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Skilling rural doctors

14th April 2021

Dr Bruce Chater took on his first registrar in his Theodore practice in 1994. He’s had a steady stream ever since as he has continued to build his practice in central Queensland. It’s a role he believes is crucial in ensuring a skilled medical workforce for rural, regional and remote communities.

Ensuring a rural workforce

There are three main reasons I have embraced being a supervisor over the decades. The first is that I’ve always felt that we owe a debt to the people who looked after us, and the way we do this is to in turn to look after the next generation and give them a good, positive learning environment. Secondly, we need to. If we don’t train people in rural areas, they’re not going to experience rural areas, and they’re not going to live and work in rural areas. The third reason is purely selfish. I want to ensure that my community has good doctors into the future. I feel that I have worked to look after the community, and I want to make sure that continues.

It’s so important that we do everything we can to ensure the future of the medical workforce in rural areas. To do this you have to start early, as James Cook University does. You’ve got to ensure that even as students, you are getting them out for reasonable experiences in rural areas. You’ve got to expose them early and frequently and give them a good chance to consolidate their skills. If you are waiting until registrar time, you are getting afraid young doctors. But if you have primed them well with that rural exposure early in their medical training, that makes all the difference. Our current registrar wants to stay and become part of our practice. She was born about 60 kilometres north of here, came back as a medical student and then asked to come back as a registrar and will stay on as a Fellow.

Some may hate the term ‘pipeline’, but it is crucial. You’ve got to impassion them at that early stage with the thought of great rural career, and then build on that strong base when you when you get them to the registrar level.

Foundations of solid supervision

A really good supervisor is one who engages registrars in the practice as true partners. They’re not there as lesser beings. It must be a genuine partnership in rural practice. You must also open their eyes as to how to engage with and enjoy rural practice. A lot of junior doctors come with a very hospital view of medicine, a very academic view of the world, disengaged from the patients in front of them. It’s a matter of nurturing their engagement with rural areas and their rural patients.

I also believe good supervisors protect their registrars, allowing them to flourish in their careers, teaching them to stand up for their own privacy, their own time and their own needs. You have to make sure the community doesn’t use and abuse them. I always say that our community looks after me and I look after the community, that it’s a partnership. That’s what I really want to teach them. That they are allowed to stand up for themselves and recognise that they have needs too.

Staff out the front of the Theodore Medical Clinic

Friends and patients

A rural GP career is vastly different to a metropolitan GP career. Registrars come knowing that some authorities say you shouldn’t treat your friends, but that’s completely absurd in rural areas. Living and working in a rural community, they get to know almost everyone. As a supervisor you need to teach them the joys of that and not to fear it. I had an experience where I had to diagnose my best mate with a brain tumour, which he subsequently died of. He said the greatest thing about the situation was that he had a friend to care for him. We fear how that will play out when in fact it strengthens a connection. We do have to teach registrars how not to let that relationship cloud their judgment, but we also need to teach them that callous distancing also clouds your judgement. The model of care that is touted in urban areas is a kind of callous distancing, but that doesn’t necessarily give you better results.

We must teach them when to wear their doctor’s hat and when to be a mate. It’s the ability to say in a situation, like when you are delivering a baby, this is serious. But you can also open the bottle of champagne later with the family as a friend to celebrate the birth. Registrars need to be comfortable with that.

A two-way street

Just as I believe there is a lot I can give to a registrar, they also give a lot back to me. They keep me thinking. There’s even research which shows doctors who have registrars last longer in practice. Of course there are frustrations, but it challenges you and keeps you thinking. Registrars keep you fresh with different ideas. You’re able to teach and provide the experience, but at the same time you get so much back.

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