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Trouble in paradise: Cooktown’s healthcare workforce crisis

2 August 2022

Cooktown, in Queensland’s Far North, has plenty going for it. This coastal community offers outback charm, friendly locals, an abundance of fishing hotspots, and the Great Barrier Reef and world-heritage rainforest right on its doorstep.

By all accounts, it’s a tropical paradise and a great place to live. But when it comes to doctors, Cooktown is currently struggling to attract and retain them, and it’s hurting the health of the community.

Dr Natasha Coventry is the Director of Medical Services at Cooktown Hospital and a supervisor in  James Cook University’s (JCU) general practice training program. Since 2007, she’s worked as a rural generalist in Cooktown, demonstrating a level of commitment to the town that saw her awarded Legend of the Bush status by the Rural Doctors Association of Queensland (RDAQ) in June this year.

We caught up with Dr Coventry and one of her GP registrars, Dr Shane Sadleir, to hear more about the medical workforce shortage gripping the town and the impact it’s having on the community. They explain that while the need is severe, it comes with plenty of opportunities, and they’re urging doctors-in-training to discover for themselves all that Cooktown has to offer.


A microcosm of a national problem

The doctor shortage is not unique to Cooktown; it’s a problem that’s worsening in regional, rural, and remote areas around the country.

The statistics indicate that there are plenty of doctors in Australia, the issue is with the distribution of this workforce. According to the Health Workforce Dataset 2019, there are 4.3 doctors per thousand people in the cities, compared to just 3 doctors per thousand in rural and remote areas. While the ranks of general practitioners grow by approximately 680 per year, two-thirds will work in cities[1].

For years, Cooktown had enjoyed a level of stability in its medical workforce at odds with the situation facing rural and remote towns around Australia. But that has now changed. Dr Coventry says the problem of health workforce attraction and retention has well and truly arrived in town.

“We had a golden period with an incredibly stable workforce. I would see the plight of colleagues around the state and felt so privileged to have four GPOs and four GPAs, with most of my staff hitting the 10-year plus mark. Unfortunately, things have changed for us,” Dr Coventry says.

In the past two years, the town has seen several long-term doctors leave and others retiring or nearing retirement. Short staffing has added an increased workload on the remaining staff, leading to a greater risk of fatigue, burnout, and ultimately, more departures.

“Everyone is a bit weary,” Dr Coventry says. “We have been understaffed for an increasing amount of acute care and even primary health care and that is leading to chronic fatigue within our workforce.”

The impact on the community

For patients in rural and remote areas, limited access to a doctor can mean longer waiting times, further travel, and for some patients going without seeing a doctor altogether.

In rural and remote communities across Australia, reduced access to a GP is leading to poorer health outcomes. According to a 2020 Australian Institute of Health and Welfare report, people living outside major cities had higher rates of arthritis, asthma, and diabetes[2]. The same report revealed that for those in very remote areas, potentially preventable hospitalisation rates were two and a half times as high as in major cities.

Staff shortages in Cooktown, like in other rural settings, could force a shift in the distribution of doctors' availability away from general practice to meet immediate needs in acute care. It would mean Cooktown locals potentially losing out on one of the key benefits provided by a GP, preventative health care.  

“With fewer GPs there's less continuity of care. You lose the benefits that come with having a stable rural generalist workforce; the therapeutic relationship, the corporate memory and clinical memory which helps the patient significantly,” Dr Coventry says.

“There is so much benefit in having long term medical staff, such as our local GP Dr Des Hill, provide services. He is responsible for the training and support of hundreds of medical students and GP Registrars (including myself!), and really provided the foundation on which Cooktown’s overall medical services have grown.”

But, with health services in a rural setting tightly interlinked, when one part of the workforce is strained there can be far-reaching flow-on effects. Dr Coventry has seen this unfolding in Cooktown.

“Losing staff inherently puts an increased load on those remaining. The result is a reduction of the services we can provide to the community to maintain those most critical,” Dr Coventry says.

Unfortunately, you’d have to look far back for an example of this, with the temporary closure of the Cooktown maternity services in February this year. After being reopened in 2015, the service has been suspended due to a combination of issues involving staffing, resources, and funding.

“There is certainly a lot of community desire to have birthing services in Cooktown, and it would be lovely to offer those services,” Dr Coventry says. “But it comes down to having enough staff, ensuring their relevant skills are up-to-date, and the equipment is maintained. As a service, it is vulnerable to closure if any one of those elements is missing – such as the position we are in now.”

While the situation is severe, there is hope. According to Dr Coventry, the tide is slowly turning with a recent boost in staffing, and she’s got her fingers crossed for more to come.

“We’ve had another three junior staff registrar/principal house officer positions added to our establishment and are now looking at increasing our senior medical workforce,” Dr Coventry says.  “And based on new staff commencing, we’re planning to be open for birthing again later this year”.

With need comes opportunity

There is still an urgent need for more healthcare workers, particularly GPs, to come to Cooktown. In choosing to work in a community that needs them, doctors are discovering just how rewarding a career in rural general practice can be.

Dr Shane Sadleir is a GP registrar who joined the team in August 2021 as an Australian College of Rural and Remote Medicine (ACRRM) trainee in James Cook University’s GP training program. After years of working in emergency medicine at a larger tertiary hospital, he was searching for more.

“I just felt something was missing,” Dr Sadleir says. “I needed some more diversification. Once I got to see what the rural generalist program was about, and the current situation and prospects available in Cooktown, it was a no-brainer for me.”

Dr Sadleir has found the diversification he was looking for. His week is a mix of acute and primary care at the hospital, local general practice with Dr Hill, and primary health care settings across the region.

“I have great continuity of care, particularly working in Cooktown and Hope Vale. I see patients at the hospital, and I can follow them up out in the community clinic and build that trust with them,”

Dr Sadleir is a big advocate for choosing Cooktown, particularly during your training years. He says he sees JCU medical students on extended rural placements in Cooktown who are ‘streets ahead’ of where a final year student might typically be at.

“What they’re getting out of this experience would be invaluable. We essentially treat them like intern doctors, and you can see their breadth of knowledge and patient management skills growing rapidly,” Dr Sadleir says.

With a less competitive training environment compared to larger settings, Dr Sadleir has found plenty of opportunities for professional development. Less than a year into training in Cooktown, he’s taken on a clinical lead role with the hospital’s dialysis unit.

“I’m now a Senior Medical Officer linked with the Torres and Cape Renal Units, and I’m really enjoying it. You get a lot of diversity and your day is so different and often quite exciting,” Dr Sadleir says.

After spending his high school years in Cooktown, Dr Sadleir says the sense of tight-knit community in town is just as strong as he remembers, and he’s discovered that it extends to the team environment of the health workforce.

“One of the wonderful things I've found is that when we engage as primary care with the hospital, in terms of retrievals and advice and referrals, we get a really good response and you feel that acknowledgement of our role as a rural generalist, and how important it is,” Dr Sadleir says.

The supportive team environment is something that Dr Coventry deliberately fosters in her role as Director of Medical Services, knowing how important it is to staff retention.

“There's so much to benefit from building that sense of team and fostering a culture of open discussion about management and care. It’s building the sense we're in this together. We're looking after this community together.

“Over time, everyone gets to know each other really well. You have this support and a very privileged working relationship with both outreach specialists and our hospital-based consultants. Because of this, you have a heightened opportunity to advocate and get your patients the help they need when they need it,” Dr Coventry says.

Sunrise

Are you up for the challenge?

If you are a medical student or junior doctor who is considering general practice, ask yourself ‘what type of training experience do I want?’. What Cooktown can offer you is a broad range of clinical experiences and a genuine sense that you’re making a difference to a community that needs you.

It’s the type of supportive training environment, fostered by the likes of Dr Coventry, that can set you up for a successful and rewarding career.

“We strive to make sure that when positions become available, it's’ not just ‘we’ve got a workforce to do paperwork, like discharge summaries’. Instead, it’s knowing we have interns and RMOs who might be yet to decide on a career choice so let's give them opportunities to get out into primary healthcare to see the best of what the career looks like and provide opportunities to improve their skills and knowledge,” Dr Coventry says.

“From a professional perspective, I think in a small facility and hospital service like Cooktown, as a doctor if you're committed and sticking around, you have a great opportunity to really affect change and influence service development,” Dr Coventry says.

As Dr Coventry has experienced herself, if you commit to Cooktown, then the town will commit to you and welcome you in as one of its own. While she might not call herself a ‘local’ just yet, she did marry one, and it feels like home for them and their four children.

“You get a real sense that this would be a lovely community to grow old in. People look after their own here and go out of their way to care for each other. It’s really lovely,” Dr Coventry says.

Dr Sadleir took a chance on Cooktown as well and is very glad he did. His message to those who are considering their training options is to make sure Cooktown is on their radar.

“Why come work in Cooktown? Come for the breadth of experience across that spectrum in medicine from primary health care to acute care. You get to complete that cycle of inpatient management, involving social work and allied health, which I think is amazing. I think the experiences you have as a GP in Cooktown are second to none and the lifestyle is not so bad either!” Dr Sadleir says.

For as long as there is still a need for better access to health care in rural communities like Cooktown, JCU will remain committed to producing a fit-for-purpose medical workforce. For us, it starts from providing outstanding rural experiences to undergraduate medical students and goes right through to training GPs and promoting other specialist training opportunities in the North. We work in, with, and for regional, rural, and remote Queensland.

[1] National Health Workforce Dataset, Annual Health Workforce Survey.

[2] Australian Institute of Health and Welfare (2019) Rural & remote health, AIHW, Australian Government, accessed 01 April 2022.

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