University Of Tasmania
There has been a lot of research done in the last five to ten years about what determines a medical student to choose rural General practice for their career. This is in response to the crisis in rural health care prompting governments and communities to find ways to increase numbers of students, and ultimately doctors, interested in rural medicine. Rural general practice in Australia is the only branch of medicine in which there are fewer applicants than requirements and the shortage of GPs is having devastating effects on health in these areas. In order to counter this trend in the future, rural medicine must be attractive to the next generation, my generation, and I am here today to discuss the experiences that I have had during my time as a medical student and particularly share those which have influenced me when making decisions about my future direction.
Positive rural experiences, especially in the early years of the course, can be vital for students to increase their awareness of rural general practice as a career choice. Governments and Universities have identified this and rural health is now increasingly being incorporated into the mainstream of medical education curricula. New rural streams are being developed where students can chose to take their medical education for periods up to a year in a rural setting, rather than the urban hospital. In Tasmania, students can choose to take their fifth year of studies in Burnie on the North West Coast. The predominant experience I have had in rural medicine is through my John Flynn Scholarship in southwest NSW and elective general practice placements in Southern Tasmania during my course. Undertaking placements voluntarily, which are not restricted by assessments or tutorial timetables have proved to be particularly influential, and enjoyable in my case.
I guess that having a rural upbringing is another form of gaining a rural experience, I grew up in Woodbridge, a small country town south of Hobart in the Channel District of Tasmania. My parents have a hobby farm of about one hundred acres and I would walk across paddocks to visit friends. Governments are urging medical schools to increase their intake of rural students like me into medical schools. They believe that rural students are more likely to enter rural medicine in the future. My experience of growing up in a small town where I knew my neighbours, the local shopkeeper and most of the kids around, meant that I have experienced the rural lifestyle that is one of the main attractions of working rurally. I experienced the isolation from the city, but I enjoyed the sense of community and connectedness, and think a country environment is a great place for children to grow up.
Rural Health Clubs are a new and exciting way for students to learn about and experience rural health. The sixteen clubs at universities around Australia are funded by the Commonwealth Government and their role includes supporting rural origin students, increasing awareness of rural and rural health issues among members, and provision of strategies for more students to learn about, experience and become active in rural health. I have been involved with the University of Tasmania’s rural health club, Rustica.
Our club has a membership of over two hundred students and holds frequent meetings with information about rural placements or scholarships, or different rural health issues, often inviting guest speakers. Other functions include social events and weekend events where students can be involved with rural communities and meet rural GPs. We have also recently become involved in going out to country schools to encourage high school students to consider health courses at university. These High School Programs are the new wave in trying to improve health professional numbers in rural communities.
The advantage for me of being part of Rustica is that I have been able to share my thoughts and expectations of rural practice with like-minded students in different years of the course. Students who have had different rural or urban experiences, or with different lifestyle priorities. I have also had the chance to build up networks with rural GPs around Tasmania, and learn about their practices. Of course we also have heaps of fun learning skills that rural GPs need, like suturing, plastering and emergency resuscitation, and getting out and about in rural communities. It is exciting to see how many students are interested to learn and experience more about rural general practice through the rural health club. Their voluntary involvement fosters interest in rural health where it already exists and educates those who want to learn more. Students from rural and urban backgrounds alike are involved in the various activities, which they otherwise may not have had the opportunity or interest to take part in.
All of the clubs form the National Rural Health Network, which oversees the annual national undergraduate rural health conference. The conferences are vital for students to get together from around Australia to discuss issues pertinent to rural practice and share experiences at the club level. The increased involvement of young men and women at a student level has made rural general practice a more high profile career option. Many students are considering the advantages and disadvantages of working in this field, and I’d like to share today some of the outcomes from discussions with my collegues.
In my experience and through my discussions, two main issues concern female students when contemplating rural general practice. These are more important to female students than our male counterparts, because we are trying to find a career which will be stimulating professionally, but also be compatible with our future roles as wives and mothers.
These issues are:
- Long work hours and on-call commitments, and
- The lack of opportunities for family and spouse
The perception of the long working week and heavy on-call commitments is a major consideration of my peers. Female students like me, who want to find a career to combine with family, see most rural practice as unworkable. I don’t think enough has been discussed about possibilities like job-sharing, or working part-time in rural areas. Not only would this make rural practice more manageable and less stressful, the extra doctors in the town would contribute to decreasing professional isolation. It is also necessary that communities understand that doctors need family and individual time so that they don’t place unrealistic expectations on their GPs. Opportunities for doctors to take leave is vital too, especially in decreasing the incidence of “burn-out”, and this is strongly dependent on the availability of locum support.
The other major factor we consider is the lack of spouse employment and child education opportunities in the country. Boarding schools and long hours of commuting are unacceptable to many who desire a more traditional family lifestyle. The reduction in services in many rural areas makes this a very real problem that I see few solutions to. I think that the involvement and discussion of students with female rural GPs who have managed to overcome these difficulties would be very important to make rural practice a more accepted possibility.
During my time in South-West New South Wales, I was exposed to many of the difficulties rural women face. The social difficulties in rural areas including unemployment, farming hardship and increased violence and mental health problems were obvious and many patients suffered more from the consequences of these, than an organic illness. It was the role of the GP to offer counseling and support to these patients, a task that was successfully carried out by my female GP mentor. Rural Australia needs female doctors, and as such it is vital female medical students see rural general practice as an attractive career choice. In order to address student perceptions regarding rural practice, and make it more accessible, I believe female medical students should be involved in gender issues programs during their medical education. These programs can educate students about the different ways men and women practice medicine and allow female students to become more aware of themselves as women in medicine and of the strengths and weaknesses that are inherent in this identity.
I was one of the many students who was unwilling to acknowledge or consider the differences between male and female doctors and avoided the issue’s discussion. That was until I was involved in a gender issues workshop three years ago at a rural health conference. I became aware of the different priorities men and women have in terms of career and family, the different practice styles men and women use, and the effects the male-oriented traditions, which are deeply engrained in medicine, will have on my career. These topics are not traditionally mentioned in hospitals or medical lecture theatres, but their discussion has the ability to produce many more aware and prepared doctors, both male and female, who will be equipped to make better career decisions as they enter the changing workforce in the future.
Workshops like the one I was involved in have been part of many of the NRHN national conferences and have been facilitated by rural health clubs in many universities. Gender issues have also been identified as a key discussion for the 2001 conference, which will be held in Tasmania in September. Issues affecting women in rural practice are identified and discussed between students and female doctors. Students become educated in the issues. Many female students are drawn to rural practice for its sense of community and the concept of holistic care, but they have heard about disadvantages and think they are too great. These workshops are vital in identifying student perceptions and targeting areas for change. The importance of positive female GP role models in these workshops and as mentors for female students has been emphasised because the exposure to real, working, female GPs is invaluable in sorting out which barriers really do exist and how they can be overcome, or worked around.
I was fortunate to be awarded a John Flynn Scholarship that has enabled me to visit a town in South West New South Wales, in Deniliquin, every summer for the past four years. I was especially lucky to be accepted by a female GP in this town who has become an important mentor to me. This experience has been the most valuable program during my medical course in terms of giving me a perspective on my career. Not only have I learned a lot about rural medicine and rural health care provision, but I also had eight weeks of positive rural experiences, meeting the locals, visiting the farms, swimming in the river and bike-riding through the town. The longitudinal nature of the scholarship allowed me to feel a part of the community, and develop friendships I renewed each visit.
My GP mentor and I often discussed the problems she has faced as a woman doctor, and the choices she has made about what services she offers and her involvement in the hospital. The field appealed to me in that there was a strong community involvement and close relationships between patient and doctor, but there was also the access to the hospital with its clinical problem-solving, anaesthetics, surgery and obstetrics. As I progressed through my degree I became more interested in the effect her work has on her family and marriage, and how she balances the commitment to home with that to her patients, especially as more doctors left the town and pressures on the existing doctors increased. The rural medicine career path was made accessible and attractive to me. I can’t speak highly enough about my experience and the value I feel an experience such as mine would have for many other young female doctors in training.
I can tell you that most medical students are aware of the need for more doctors to work in rural practice, and have developed perceptions of the disadvantages and advantages of this work. I think that, particularly in the case of female students, it is necessary for these perceptions to be challenged by more experience in rural communities and contact with working female GPs. Young women need to become more aware of the strengths their gender can bring to their role as a woman in rural medicine and the difficulties they may need to overcome during their career in rural general practice. They need to be given the opportunity to discuss these issues with fellow students and practicing doctors.
Medical schools can incorporate gender issues into their curriculum, and rural health clubs can be involved in organising workshops for their members. Female rural GPs can be involved with students with them on placements, or by being involved with the university or rural health club. I urge you to become involved with your local university and the young women who are trying to choose a career path within medicine. As a result of the various initiatives introduced over the last few years there certainly is a lot of medical student interest in rural medicine. Up until now, though, little is being done to educate women about the strengths they can bring to a rural practice and the strategies they can use to overcome any barriers which will stand in their way. Lets hope we can make rural general practice more accessible to the next generation of women in medicine.
