A Major supporter of Rural Generalism
As a self-proclaimed “late starter” to medicine, Major (Dr) Bob Worswick served in the Australian Defence Force (ADF) for nearly 20 years as an infantry officer—and then decided he needed a change.
“I was looking for something that would be intellectually challenging, something that would allow me to serve with soldiers again, and allow me to give something back to the army,” Bob says. “Medicine just ticked all of the boxes. I thought, ‘Why not, I’ll give it a go’.”
Before Bob was accepted into medical school, he knew he wanted to be a GP.
“Just as an army marches on its stomach, an army relies upon medical practitioners to ensure that the force is fit to fight and fighting fit—general practice underpins that.”
But according to Bob, ADF doctors practise medicine in ways that are quite different to the day-to-day practice of most Australian GPs.
“Firstly, there is a lot more expected from an ADF doctor at a very early stage in their career than any other trainee or registrar in Australia. The majority of registrars train in a comfortable and controlled clinical environment with lots of people around to mentor, support, and give advice.”
“Whereas for ADF doctors, fairly early in their career, can find themselves in the middle of nowhere leading a small health team. All the responsibility for patient care rests on their shoulders, with a degree of support via radio or satellite phone.”
“This means that ADF doctors have a requirement for a higher level of training early on in their career.”
“If you are someone who is looking to be challenged, looking to have unique experiences, looking to serve with a diverse range of people and do a whole bunch of interesting things, the ADF is a fantastic career.”
The importance of rural generalism in the ADF
Bob argues that, in his experience, ADF doctors are required to be Rural Generalists.
“Historically, the ADF, and Army in particular, has relied upon GPs with additional skills—these days we call these doctors rural generalists,” Bob says.
According to the Collingrove Agreement, a Rural Generalist is “a medical practitioner who is trained to meet the specific current and future healthcare needs of Australian rural and remote communities, in a sustainable and cost-effective way, by providing both comprehensive general practice and emergency care, and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team.”
“This is exactly what ADF doctors do,” says Bob, referring to the Collingrove Agreement.
“Although our community is different to the broader Australian community, in that the ADF community is predominantly young men and women, we are required to provide comprehensive general practice care as well as emergency and aspects of other specialist care, and we often do this in rural and remote locations.”
“An ADF doctor has to be comfortable delivering emergency care in a pre-hospital space, often providing prolonged care in the field, because it can take a long time to get your patient out of the middle of nowhere.”
Rural Generalism is especially important for doctors working within the Australian Army.
“One of the things I’m really passionate about is Rural Generalism and I believe the ADF needs to embrace this concept when thinking about the capability it wants from its general duties medical officers.”
“Typically, the army will go into rural and remote locations. The Air Force doctors will typically be supporting troops who are deployed to an airbase. The airbase might be in the middle of nowhere, so they still need Rural Generalist skills, but they have a little bit more infrastructure to support them.”
“Likewise, a Navy doctor will not be under canvas; they will be on a ship, and on a small vessel, such as a patrol boat, they have very limited resources available to them to treat all manner
of presentations.”
“It doesn’t matter what colour your uniform is, whether you’re Navy, Air Force or Army, as an ADF doctor you are practising as a Rural Generalist.”
Bob holds a Fellowship with the Royal Australian College of General Practitioners (RACGP) and is working towards achieving Fellowship of the Australian College of Rural and Remote Medicine (ACRRM).
In Bob’s opinion, “both colleges produce good GPs, but army doctors don’t just need to be good GPs, they need to be very good Rural Generalists.”
ACRRM’s training program enables Fellowship as a Rural Generalist. The RACGP’s new Rural Generalist Fellowship program is available from 2020.
The unique aspects of military medicine
“There is no standard day in medical practice when you’re an ADF doctor, because there is such a broad scope of things that you could do—and some of them you may have to do at very short notice, without forewarning,” says Bob.
“You may be providing general practice care in the barracks, which may have about 3,000 to 4,000 people there. Equally, you may find yourself supporting troops deployed in the field—whether that be supporting operations in Iraq or Afghanistan or East Timor—
or supporting the response to a crisis, such as the
recent bushfires.”
“One of the unique aspects of being a military doctor is that often you’re required to set up your medical practice in a tent in the middle of nowhere. You don’t take bookings, you deal with whatever comes in, ranging from minor ailments to significant injuries.”
As to the occupational aspects of military medicine, Bob, having served in the infantry and as a former commander, understands what it means to assess whether a soldier is fit for employment or deployment.
“In addition to giving clinical advice on healthcare, an army doctor can also provide advice on things like the morale of the unit, and the mental health and wellbeing of the collective organisation.”
Considering a medical career with the ADF?
A person’s suitability to the environment and culture of the ADF is key in deciding if the medical career in the ADF is right for them.
“If you are looking to be challenged, looking to have unique experiences, looking to serve with a diverse range of people and do a whole bunch of interesting things, the ADF is a fantastic career,” says Bob.
Bob’s key piece of advice for young doctors early in their medical career is simple—don’t rush.
“You don’t need to become the youngest surgeon in your town because if you qualify and take on your final calling early in life, you’re going to do it for a long time. Instead it is worth thinking carefully about those extra things you can potentially do throughout a long and rewarding medical career.”
“The ADF offers one opportunity in medicine that doesn’t need to be your only and final opportunity. It’s a great stepping stone into anything else in a medical career—particularly in general practice.”
“Start in general practice…and if you chose that path, then come and have a look at the ADF.”
Images provided by Commonwealth of Australia, Department of Defence ©
