A Rural Pipeline: from Medical Student to Rural Generalist in Queensland

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1 A Rural Pipeline: from Medical Student to Rural Generalist in Queensland Dr Andrew McKenzie, Senior Lecturer in General Practice and Rural Medicine, Prof Tarun Sen Gupta, Head of Medical Education School of Medicine and Dentistry, James Cook University, and Co-Directors Vocational Training, Rural Generalist Pathway, Queensland Health

2 Brief History of Rural Doctors Movement in Australia Qld Health Rural Scholarships 1944 Rural Doctors Association of Qld 1990 National Rural Health Alliance 1991 National Rural Faculty RACGP 1992 Rural Training Stream 1992 Advanced Rural Skills Training ARSP Grad Dip Rural >> FARGP Australian College of Rural and Remote Medicine ACRRM 1996/97

3 Brief History of Rural Doctors Movement in Australia - ACRRM the importance of rural and remote medicine as a broad but discreet form of general practice the need for well-designed vocational training and continuing medical education for rural doctors the need to address the shortage of and remote doctors in Australia, by providing them with a separate and distinctive professional body

4 Brief History of Rural Doctors Movement in Australia University Departments of Rural Health UDRH 1997 John Flynn Scholarship Program 1997 James Cook University School of Medicine 1999 General Practice Education and Training GPET 2000 Regional Training Providers 21 >>19 RTPs Rural Pathway $$ General Pathway 250

5 Brief History of Rural Doctors Movement in Australia Rural Students Clubs RHINO at JCU Rural Clinical Schools 2001 (14) 10 additional Medical Schools >> medical graduates x2 Fellowship of ACRRM accredited by AMC vocational recognition 2006/07

6 JCU School of Medicine Vision Rural, Remote, Indigenous and Tropical Health Selection to target rural NQ students 100% students do rural program

7 Tropical Australia 995,000 total population Northern Queensland 116,000 Indigenous (12%) 750,000 total 27% of national Indigenous population population Top End 55,000 Indigenous (7.5%) JCU School of Medicine 162,000 total population 38,000 Indigenous (23%) Kimberley & Pilbara 83,000 total population 23,000 Indigenous (27%)

8 JCU School of Medicine Curriculum clear rural focus Staff with rural backgrounds RRITH year 2 semester subject Attracting students with rural/international interest Flagship of rural medical education

9 Sites of JCU Australian Year 2 Rural Placements Year 2 Rural Placement 4 weeks Immersion experience Small rural Australia Internationally Year 4 Rural Term 8 weeks 25% students at any time defined locations Year 6 Rural Internship 8 weeks Small rural hospitals NQ

10 JCU School of Medicine & Dentistry Rural Internship Sites Darwin (NTCS) East Kimberley Thursday Island JCU School of Medicine Tablelands Cairns Mt Isa (MICRRH) Innisfail Charters Towers Townsville Proserpine Ayr Longreach Emerald Moranbah Mackay

11 Adelaide ANU Bond Flinders Griffiths JCU Monash Melbourne Newcastle UTAS UNSW QLD USYD UWA Wollongong Australian Medical Students Association Medical Education Survey Question: My pre-clinical exposure to rural medicine has been adequate Panacea. Vol. 42, No. 1. May p. 9.

12 U Sydney U Queensland U Melbourne U Adelaide U Tasmania UNSW U WA Monash Flinders Newcastle The Tsunami

13 The Tsunami U Sydney James Cook Uni 1999 U Queensland ANU (Canberra) 2003 U Melbourne Notre Dame Freemantle 2004 U Adelaide Bond (Gold Coast) 2004 U Tasmania Griffiths (South East Qld) 2004 UNSW U Western Sydney 2004 U WA Deakin (Geelong) 2007 Monash Wollongong 2007 Flinders Notre Dame Sydney 2007 Newcastle U New England 2007

14 Dilemma for Qld Health: Opportunity for change Foster Inquiry into Bundaberg Hospital 2005 Significant cultural shift required Rural hospitals cannot be ignored Rural SMOs ageing and skills being lost Better to staff hospitals with local graduates with good training and clear understanding of scope of practice A specialist career pathway for Rural Generalists

15 The training program has a jurisdictional focus supplying rural generalist to both public and private sectors of the bush Roma Agreement October 2005 Qld Health, ACRRM, other stakeholders: This goal fulfils the State government s August 2005 promise of a specialist career pathway for rural generalists Service (with the State) and training are to be integrated (with the intent that a trainee may complete training while in service with the State)

16 Rural Generalist On 24 August, 2005, Qld Health announced recognition of Rural Generalist defined as a rural medical practitioner credentialed for: 1. Hospital-based and community-based primary medical practice AND 2. Hospital-based secondary medical practice: in at least one specialist medical discipline (commonly, but not limited to obstetrics, anaesthetics and surgery) AND without supervision by a specialist medical practitioner in the relevant disciplines 3. AND possibly, hospital and community-based public health

17 Qld Health Reforms Rural Generalist defined with credentialed practice Salary scale near equivalence to Staff Specialist and Senior Staff Specialist Training Pathway to support and supplement training with GPET (ACRRM and/or RACGP) Generalist in Emergency Medicine (GEM)

18 Qld Health Reforms Career pathway for hospital SMOs Additional rural hospital posts Appointment of education staff Pre-vocational assessment and VIP Linked to Qld Health Rural Scholarships

19 Rural Generalist Pathway PGY 1 42 PGY 2 37 PGY 3 20 PGY 4 23 PGY Total 156

20 Rural Generalist locations PGY1 & 2 Cairns Townsville Mackay Rockhamptom Nambour Redcliffe Caboolture Toowoomba Ipswich Logan

21 Rural Generalist Locations PGY 4 & 5 Thursday Island Proserpine Biggenden Bamaga Moranbah Munduberra Cooktown Longreach Mitchell Mossman Eidsvold Charleville Atherton Cherbourg Roma Mareeba Monto St George Mount Isa Kingaroy Stanthorpe Palm Island Dalby Goodiwindi

22 Qld Health Rural Scholarships Increased from 20 to 30 places No longer a mechanism to fill unpopular rural posts 21k/year for 4 years with 4 year return of service Return of service completed by end of RG training Popular because they lead to a defined career path as rural hospital SMO

23 Vanguard Rural Generalists Thursday Island Med Super 2007 Cooktown Med Super 2006 Mossman Med Super 2003 Palm Island Med Super 2006 Cloncurry Med Super 2006 Proserpine SMO 2000

24 PGY RGP GEM QH Service QHRSS AGPT RVTS ACRRM RACGP Rural Generalist Pathway 1 Intern RoS Apply PreVoc PreVoc Core Clinical Hospital Training 2 JHO RoS Year 1 - Training Time ARST 3 (or ASRT - EM Registrar Deferral Year 2 Apply more) Advanced Specialised Training Advanced Skills Training 4 SMO Primary Rural & RoS Year 3 Year 1 GP Terms (Provisional Remote Training Voc Voc Fellow) Primary Rural & 5 MORPP RoS Year 4 Year 2 GP Terms Remote Training Post Fellowship SMO (RGM) in EM MSRPP/MOR CPD PP 7 VMO(AP) SMO (GEM) CPD FACRRM + Advanced Skill(s) + (Post Fellowship GEM) FARGP + Advanced Skill(s) + Certified Women's Health (ACRRM Curriculum)

25 Rural Generalist Pathway Provisional Fellow Rural Generalist Base Salary $108k $150k PDA $20k $20k IIS $7k - $48k $7k - $48k Private Practice All $38k - $52k $52k - $77k Vehicle $19k $23k Super $14k $19k TOTAL $206k - $261k $271 - $337k

26 The Rural Pipeline in Queensland High School recruiting and Health Career Workshops Admission policy JCU that favours rural origin Strong rural focus with rural placements Rural students club RHINO John Flynn and Qld Health Rural Scholarships Promotion of RG Pathway to undergrad students Interview and selection to RGP in final year

27 The Rural Pipeline in Queensland Dedicated intern posts in regional hospitals Qld Health Rural Scholars follow RGP Rural Pathway in GP training to FACRRM Workshops and Prevoc assessment PGY2 Support via VIPs to Advanced Skills Training and beyond to PGY4/5 in rural hospitals Clear career pathway for RG and GEM

28 JCU School of Medicine