Always choosing your own adventure – the life of a Rural GP.
Ever since I was a child I have always been drawn to the idea of adventures. The excitement of heading out from your safe haven into the unknown, meeting a variety of colourful characters along the way, relying on your wits and improvisation to get out of sticky situations and of course learning invaluable life lessons as you go to enrich the rest of your life – who wouldn’t want a part of that! Fortunately for me, the chance to have experienced and continue experiencing my very own adventures has been more than embodied through my medical training and early career as a rural GP. I hope that reading some of my experiences within five weeks of starting in a new rural GP placement can shed some light, dissolve misconceptions and encourage the adventurous part of your spirit to take the chance and set out on your own journey.
One type of story I particularly loved was the “choose your own adventure” novel. If you were reading the introduction to my rural GP adventure, perhaps it would go something a little like this…
Journey to the Forest of Januvia
“Driving into the small town that will be your home for the next 12 months, you park your fully loaded car into one of the free spaces outside the local town’s bakery. Looking around you notice the tidy street with bright green grass hosting a central rotunda. Sounds of birds chirping and a speedboat making the rounds on the river close by fill your ears. After stretching out your legs you enter through the door and observe the variety of locals going about their day. You notice a young child at the counter pointing at a colourful cupcake and begging their mother to buy it for them. You see a young teenager with long blonde hair working as a server at the checkout who must have only just finished high school. Glancing around at the tables you catch an elderly couple enjoying a cappuccino and overhear them talking about their upcoming bridge tournament. Lastly, you turn to see a stocky middle-aged tradie who you are not at all surprised to see head straight to the fridge and pick up a 600ml farmers union iced coffee.
You think nothing more of this encounter, order a flat white and pasty. Just as you are about to sit down the elderly lady has clearly become too excited about her upcoming tournament and has collapsed! Simultaneously you notice the young child’s mother is panicking as they began to choke and splutter!
You have to think quickly as you have a decision to make, what will you do??
If you decide to alert the bakery staff that you are a new doctor who has just walked into town and go and offer assistance to the elderly lady turn to page 27…
If you decide to go attend the child who seems to be choking on a lolly turn to page 79…
If you realise that nobody in town knows that you are a doctor and decide to ignore the events happening in front of you by quietly sneaking out the front door turn to page 161…
The reality of daily rural GP life
Ok, so perhaps you may find this scenario a little bit unrealistic and I may have added some poetic license! For myself only having moved to a new rural town in the Riverland of South Australia, more realistic scenarios of the variety of medicine you can experience on a daily basis would read like this:
The tradie you noticed earlier presents to your clinic on a Thursday morning concerned about a recent episode of chest pain. You soon discover his father has recently had a heart attack at 52 and he is anxious about his own cardiovascular risk going into the future. You discuss modifiable risk factors, organise some baseline bloods and agree to make another appointment to address his keenness to stop smoking.
A 52-year-old woman presents to you for her annual health check. You measure her BP, describe the pros and cons of each test and chat with her about how long she has been in the town and what she enjoys doing. On the next visit to get the results of her blood tests, she brings in a huge bag of home grown peaches for you to enjoy.
A 19-year-old girl presents with concerns about an ex-partner having told her she may have chlamydia. After exploring her concerns, you calmly explain about appropriate testing, treatment and follow-up and she looks and feels far more reassured.
You have just finished a busy day of consulting and are on-call until 8am the next morning. You are alerted that one of your inpatients, a 78-year-old man with new onset atrial fibrillation, is becoming more breathless and wheezy so quickly walk down to the wards to investigate. You immediately realise that something is not right and your patient has severely increased work of breathing. You call for help from several of your senior doctors and bring the patient down to the local resuscitation room. Over the next several hours you have been working as a team to stabilize the patient with a GTN infusion, CPAP mask, urinary catheter, dual IV access and medstar is on the way to retrieve the patient via helicopter.
What I love most about being a rural GP
I already think that a career as a general practitioner is extremely rewarding and the diversity of medicine you will encounter can be found in any practice. However, being a rural GP has its extra challenges and advantages that simply enhance and enrich this experience.
To me some of the best advantages of practising general practice in the country include:
Up-skilling your procedural skills
As there are often no immediate full-time specialists within close distance to your town, you have the chance (and are actively encouraged) as a rural GP to develop and use your skills to better serve the community. This could mean doing extra hospital time in the always needed areas of obstetrics, anaesthetics and surgery or perhaps up-skilling in a non-procedural area such as mental health, palliative care, Aboriginal and Torres Strait Islander health, medical teaching or research. Once you have any of these qualifications you are immediately able to put them into practice and it can be a great way to break up days of consulting and add even more variety to your work life.
Appreciation within the community
It is well known that recruiting and retaining a strong health workforce is an ongoing challenge and at the same time vital to the future of rural towns and regional centres. Without access to basic health services, community members have to undergo increasing travel times or are forced to wait weeks to get an appointment with their regular GP. Community members genuinely appreciate the work you do within the town and in my experience have made every effort to make you feel part of the community. This could include anything from being invited along to the local lawn bowls night, to checking how you are settling into town in the local supermarket or loaning you a piano for the year. Some of the oldies may even bring out the big guns and try to marry you off to one of the locals to guarantee you will stick around!
Better lifestyle work balance
The old school mentality of rural general practice meaning you are on-call 24 hours, 7 days a week and never have a chance to get a break or leave town is a common misconception. Perhaps this was true back in the so-called “good old days”, but the life of a rural general practitioner has changed significantly since the mid half of the 20th century. These days you are much more likely to encounter practices with four to six doctors, rather than the solo or duo doctor practice. This allows more flexibility and less on-call time – all vital factors to avoid long-term burnout and to increase work satisfaction. With the work side of life being much more manageable I believe rural general practice to be more social and lifestyle friendly. With a less than five minute commute to and from work each day this already gives me over an extra hour not spent in city traffic with more time to enjoy life and recreational activities.
Working in a community away from the city and servicing rural areas is not only deemed valuable by patients, but the government also recognises and rewards this. Sure, you can make a good salary in many areas of medicine but, particularly for rural GPs, there are financial incentives which include a higher charge for bulk billing patients, generous hospital on-call payments and yearly rural medicine incentives which are paid as lump sums, the value depending on how rural and how long you have been practicing. If that wasn’t enough, the price of land and housing is far cheaper in the country so the money saved on a house deposit and mortgage can be freed up to spend on whatever you like – overseas holidays, travel or a new boat if that’s what you are into!
So what are you waiting for?
Having grown up and loved spending my childhood in a small country town I can appreciate it may be difficult to take the gamble and venture out from the city to see what is out there. All the reasons about why I look forward to a career as a rural GP have hopefully shed some light on the myriad of opportunities out there. Despite all this, at the end of the day, it is up to you to take the first step. Basically, if you have always had an adventurous spirit and yearning for something more than the regular working life, then life as a rural GP could be just the adventure you were looking for.
So why become a rural GP?
That’s easy – it’s the best way to start your very own adventure today!
If you are interested in general practice, applications are now open for the 2019 Australian General Practice Training (AGPT) Intake, and close Monday, 30 April 2018 at 10am AEST. Visit our How to Apply page for further details.