Perth doctor Rachel James was far from sold on the perks of rural living when the self-described \u201ccity girl\u201d moved to regional NSW five years ago.<\/p>\n
\u201cI was your typical city doctor,\u201d she says as she unwinds before spending her night on-call for \u00adDeniliquin hospital, near the NSW-Victoria border.<\/p>\n
Dr James has chosen to pursue a career as a rural generalist, a trained GP who also has emergency skills in another key area.<\/p>\n
As a GP-obstetrician, she says a career in the country has meant she gets to care for patients from \u201ccradle to grave\u201d, a welcome \u00addeparture from the \u201cconveyor belt\u201d experience that comes with working long hours in the emergency departments of city hospitals.<\/p>\n
\u201cMy now husband and I were seeing so many patients but we felt as though we were not making a difference to the communities,\u201d she says.<\/p>\n
\u201cWe missed the variety of rural practice, so in the end we just thought \u2018let\u2019s give it a go\u2019, and we took the plunge to move rural.\u201d<\/p>\n
Dr James is one of nine general practitioners in the district, which has 7800 residents. Six of those doctors contribute to the town\u2019s emergency department.<\/p>\n
Dr James is on call \u201call the time for obstetrics\u2019\u2019, and about once or twice a week for the emergency department.<\/p>\n
Her experience speaks to a wider challenge facing the medical profession: how to attract more doctors like Dr James and her husband to country practice?<\/p>\n
The bush is facing a chronic shortage of doctors as medical graduates increasingly seek to specialise rather than pursue a \u00adcareer in \u00adgeneral practice.<\/p>\n
Around the country, rural and regional communities are crying out for more GPs like Dr James.<\/p>\n
<\/p>\n
Peter Stafford had to close the only private GP clinic in Katherine due to a lack of doctors willing to work there. Picture: Che Chorley<\/p>\n
In Katherine, southeast of Darwin, with a local government population of more than 10,000, the ideal staffing level is nine \u00addoctors. But for years, the town has relied on just two GPs.<\/p>\n
\u201cWe were always borderline viable,\u201d says Peter Stafford, who closed the town\u2019s only private GP clinic in October, which forced patients to drive three hours to Darwin for an appointment.<\/p>\n
\u201cI was so burnt out and I was really struggling to make ends meet,\u201d Dr Stafford says. \u201cI had no option but to close up shop, and at least a third of rural practices are borderline viable.\u201d<\/p>\n
It\u2019s no secret that the nation is facing a shortfall of GPs in the bush, but few people appreciate the intense financial and emotional pressures placed on those who manage their own clinics.<\/p>\n
GPs who own their own practice are often forced to pay recruitment agents, many of whom are based overseas, up to $40,000 in an effort to lure foreign-trained GPs to rural areas.<\/p>\n
\u201cI spend half my time speed dating with recruitment agents,\u201d says Simon Holliday, who owns two medical centres in Taree on the NSW mid-north coast.<\/p>\n
\u201cIf I\u2019m lucky, I get about two Australian-trained doctors per decade. I have had to pay up to $28,000 to get the right overseas candidate.\u201d<\/p>\n
At Gunnedah, in the state\u2019s northeast, the town\u2019s two GPs cover a population of 10,000 and are \u201ceffectively running a crisis medical service\u201d, according to the local council.<\/p>\n
In a blistering account of the dire situation faced by the residents of Gunnedah, the council\u2019s general manager, Eric Groth, says locals are \u201clucky\u201d if they ever get to see a GP.<\/p>\n
\u201cThose lucky enough to get an appointment with a local GP face long waits, and appointments are significantly delayed or not sought until a health complaint has escalated to a critical level,\u201d Mr Groth wrote in a submission to a NSW inquiry set up to examine rural health.<\/p>\n
\u201cThe concept of an annual health check-up with a local GP is a luxury that is simply not attainable for many local people.\u201d<\/p>\n
Despite moving to regional NSW only five years ago, Dr James is already well-acquainted with the consequences for those patients who are forced to delay critical medical care.<\/p>\n
\u201cI\u2019ve completed so many cervical screens that have been very much overdue,\u201d she says.<\/p>\n
While many older GPs in country towns say they are stretched to breaking point, younger doctors who make the pilgrimage to the bush believe the tide could finally be turning.<\/p>\n
Teena Downton, a medical educator with the Australian College of Rural and Remote medicine, says the challenges of rural practice are outweighed by the satisfaction of the work.<\/p>\n
\u201cWorking rurally allows you to do far more as a doctor and you get to help and manage a wider variety of conditions,\u201d she says.<\/p>\n
\u201cThe exposure to specialist culture in the cities made me \u00adrealise that your breadth of (medical) knowledge starts to get compartmentalised.\u201d<\/p>\n
As a rural generalist, Dr Downton says the opportunity to select an extra skill, in her case \u00adobstetrics, played a key role in her decision to settle in Cowra, in central western NSW.<\/p>\n
Yet she is still in the minority, with a report by the Royal Australian College of GPs revealing that only 15 per cent of final year medical students say they are interested in becoming GPs.<\/p>\n
\u201cRural doctors work longer hours and they are often working with a much broader scope of practice,\u201d explains Peta Rutherford, the chief executive of the Rural Doctors Association of Australia. \u201cRural exposure basically becomes non-existent after medical school, and key positions like internships are in capital \u00adcities or big regional centres.\u201d<\/p>\n
Even so, this is a statistic that Dr James, who has lived in Den\u00adiliquin for more than two years now, is prepared to readily dismiss.<\/p>\n
\u201cTake the plunge,\u201d she says. \u201cWhen you have lived in the city your whole life, it can be challenge \u2014 but life is about having an adventure and taking risks. Moving rural can be amazing.\u201d<\/p>\n