormous benefit for women, families, health services, and entire communities.

RGs excel at identifying gaps in care and leveraging their broad skill sets to bridge them. When systems and services support us to do this, our work will ensure that communities receive health care of the highest possible quality/safety and at the lowest possible cost! A win for all!

ACRRM Policy, Training Systems, and Resources 

As the inaugural Regional Director of Training for Tasmania, I identified workforce instability in remote areas like the Bass Strait Islands and West Coast. This instability negatively impacted primary healthcare consistency and continuity. These locations were ideal training grounds for registrars, but without a stable workforce there was not suitable onsite supervision to support a registrar and seemingly little hope of securing a stable workforce – which we know comes as a result of ‘growing your own’. ACRRM addressed this by implementing a remote supervision policy, allowing for a combination of onsite and remote supervision.

This innovation enabled us to: 

• Place a registrar on the West Coast, providing consistent care and reducing workforce turnover. 
• Place a registrar on King Island for a 12-month placement—a vast improvement over the previous one- to two-week stints. This registrar now hopes to return post-hospital training. 

The College’s policies and resources have facilitated flexible training models that bring registrars back into remote communities. This approach will ultimately lead to greater workforce stability and improved continuity of care. 

Why rural generalism makes a meaningful difference 

These examples illustrate how Rural Generalists deliver meaningful improvements at every level of healthcare delivery. Our work aligns with the fundamental goals of Australian healthcare: providing the best possible care cost effectively. 

RGs use their broad skill sets not just to deliver care but to strategically fill gaps in health services and systems. To maximise our impact, we need greater support from healthcare systems and services. This means allowing Rural Generalists the space to identify and bridge gaps, which in turn improves quality, safety, and cost-effectiveness across entire regions.