The shortage of doctors and other health professionals in regional, rural and remote (RRR) Australia is a decades-old problem which is proving difficult to solve. On Saturday 21 October, the Federal Assistant Health Minister Dr David Gillespie MP announced the appointment of Emeritus Professor Paul Worley as Australia’s first National Rural Health Commissioner. The aim of his new position is to remedy the current inequities in the bush where, despite an estimated higher prevalence of general and mental health disorders, appropriate services are sadly lacking. Medicare statistics indicate that, while the need is higher, service delivery for those in rural areas is less than one-third that of their ‘metro counterparts’. The key objective of Professor Worley’s appointment is to “get hundreds more doctors to areas of need in regional and rural Australia and to provide better services to those living in the bush”, thereby remedying, as David Gillespie indicated, the “flood of doctors in the city and a drought out in the regions!”
Professor Worley has had a distinguished career in rural health as both an academic and practitioner: as a general practitioner (GP) in a number of locations including rural practice in South Australia, Dean of Medicine at Flinders University (where he established best-practice models and programs for the establishment of rural medical education) and in leadership roles in the Rural Doctors Association of South Australia and the Australian College of Rural and Remote Medicine (ACRRM). His aim is to consult widely with a range of health professionals and stakeholders to improve rural health policies and to champion the cause of rural practice. The new position will focus on establishing new ways of developing a sustainable health workforce in rural Australia and to advocate for rural communities to produce ‘achievable outcomes’.
A top priority will be the development of the National Rural Generalist Pathways (NRGP) to provide training in and recognition of the complex demands on doctors working outside the metropolitan context. In addition, the aim will be to consider the needs of the nursing, dental health, pharmacy, indigenous health, mental health and other workforce needs in rural areas. The Commissioner will be a member of the Federal Coalition Government’s Rural Health Stakeholder Roundtable and the Rural Health Distribution Working Group, both of which are reviewing systems to encourage more doctors to work in regional and remote areas.
The NRGP model is focused on training doctors, over a minimum five-year period, to enable them to be multiskilled in a number of key areas (given the lack of medical specialist availability in rural areas). The ultimate aim is for rural GPs to be expert not just in primary care but in secondary care as well. Like the old-fashioned GP, these generalist doctors will have skills in a number of specialty areas including obstetrics and gynaecology, surgery – as well as community general practice. These rural generalist pathways have already been piloted successfully in Queensland (e.g., Beaudesert, Cooktown and Weipa).
So, where does psychology fit into this scenario and what opportunities can we create out of this timely appointment? The almost parallel launch (on 1 November) of the new online telehealth psychological service items under Better Access highlights how integral we are in this process (www.psychology.org.au/medicare/telehealth). This Better Access initiative, coordinated by primary care GPs, creates an exciting opportunity to increase ease of access to psychological services for a currently underserviced section of the Australian community – i.e., consumers living in rural, remote and very remote geographical regions. The items will facilitate the ongoing integration of psychological services (and science) into team-based health systems in rural primary care and create new and further opportunities to implement prevention and early psychological intervention for mental conditions. Current statistics indicate comorbidity of chronic disease with the common mental disorders of anxiety and depression in primary care is approximately 50 per cent, and our presence in this setting enables us to intervene appropriately with both (e.g., in treatment compliance with diabetes as well as intervention, with the depression often consequent upon diagnosis).
If we respond positively to these new initiatives, we can and will be a core part of integrated, collaborative, multidisciplinary care for those in the bush, contributing to the development of new team-based initiatives and greater access to evidence-based mental health treatment. It is a great opportunity!