The benefits of rural medicine

Dr Bob Vickers, on why you should be a rural GP

It is late Thursday afternoon and I am sitting in my clinic when a pleasant but profoundly deaf gentleman comes in to see me.

For the third time this week, he proceeds to recount how he and my grandfather used to walk barefoot to school together — loud enough for the entire waiting room to hear the story.

My patients and I discuss local issues such as the impact of mining on the town, the upcoming town musical or where my parents used to work and what they are doing now, and many other non-medical but interesting discussion topics.

This connection to the community and holistic continuity of care is one (amongst many) of my favourite things about working in a rural town.

Some of my patients were in my primary school class and now I treat their whole family.
Rural towns are incredibly supportive and inclusive of rural GPs; you can make many long-term friendships — my patients say hello when I pass them at the weekend markets.

The benefits of rural medicine

Rural medicine also brings about unique benefits.

I have the opportunity to contribute to the primary, secondary and tertiary care of my patients.

Urban GP registrars are unlikely to be able to care for their own patients in the hospital.

As a rural GP registrar, I can do pre-pregnancy counselling, diagnose and manage the pregnancy, deliver the baby, give the child the immunisations and manage the immediate and long-term health of mother and baby.

Rural GP registrars also have the bonus of getting to live in the country, with benefits such as clean air, open spaces, no peak-hour traffic, and a close-knit community.

I have a big house with a great view that is close to work, there is never any traffic, and the pay is good.

I have chickens, a large veggie garden, a great big shed (with a ride-on-mower) and I can spend my summer evenings relaxing in my garden.

We’ve had metropolitan doctors invited around for bonfire nights, and I can cook for them with our outdoor pizza oven without fear of smoking out my neighbours.

My hope is that by showing them the rural lifestyle, I can convince them to move and work rurally. The evidence suggests that a positive rural medical term can work wonders in building a sustainable rural workforce.

The beauty of a rural lifestyle needs to be shown off just as much as the benefits of being a rural doctor.

Rural general practice is a great profession and it enables a wonderful lifestyle.

The challenges and skills required

Rural medicine brings about unique challenges.

To make a diagnosis and form a management plan without easy access to pathology, imaging and timely non-GP specialist review is a challenge, but one that makes you better.

Training in a rural location encourages you to build on clinical reasoning skills based heavily on history and examination findings.

A good rural GP is able to keep abreast of new guidelines and evidence and critically appraise medical studies.

Communication skills are a must for working in rural general practice. Breaking bad news, counselling grief-stricken family members, educating on disease and reassuring parents are examples of vital communication skills.

These types of skills come with time and practice.

How to best prepare for rural general practice

The skillset of a rural GP is predominantly dependent on where you want to work. There are a few core skills that are essential everywhere, but some locations require specific skills.

A broad set of internship and residency terms is ideal, including terms in paediatrics, emergency, obstetrics, mental health, anaesthetics, palliative care, general surgery, orthopaedics, geriatrics and general medicine — although, not everyone will be able to attain those terms.

Look to where you want to work and talk to local GPs about what skills are needed.

Think about where you want to live. Rural medicine can allow for mobility depending on your skillset (for example, remote or retrieval medicine), but patients are happier if you choose to stay long-term.

Dr Vickers works in Singleton, NSW and was a member of GPRA’s Advisory Council.