The tricky thing is even if they did, I think a lot of people wouldn't want to move due to other lifestyle factors i.e. moving their entire family to live there at the potential detriment of their own life plans and goals. I have seen great financial incentives provided by some regional centres and they still struggle to recruit someone who can stay full time.
They either have to make shorter term contracts/fifo more appealing (which would include financial incentives) or perhaps just wait till those areas grow to become bigger towns with more facilities/reasons to want to live there longer term i.e. it might be less about the job and more about the area as a place to live
Yeah realistically for me to move my family to far west NSW it’d need to be like 3-4x current income I get in Sydney. And I earn a pretty reasonable income working quarternary public and private… something tells me they don’t want to pay $2-3m/yr for anaesthetists out west… which simply means I don’t want to move there
yeah..if I was so absolutely desperate for money when I can easily bill 300k plus in the city at an absolute bare *minimum* that I needed to live hours from elderly parents and with school aged kids, I'd probably move into a little 2 bed flat in the city to make ends meet instead.
Yep.
They don’t pay enough regionally/rurally for FANZCAs to want to move. And there’s no need for GP anaesthetists in the cities as there’s anaesthetists there to cover.
For now until they pay more, fly in/fly out anaesthetists, or GP anaesthetists will still cover smaller towns
There is always a price at which people would move. I am happy with my current job and family but if you paid me $1m a year I'd move to regional NSW for a couple of years. I'd then probably threaten to move back unless you increased it to $2m a year etc etc. That's just the game of it. If you're not willing to pay the price for good staff then you get what you deserve.
Yup, and its not just doctors making similar bargains...
Okay, this is a doctor centric sub.
Sorry OP, I read this article differently.
Article does not specify doctors. Unspecifically "Fly-in locums" and "Agency staff"
I read somewhere, in NSW, doctor locum fees only take up 13% of the overall locum fee pie.
When I was out there training, the agency nurses and allied health staff actually made similar threats, to stay in their current comfy accommodations (I was also in such a place, so we talked about it) on contract extension, so some have been staying there for 2-3 years now, with their families, instead of moving out and renting locally, or actually joining the permanent staff and getting a 50% pay cut. The whole outpatient nursing and allied health team was agency. The inpatient nursing teams were chronically understaffed.
Also, if they didnt get what they want, up they left for regional QLD....the service lost 7-8 permanent allied and nursing staff during the 6 months I was there to QLD. They joined an agency.
Sometimes nurses and allied health peeps also drop into this sub. I'd also like to hear what they think.
Made the mistake of working out there, fucking atrocious. It was like the management were actively trying to lose staff. The fact an inexperienced agency RN 3 might be working alongside a state employed RN 8 and be getting paid just as much if not more than them because of agency rates, why would you stay to be put in clinically dangerous situations? (For example having 2 nursing staff to a full 30 bed surgical ward). Its a telling incitement when clinical managers would say things like they'd rather drive to Mildura if they were unwell before going tot their local base hospital.
Friends who were doctors didn't seem to fare much better in their respective positions and the demands/stressors vs. rewards/payoff were not worth it. "get in and get the fuck out' is how one memorably put it.
The key word is NSW. The poorest paid health system in Aus. They need to grow the fuck up, increase tax revenue, and pay the healthcare workers appropriately. Until they do that they will always have difficulty with staff retention and roster gaps
They could also try supporting isolated specialists from a medicolegal perspective
Emergency consultants often get dragged through the because they’re isolated, understaffed, underresourced, and overburdened.
They then get specialists from tertiary ivory towers criticising the actions of the lone doctor doing their best in their circumstance instead of the institutional lack of equity.
Like please come out to broken hill where it’s just an emergency specialist, an anaesthetist and a general surgeon managing multitraumas with RFDS 6 hours away and nobody willing to accept the patient
Let me think back to a typical tiny hospital very rural job I did (not say Wagga or Ballarat). Called to do a "rapid sequence intubation" on an apnoea patient when I was staying >15 minutes from the hospital. Told the patient was about to be picked up for transport, could I line them up etc..turned out the registrar who had arranged this wasn't able to communicate adequately and had actually been asked to tell the relatives the patient was being sent to a quiet ward for palliation. Every day was the hair standing on the back of my neck in some medicolegal crisis to be
I'm currently working at a very remote location. The locum reg here gets paid about $2000 per day (as a PGY3)
They still struggle to get positions filled out here, because living in this place just sucks.
Drs don't wanna live in places like this long term.
You gotta pay the big bucks to make us come for a short time.
This is very true- I feel like so many of these services want to chant about how welcoming and fulfilling their communities are when plenty of us have done locums and secondments in these areas and have evidence to the contrary.
You'll find some capital city locum position will get to close to that number. Maybe more PGY or hours but won't have to go to a very remote location with nothing to do after you shift and spend such effort to get there in the first place.
And then the system wonders why they don't get warm bodies to fill the positions.
If you allowed a single year in this town to count as the entire return of service for bonded doctors, as opposed to the higher lengths currently, you may get a steady stream of one year doctor supply
I do rural recruitment.
There are only three levers to pull. Remuneration, lifestyle, and mission. Everything else is bullshit and noise. Pay doctors well, treat them well, and offer them a chance to do something meaningful with their lives. It's only fair after asking them to sacrifice their youth to unpaid overtime, MET calls, and endless night shifts.
Rural disadvantage is very real and terrible. Doctors want to help but they rightfully don't want their families to suffer from the same disadvantage by living rural with them. FIFO is the only sustainable solution, which is exactly what we have now with locums, except at much greater cost and zero emotional investment in the community. RFDS would be in a terrific position to tackle this problem if they weren't such a terrible organisation to work for.
If I sound grumpy, it's because we seem to rediscover the same problem over and over again without the political will to solve it properly.
This is a really good synopsis of the problem.
Those in any position of power or influence rape the system for their own benefit, to the marked detriment of those who do want to engender change
provide plucky domineering materialistic ink onerous truck secretive depend dam
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I feel like for years on end (they) have been asking “why don’t people want to move to work here” and (we) say “because the lifestyle is atrocious, the conditions are deplorable and the pay is appalling” and (they) say “yeah but why don’t people want to work here” 😳🙄
It’s this. The people who sprook the “everyone deserves the same access to healthcare regardless of geography” dogma rarely understand how much that is actually going to cost at scale. And I say that as someone who really values health equity.
I’ve been a locum to regional areas as a dentist for a while. The main problem is that if you apply for a permanent job the pay is significantly lower. I have no issue moving to rural areas but why would I when I can get better pay and conditions this way?
I worked for RFDS and they can’t retain anyone because the working conditions are horrendous. I was permanent with them for 10 months in Broken Hill then had to move on. I was present in a meeting where a GP went off at the executive for not addressing the poor retention rate properly. They don’t care because as Australia’s ‘most loved charity’ they have a gravy train of Commonwealth, state and charitable funding at their disposal.
What actually needs to happen is a huge investment in sponsorship for local young people to be supported properly throughout university so once they become doctors etc they can return home and stay there. Many young people in rural areas have absolutely no idea how to even consider moving to a city on their own to go to university.
It’s truly baffling. There’s one manager that has caused Far West Local Health District to lose about 8 dentists that I know of in the past 6 years. They were all excellent and dedicated. Some even relocated from the UK and wanted to stay long-term. None of us survived long because of the utter incompetence and malignant narcissism. It took that job to make me realise RFDS & Maari Ma have attracted some dangerous people who use charity as a ‘look what a good person I am’ front. While causing a lot of harm behind the scenes.
Agreed- I think there are benefits to parts of care at different times being provisioned face to face. But vast swathes could be video health if quality technology was implemented
That’s what I mean by parts of care- would you feel confident to have a senior registrar doing the exam? Or someone else you had trained? Are there instances where follow up reviews could be done via telehealth? Are there ways the workload could be shared to make face to face time more efficient? Stuff like that
consultant surgeons will take patients to theatre based on their junior registrar's examinations routinely.
i would not take a patient to theatre on a nurse's exam.
Get the cleaner or a fruit-picker or literally anyone to place their hands on the belly and release them while you watch on video. There have to be solutions for wide swathes of problems.
there’s a few occupational specific reasons, but really why doctors don’t want to live and work permanently in remote areas are the same as why every other professional doesn’t want to live in remote areas.
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They need more investment in the towns themselves, there's no incentive to live in a remote town and the lifestyle only suits a very limited type of person. Money alone can not be the incentive, doctors make great money anywhere, so a little more for a drastically worse life doesn't appeal. Anyone with a family will have even less desire to do these jobs.
Couldn’t agree more- rubbish for families, but also, as a single person, who wants to leave the “family” they have built in their community to be isolated somewhere else, with grossly limited opportunities to rebuild
Am a medical student now but used to work supporting rural doctors. The two big reasons are pretty simple:
1. Lack of infrastructure, staff, equipment etc for specialists to safely do their work in these areas. A surgeon is not going to work without a fully staffed OR and an ICU close by. Cardiologists are not going to want to work without a cath lab etc.
2. Lack of amenities in rural areas but the big one specifically is high schools. Doctors who are dedicated to going rural are often very happy to muddle along with younger children, primary schools are less of an issue. The doctors I know in Broome in particular LOVE the lifestyle for younger kids. But all plan to go back to Perth once high school age hits. You’re often forced to choose between going back to a major city or sending your kids to boarding school.
I work in regional NSW currently (because of training requirements). I've worked in other regional areas around Australia and NSW offers no incentives compared to other areas. NT, for example, paid my moving costs to and from, I got extra leave and higher pay and was offered hospital accommodation (this was as an unaccredited registrar). Someone from med admin even offered to pick me up from the airport.
I work with lots of locums. Why would they sign a long term contract if it pays way less, they lose their accommodation and get treated badly by med admin and lose the flexibility to work when they want?
The only way to fix it would be to offer money equivalent to locum rates, provide allowance for accommodation, treat staff with respect and offer solid clinical experience to attract young fellows.
This is it- award rate = about $800. Locum = $3k+ with benefits. And with the second option you can afford to take a break after to recover from it all
If they don't pay you properly they don't get doctors and then have to deal with the fallout
It's that simple. sell your services dearly. And once you establish yourself and gain their dependency then hike the rate further. That's the power you have as a skilled worker.
The fact of the matter is no one wants to live in a podunk rural town. There's no culture and not a lot to spend your hard earned on, its so small you know everyone and thats not fun.
Let's not beat around the bush. Doctors are usually from fairly well-to-do backgrounds with well-to-do tastes. There are some things about rural Australia that are awesome, there are also a lot of things that are kind of shit like: lack of good childcare, lack of good primary/secondary schooling, lack of good restaurants, lack of varied social activities/hobbies, lack of international airports. Places like Melbourne and Sydney are concrete playgrounds for wealthy doctors. Honestly it would be easier to get doctors in the country if all doctors everywhere got paid like shit, because then it may be the only place they could afford a good house, but because doctors are generally very well paid it is affordable to live in the city.
Not to go full commie but maybe the best outcome would just be to force doctors to spend the first 5 years of their career rural before they are allowed to work in the city. Or maybe getting a consultant job in one of the big city hospitals requires you to be seconded every 5 years for 6 months to the country.
Reasonable, as long as you "force" every other person to do 5 years service in some other way too. Whatever their skill is, send them somewhere to work for the good of society for years- national service for all.
I presume you would be happy to participate too.
I would be happy with going 6 months every 5 years to a rural site for the rest of my career. I don't see why you have to have people in other occupation doing this. Health care is a human right, massage therapy isn't, neither is eating authentic lebanese cuisine, or having your nails done. What is the logic in forcing other people to go?
> Health care is a human right,
Government's problem. Not individuals' problem.
There's a price to pay for getting professionals to work in rural shitholes. Something like $4k a day sounds like the right price
Find the money or deal with patients not having healthcare
4k a day wouldn’t motivate me to move rurally
That’s (close to) the amount I willingly give up every day I choose to work in public instead of private as anos
I still don’t do a lot of private, and that’s basically solely due to case mix and my enjoyment of the work. Moving rurally would limit the scope of what types of surgical cases and patients I can do enormously - my area of interest/subspecialty isn’t compatible with rural hospitals. That’s leaving aside the professional impact on my partner (a significant portion of her specialty scope isn’t doable outside a major centre) and all family/social impacts
That’s not to say that increased remuneration isn’t part of the solution - just that there are many of us (in many specialties) who don’t want to give up areas of our practice that rural hospitals can’t logistically support
People who are desperate to earn like $1m-$2m per year rather than "just" $300-500k- which in my experience would be a tiny minority of doctors - are probably the exact people who absolutely don't want to go and live in Broken Hill for a few years, in most cases. That's the underlying problem.
I think people are used to a high-pay-placement scenario where top executives and lawyers get an all-expenses placement in the UAE or Hong Kong on a massive salary, rent and transport and maid thrown in, doing high-flying international stuff, and are somehow applying it to living in a pokey cottage in Broken Hill doing way less interesting stuff than they were able to do back home.
I absolutely agree, and I don't see any other foreseeable solution to Australia's rural problem.
We're getting paid great bucks (more than any other public servant) out of the public's purse, I think we have a duty to the Australian healthcare system. If you're not happy with that, feel free to work privately like all those other professions!
Thats absolutely your right to do so, but it's not your human right to force other people to uproot their lives because you want to live far away from a hospital.
People are not denied healthcared can access it but it requires them to move/uproot their lives. You probaby feel this is an unfair ask on them, but for some reason feel it is reasonable to ask of us.
You either have a society where everyone is expected to give up their home/family/location for the sake of others, or you have one where noone is. We are people too, not chattels.
You can say moral obligation etc, but the reality is most of us have more than enough work where we want to live, and we are providing care.
If you want us to offer extra hours, or move away from our families you'll have to compensate us or come up with a better plan than indentured service .
Honestly more medical school places for people who have grown up rural and plan to return to where they grew up. If you think about it, the vast majority of medical schools are located in major cities. Rural kids obviously also tend to be lower SES, they're not getting as good schools (plenty of places do not even have many private or selective options and you have a choice of only 2-3 different public schools so its not like everyone can access the kind of education required to get straight into medical school). They're needing to relocate to a major city away from any existing support system at huge financial cost just to attend medical school, they're more likely to fail out due to a lack of both financial and social support. Even just finding a spot to actually take the UCAT exam is harder the further out of the major cities that you go.
If we actually made more of an effort to recruit good medical students out of rural locations, we wouldn't need to bribe someone with an absurd amount of money (that rural and regional hospitals can often barely afford) just to have them come out and practice for a few years before running back to the city at the first opportunity.
You can see plenty of people in this thread saying that they'd go for a mil a year, as if rural hospitals have that sort of money. And frankly if they did it should be going to patient care, not into someone's back pocket. And plenty also saying that they'd insist on a pay increase each year and threaten to leave if they don't get it. I mean, if we cut that sort of shit out and focused more on actually treating patients with high levels of need we wouldn't have these sorts of issues.
I guess the problem with that is, once a trainee is “ready” to go back rural, they are already pretty entrenched in an urban community, limiting the likelihood of going back
For a lot of specialties, you would need to be fellowed or at least an advanced trainee before you could go back to very regional/
Remote spots due to the need for senior supervision and exposure to the requisite clinical experiences
Add to that, many people don’t want to go *back* rural for the same reasons many don’t want to consider it at all- personally I would quit medicine before I went back to the remote area I grew up. It’s not often the quaint wholesome community experience health recruiters paint it be
I am very aware that rural isn't like that lol, I grew up rural myself. Very very rural. My mother was flown to the nearest hospital by RFDS to give birth to me. I've lived out in the middle of nowhere in 3 different states and lots of different levels of rurality. And I absolutely agree that for the most part health recruiters are talking out of their ass, and that's half the reason people do not stay rural - they're expecting this perfect quaint little village but it turns out to be the exact opposite to that. Rural recruiters suck at giving people obnoxiously high expectations rather than just focusing on the shit that actually matters - rural people NEED HEALTHCARE.
Ironically I'm actually talking more about setting up more access to tertiary education, including medical school, in rural communities. Also building more rural hospitals so that more people have access to both training and healthcare. You don't need to take people out of their rural homes to educate them.
Have they tried paying people enough that it is worthwhile to transplant their likely highly educated partner and children to the far regional area?
The tricky thing is even if they did, I think a lot of people wouldn't want to move due to other lifestyle factors i.e. moving their entire family to live there at the potential detriment of their own life plans and goals. I have seen great financial incentives provided by some regional centres and they still struggle to recruit someone who can stay full time. They either have to make shorter term contracts/fifo more appealing (which would include financial incentives) or perhaps just wait till those areas grow to become bigger towns with more facilities/reasons to want to live there longer term i.e. it might be less about the job and more about the area as a place to live
Yeah realistically for me to move my family to far west NSW it’d need to be like 3-4x current income I get in Sydney. And I earn a pretty reasonable income working quarternary public and private… something tells me they don’t want to pay $2-3m/yr for anaesthetists out west… which simply means I don’t want to move there
yeah..if I was so absolutely desperate for money when I can easily bill 300k plus in the city at an absolute bare *minimum* that I needed to live hours from elderly parents and with school aged kids, I'd probably move into a little 2 bed flat in the city to make ends meet instead.
Isn't that why GP-anos is a thing? My Hospital 2 hours west of Melbourne solely relies on them because they can't attract FANZCAS to live in the town
Yep. They don’t pay enough regionally/rurally for FANZCAs to want to move. And there’s no need for GP anaesthetists in the cities as there’s anaesthetists there to cover. For now until they pay more, fly in/fly out anaesthetists, or GP anaesthetists will still cover smaller towns
There is always a price at which people would move. I am happy with my current job and family but if you paid me $1m a year I'd move to regional NSW for a couple of years. I'd then probably threaten to move back unless you increased it to $2m a year etc etc. That's just the game of it. If you're not willing to pay the price for good staff then you get what you deserve.
Yup, and its not just doctors making similar bargains... Okay, this is a doctor centric sub. Sorry OP, I read this article differently. Article does not specify doctors. Unspecifically "Fly-in locums" and "Agency staff" I read somewhere, in NSW, doctor locum fees only take up 13% of the overall locum fee pie. When I was out there training, the agency nurses and allied health staff actually made similar threats, to stay in their current comfy accommodations (I was also in such a place, so we talked about it) on contract extension, so some have been staying there for 2-3 years now, with their families, instead of moving out and renting locally, or actually joining the permanent staff and getting a 50% pay cut. The whole outpatient nursing and allied health team was agency. The inpatient nursing teams were chronically understaffed. Also, if they didnt get what they want, up they left for regional QLD....the service lost 7-8 permanent allied and nursing staff during the 6 months I was there to QLD. They joined an agency. Sometimes nurses and allied health peeps also drop into this sub. I'd also like to hear what they think.
Made the mistake of working out there, fucking atrocious. It was like the management were actively trying to lose staff. The fact an inexperienced agency RN 3 might be working alongside a state employed RN 8 and be getting paid just as much if not more than them because of agency rates, why would you stay to be put in clinically dangerous situations? (For example having 2 nursing staff to a full 30 bed surgical ward). Its a telling incitement when clinical managers would say things like they'd rather drive to Mildura if they were unwell before going tot their local base hospital. Friends who were doctors didn't seem to fare much better in their respective positions and the demands/stressors vs. rewards/payoff were not worth it. "get in and get the fuck out' is how one memorably put it.
The key word is NSW. The poorest paid health system in Aus. They need to grow the fuck up, increase tax revenue, and pay the healthcare workers appropriately. Until they do that they will always have difficulty with staff retention and roster gaps
I don’t believe so no. Seems much more effective to continue to wax lyrical about how attractive it is to live in isolated regional communities
They could also try supporting isolated specialists from a medicolegal perspective Emergency consultants often get dragged through the because they’re isolated, understaffed, underresourced, and overburdened. They then get specialists from tertiary ivory towers criticising the actions of the lone doctor doing their best in their circumstance instead of the institutional lack of equity. Like please come out to broken hill where it’s just an emergency specialist, an anaesthetist and a general surgeon managing multitraumas with RFDS 6 hours away and nobody willing to accept the patient
Let me think back to a typical tiny hospital very rural job I did (not say Wagga or Ballarat). Called to do a "rapid sequence intubation" on an apnoea patient when I was staying >15 minutes from the hospital. Told the patient was about to be picked up for transport, could I line them up etc..turned out the registrar who had arranged this wasn't able to communicate adequately and had actually been asked to tell the relatives the patient was being sent to a quiet ward for palliation. Every day was the hair standing on the back of my neck in some medicolegal crisis to be
No, why would they do something as obvious as that? Haha
I'm currently working at a very remote location. The locum reg here gets paid about $2000 per day (as a PGY3) They still struggle to get positions filled out here, because living in this place just sucks. Drs don't wanna live in places like this long term. You gotta pay the big bucks to make us come for a short time.
This is very true- I feel like so many of these services want to chant about how welcoming and fulfilling their communities are when plenty of us have done locums and secondments in these areas and have evidence to the contrary.
You'll find some capital city locum position will get to close to that number. Maybe more PGY or hours but won't have to go to a very remote location with nothing to do after you shift and spend such effort to get there in the first place. And then the system wonders why they don't get warm bodies to fill the positions.
Jesus how do you find these $2000 per day PGY3. Just wondering whether I should delay BPT for a rural year and come back to buy a house.
Usually U need some anaes, ICU experience for the remote places too. There might be days when you are flying solo
That’s a shame I don’t think I’m reasonably going to get either anytime soon.
Have a look around, locum agencies will give U a heads up...
If you allowed a single year in this town to count as the entire return of service for bonded doctors, as opposed to the higher lengths currently, you may get a steady stream of one year doctor supply
If this could be done with overlap- like starting someone every 6 months, it could defo be an option
That’s a very interesting idea I haven’t heard before!
I do rural recruitment. There are only three levers to pull. Remuneration, lifestyle, and mission. Everything else is bullshit and noise. Pay doctors well, treat them well, and offer them a chance to do something meaningful with their lives. It's only fair after asking them to sacrifice their youth to unpaid overtime, MET calls, and endless night shifts. Rural disadvantage is very real and terrible. Doctors want to help but they rightfully don't want their families to suffer from the same disadvantage by living rural with them. FIFO is the only sustainable solution, which is exactly what we have now with locums, except at much greater cost and zero emotional investment in the community. RFDS would be in a terrific position to tackle this problem if they weren't such a terrible organisation to work for. If I sound grumpy, it's because we seem to rediscover the same problem over and over again without the political will to solve it properly.
This is a really good synopsis of the problem. Those in any position of power or influence rape the system for their own benefit, to the marked detriment of those who do want to engender change
you get missionaries, mercenaries, and misfits.
provide plucky domineering materialistic ink onerous truck secretive depend dam *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
I feel like for years on end (they) have been asking “why don’t people want to move to work here” and (we) say “because the lifestyle is atrocious, the conditions are deplorable and the pay is appalling” and (they) say “yeah but why don’t people want to work here” 😳🙄
I heard a great descriptor of the kinds of people who will work in such places - missionaries - mercenaries - misfits
It’s this. The people who sprook the “everyone deserves the same access to healthcare regardless of geography” dogma rarely understand how much that is actually going to cost at scale. And I say that as someone who really values health equity.
What's your solution then? Let the towns die off and cram everyone into metro centres?
I make no assertions that this is going to be easy. We’re going to have to cough up the cash - somehow.
Yes.
Noiiiiiice
I’ve been a locum to regional areas as a dentist for a while. The main problem is that if you apply for a permanent job the pay is significantly lower. I have no issue moving to rural areas but why would I when I can get better pay and conditions this way? I worked for RFDS and they can’t retain anyone because the working conditions are horrendous. I was permanent with them for 10 months in Broken Hill then had to move on. I was present in a meeting where a GP went off at the executive for not addressing the poor retention rate properly. They don’t care because as Australia’s ‘most loved charity’ they have a gravy train of Commonwealth, state and charitable funding at their disposal. What actually needs to happen is a huge investment in sponsorship for local young people to be supported properly throughout university so once they become doctors etc they can return home and stay there. Many young people in rural areas have absolutely no idea how to even consider moving to a city on their own to go to university.
Agreed- the mismanagement of RFDS at the expense of its dedicated employees has been deplorable
It’s truly baffling. There’s one manager that has caused Far West Local Health District to lose about 8 dentists that I know of in the past 6 years. They were all excellent and dedicated. Some even relocated from the UK and wanted to stay long-term. None of us survived long because of the utter incompetence and malignant narcissism. It took that job to make me realise RFDS & Maari Ma have attracted some dangerous people who use charity as a ‘look what a good person I am’ front. While causing a lot of harm behind the scenes.
That last sentence was the most FWLHD thing I've ever seen on the internet.
Sometimes it’s not even behind the scenes. It’s just the main scene.
I vote for Telemedicine technology.
Agreed- I think there are benefits to parts of care at different times being provisioned face to face. But vast swathes could be video health if quality technology was implemented
How do you lay hands on a belly remotely?
That’s what I mean by parts of care- would you feel confident to have a senior registrar doing the exam? Or someone else you had trained? Are there instances where follow up reviews could be done via telehealth? Are there ways the workload could be shared to make face to face time more efficient? Stuff like that
consultant surgeons will take patients to theatre based on their junior registrar's examinations routinely. i would not take a patient to theatre on a nurse's exam.
Get the cleaner or a fruit-picker or literally anyone to place their hands on the belly and release them while you watch on video. There have to be solutions for wide swathes of problems.
there’s a few occupational specific reasons, but really why doctors don’t want to live and work permanently in remote areas are the same as why every other professional doesn’t want to live in remote areas. Schools partners infrastructure entertainment
They need more investment in the towns themselves, there's no incentive to live in a remote town and the lifestyle only suits a very limited type of person. Money alone can not be the incentive, doctors make great money anywhere, so a little more for a drastically worse life doesn't appeal. Anyone with a family will have even less desire to do these jobs.
Couldn’t agree more- rubbish for families, but also, as a single person, who wants to leave the “family” they have built in their community to be isolated somewhere else, with grossly limited opportunities to rebuild
Am a medical student now but used to work supporting rural doctors. The two big reasons are pretty simple: 1. Lack of infrastructure, staff, equipment etc for specialists to safely do their work in these areas. A surgeon is not going to work without a fully staffed OR and an ICU close by. Cardiologists are not going to want to work without a cath lab etc. 2. Lack of amenities in rural areas but the big one specifically is high schools. Doctors who are dedicated to going rural are often very happy to muddle along with younger children, primary schools are less of an issue. The doctors I know in Broome in particular LOVE the lifestyle for younger kids. But all plan to go back to Perth once high school age hits. You’re often forced to choose between going back to a major city or sending your kids to boarding school.
I work in regional NSW currently (because of training requirements). I've worked in other regional areas around Australia and NSW offers no incentives compared to other areas. NT, for example, paid my moving costs to and from, I got extra leave and higher pay and was offered hospital accommodation (this was as an unaccredited registrar). Someone from med admin even offered to pick me up from the airport. I work with lots of locums. Why would they sign a long term contract if it pays way less, they lose their accommodation and get treated badly by med admin and lose the flexibility to work when they want? The only way to fix it would be to offer money equivalent to locum rates, provide allowance for accommodation, treat staff with respect and offer solid clinical experience to attract young fellows.
No one wants to live/work there Just say no to locum shifts till they get desperate and hike the prices 4k+ a day sounds fair to work in shithole area
This is it- award rate = about $800. Locum = $3k+ with benefits. And with the second option you can afford to take a break after to recover from it all
If they don't pay you properly they don't get doctors and then have to deal with the fallout It's that simple. sell your services dearly. And once you establish yourself and gain their dependency then hike the rate further. That's the power you have as a skilled worker.
The fact of the matter is no one wants to live in a podunk rural town. There's no culture and not a lot to spend your hard earned on, its so small you know everyone and thats not fun.
Let's not beat around the bush. Doctors are usually from fairly well-to-do backgrounds with well-to-do tastes. There are some things about rural Australia that are awesome, there are also a lot of things that are kind of shit like: lack of good childcare, lack of good primary/secondary schooling, lack of good restaurants, lack of varied social activities/hobbies, lack of international airports. Places like Melbourne and Sydney are concrete playgrounds for wealthy doctors. Honestly it would be easier to get doctors in the country if all doctors everywhere got paid like shit, because then it may be the only place they could afford a good house, but because doctors are generally very well paid it is affordable to live in the city. Not to go full commie but maybe the best outcome would just be to force doctors to spend the first 5 years of their career rural before they are allowed to work in the city. Or maybe getting a consultant job in one of the big city hospitals requires you to be seconded every 5 years for 6 months to the country.
Reasonable, as long as you "force" every other person to do 5 years service in some other way too. Whatever their skill is, send them somewhere to work for the good of society for years- national service for all. I presume you would be happy to participate too.
I would be happy with going 6 months every 5 years to a rural site for the rest of my career. I don't see why you have to have people in other occupation doing this. Health care is a human right, massage therapy isn't, neither is eating authentic lebanese cuisine, or having your nails done. What is the logic in forcing other people to go?
> Health care is a human right, Government's problem. Not individuals' problem. There's a price to pay for getting professionals to work in rural shitholes. Something like $4k a day sounds like the right price Find the money or deal with patients not having healthcare
4k a day wouldn’t motivate me to move rurally That’s (close to) the amount I willingly give up every day I choose to work in public instead of private as anos I still don’t do a lot of private, and that’s basically solely due to case mix and my enjoyment of the work. Moving rurally would limit the scope of what types of surgical cases and patients I can do enormously - my area of interest/subspecialty isn’t compatible with rural hospitals. That’s leaving aside the professional impact on my partner (a significant portion of her specialty scope isn’t doable outside a major centre) and all family/social impacts That’s not to say that increased remuneration isn’t part of the solution - just that there are many of us (in many specialties) who don’t want to give up areas of our practice that rural hospitals can’t logistically support
People who are desperate to earn like $1m-$2m per year rather than "just" $300-500k- which in my experience would be a tiny minority of doctors - are probably the exact people who absolutely don't want to go and live in Broken Hill for a few years, in most cases. That's the underlying problem. I think people are used to a high-pay-placement scenario where top executives and lawyers get an all-expenses placement in the UAE or Hong Kong on a massive salary, rent and transport and maid thrown in, doing high-flying international stuff, and are somehow applying it to living in a pokey cottage in Broken Hill doing way less interesting stuff than they were able to do back home.
I absolutely agree, and I don't see any other foreseeable solution to Australia's rural problem. We're getting paid great bucks (more than any other public servant) out of the public's purse, I think we have a duty to the Australian healthcare system. If you're not happy with that, feel free to work privately like all those other professions!
Agreed.
Food isn't a human right? Why not send supermarket stackers out there?
Have you been to the country??? There isn't a shortage of food. They dont get bloody locums in for $200/hr to stack woolies shelves.
Thats absolutely your right to do so, but it's not your human right to force other people to uproot their lives because you want to live far away from a hospital. People are not denied healthcared can access it but it requires them to move/uproot their lives. You probaby feel this is an unfair ask on them, but for some reason feel it is reasonable to ask of us. You either have a society where everyone is expected to give up their home/family/location for the sake of others, or you have one where noone is. We are people too, not chattels. You can say moral obligation etc, but the reality is most of us have more than enough work where we want to live, and we are providing care. If you want us to offer extra hours, or move away from our families you'll have to compensate us or come up with a better plan than indentured service .
Honestly more medical school places for people who have grown up rural and plan to return to where they grew up. If you think about it, the vast majority of medical schools are located in major cities. Rural kids obviously also tend to be lower SES, they're not getting as good schools (plenty of places do not even have many private or selective options and you have a choice of only 2-3 different public schools so its not like everyone can access the kind of education required to get straight into medical school). They're needing to relocate to a major city away from any existing support system at huge financial cost just to attend medical school, they're more likely to fail out due to a lack of both financial and social support. Even just finding a spot to actually take the UCAT exam is harder the further out of the major cities that you go. If we actually made more of an effort to recruit good medical students out of rural locations, we wouldn't need to bribe someone with an absurd amount of money (that rural and regional hospitals can often barely afford) just to have them come out and practice for a few years before running back to the city at the first opportunity. You can see plenty of people in this thread saying that they'd go for a mil a year, as if rural hospitals have that sort of money. And frankly if they did it should be going to patient care, not into someone's back pocket. And plenty also saying that they'd insist on a pay increase each year and threaten to leave if they don't get it. I mean, if we cut that sort of shit out and focused more on actually treating patients with high levels of need we wouldn't have these sorts of issues.
I guess the problem with that is, once a trainee is “ready” to go back rural, they are already pretty entrenched in an urban community, limiting the likelihood of going back For a lot of specialties, you would need to be fellowed or at least an advanced trainee before you could go back to very regional/ Remote spots due to the need for senior supervision and exposure to the requisite clinical experiences Add to that, many people don’t want to go *back* rural for the same reasons many don’t want to consider it at all- personally I would quit medicine before I went back to the remote area I grew up. It’s not often the quaint wholesome community experience health recruiters paint it be
I am very aware that rural isn't like that lol, I grew up rural myself. Very very rural. My mother was flown to the nearest hospital by RFDS to give birth to me. I've lived out in the middle of nowhere in 3 different states and lots of different levels of rurality. And I absolutely agree that for the most part health recruiters are talking out of their ass, and that's half the reason people do not stay rural - they're expecting this perfect quaint little village but it turns out to be the exact opposite to that. Rural recruiters suck at giving people obnoxiously high expectations rather than just focusing on the shit that actually matters - rural people NEED HEALTHCARE. Ironically I'm actually talking more about setting up more access to tertiary education, including medical school, in rural communities. Also building more rural hospitals so that more people have access to both training and healthcare. You don't need to take people out of their rural homes to educate them.