Rural generalists are GPs with training in emergency care and one other advanced skill area. While Tasmania has a training program for rural generalists, doctors say their skills are not properly recognised by the Tasmanian Health Service.
Every few weeks, Alan Richardson leaves his home in regional Tasmania , hops on a plane to rural Queensland, and gets to work delivering babies. It might sound like a sun chaser's dream, but it's not the warmer weather driving Dr Richardson's decision to leave behind a state that could really use his skill set.
"The reason I'm not working in Tasmania, even though I'd very much like to, is because there isn't a role for ," he said. Dr Richardson is a rural generalist. He is a fully qualified general practitioner, has advanced skills in obstetrics, and works as a senior doctor across other areas such as paediatrics, emergency and internal medicine. If it were up to him, he would spend his days travelling to north-west Tasmania rather than south-west Queensland. "I've done a bit of work for short periods of time as a locum doctor in the North West Regional Hospital up in Burnie," he said. " really love the team up there, I really love the work, but there's no role for rural generalist obstetricians in that unit or in that hospital." Alan Richardson says he loves working at the North West Regional Hospital in Burnie but it has no role for someone with his qualifications.Rural generalists have just been officially recognised as a speciality field within general practice by the federal government. They are GPs with training in emergency care and at least one other advanced skill, such as anaesthetics or mental health. Their skill set allows them to support regional and remote communities, often splitting their time between GP work and local hospitals. They are generalists rather than specialists, meaning they do not have the same level of training in their advanced skill as those working as anaesthetists or obstetricians, but they can work across multiple fields. "Depending on gaps in the system on a day-to-day basis, rural generalists can be moved around to fill those gaps," Dr Richardson said.Tasmania provides 'great training' but 'no positions' Generalists began in Queensland 20 years ago, and the idea has since spread across rural and regional Australia. But while every other state has found a place for rural generalists in their system, doctors say Tasmania seems oddly resistant. More than 150 medical practitioners and stakeholders gather in Roma to discuss the future of rural generalist medicine."It has just exploded in the last 10 years or so in Tasmania," Aaron Hawkins said. Dr Hawkins is the Tasmanian regional director of training for the Australian College of Rural and Remote Medicine . He said there were somewhere between 70 and 80 registrars in Tasmania training in areas such as emergency medicine, obstetrics, anaesthetics, mental health, paediatrics and internal medicine."But then they get to the end of their training and there are no positions or jobs or recognition of that experience in the THS ." While Tasmania's regions are crying out for rural GPs, the two main hospitals in the north-west -- the Mersey Community Hospital and the North West Regional Hospital -- prefer to use specialists, even if it means relying heavily on costly locums.ABC News: Monte BovillACRRM and the Rural Doctors Association of Tasmania have told the ABC that while the hospitals will hire rural generalists, it is only as locums, and, depending on the field of their advanced skill, some of them will not be allowed to work to their full scope of practice. Rural generalist obstetricians, for example, will be treated as junior doctors and are expected to work under the supervision of specialists -- something that does not occur in interstate hospitals. The state's district hospitals, like Deloraine and St Helens, have embraced rural generalists, but the opportunities are limited because those hospitals offer a reduced range of services."They're all finishing their training in Tasmania and then moving over to the mainland, to Queensland, New South Wales and, to a lesser extent, Victoria and South Australia, where they've got really, really established endpoints for these positions," he said. The ACRRM says rural generalist graduates are leaving for states where they can use their advanced skills."They're all GPs that would be working part time in the north-west and instead we're losing them as well," Dr Hawkins said. " has an incredibly direct impact on the load in the emergency departments and the flow through the hospitals."Claire Griffiths is one of those trainees, forced to choose between "turning away" from the career she has worked towards or moving her family interstate.Dr Griffiths grew up in Burnie and has been in training for four years. She was drawn to becoming a rural generalist because of the diversity of work and the focus on delivering care to rural areas. She has trained at both the NWRH and the Mersey, but has been told there would not be a place for her to use her advanced emergency care skills at NWRH when she finished. Claire Griffiths wants to stay in Tasmania but will not be able to use her skills in emergency medicine.The Mersey was an option but would require her to do further training in anaesthetics, which was more than would be required in other states."It's really frustrating. It means that I'll have to leave the community that I grew up in, that I have family and friends and ties here.How rural medical schools are driving cultural change in the bush A shortage of doctors is compromising the health of people living outside Australia's big cities, but rural medical schools hope to change this.If she chooses to stay and work as a GP in Tasmania, it would mean giving up everything she trained for. "I'm not sure if I will remain in Tasmania because I will no longer be able to maintain my skills in emergency if I'm not practising," Dr Griffiths said. The ABC is aware of multiple rural generalists who trained in Tasmania but could not stay in the state because of the lack of job opportunities in hospitals.As doctors warn Tasmania is becoming a "mass exporter" of locally trained rural generalists, regional hospitals are struggling to find enough permanent specialists. The RDAT's Ben Dodds said modelling showed there just were not enough specialists to work in places like Burnie and Devonport. Ben Dodds says rural generalists could help address workforce shortages in Tasmania's regional hospitals."We know that there are dire workforce shortages of ... specialists in rural and remote Tasmania," Dr Dodds said. "We saw that exacerbated quite significantly during COVID where the Mersey had to reduce its hours because we couldn't fly locums in and out of the state, and certainly this comes at quite an expensive cost to the state." He estimated the Mersey and NWRH spent more than $100 million on locums in the past financial year. The health department did not provide a figure when asked by the ABC. Dr Dodds wants Tasmania to adopt a workforce model where hospitals hire a combination of rural generalists and sub-specialists. The rural generalists would work independently and sub sub-specialists would deal with more complex cases. The state government is on board, with Premier Jeremy Rockliff promising more than a year ago that Tasmania would embrace the model, but Dr Dodds said the health department and hospitals had been resistant to change. "We've really hit major barriers with that, in terms of the senior executive at the Tasmanian Health Service not understanding how this could be an ideal solution for Tasmania to increase Tasmanians' access to health care and reduced costs on the health system," Dr Dodds said. Ben Dodds and Claire Griffiths say rural generalists would help with Tasmania's medical workforce shortage.In a statement, a health department spokesperson said further work was underway to create new opportunities for rural generalists in the public hospital system "once they have completed appropriate training". "New roles will be trialled across the North West Regional Hospital and the Mersey Community Hospital, aligned with current areas of need in the region's medical workforce,"The four roles are only 0.2 full-time equivalents and emergency department only, not the full scope of practice. "The department is also exploring similar opportunities for rural generalists that have advanced training in other medical specialties," it said. "We have also implemented a state-wide policy that considers a rural generalist for a certain role before a locum is engaged to fill that position." Dr Dodds said feedback was that the department was "still selecting locum specialists over permanent and locally trained rural generalists". Rural generalists are fully qualified general practitioners with training in emergency care and at least one other advanced skill.When he left Tasmania for work, Dr Richardson missed his island home, and he was not alone. He knows of at least four other rural generalists who, like him, chose to live in Tasmania but work elsewhere."Every other state in Australia uses rural generalists in one way or another ... but Tasmania is not set up for that." Working in regional Tasmania, Dr Griffiths said she felt like there was a disconnect between what the community wanted and the "barriers" she said the THS was putting up. "When I tell family and friends that I'm not able to work once I finish my training in Tasmania, they become really puzzled and confused because everything in my training sounds like it's exactly what the community wants," she said. "We don't want doctors who are flying in and flying out. We want doctors who are living in community, who understand community and care about community, to be providing that care here."
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