Professor Richard Murray (left) presenting on Australian approaches to rural medical education, recruitment, and retention strategies at a discussion panel at 2013 SRPC conference in Victoria, BC.
At the recent 2013 Society of Rural Physicians of Canada (SRPC) Rural and Remote Medical Course in Victoria, BC, the Rural Coordination Centre of BC (RCCbc) spoke with Professor Richard Murray, Dean of Medicine, and Head of the School of Medicine and Dentistry at James Cook University in Australia. Professor Murray is part of a group of Canadian and Australian physicians who are interested building a formal alliance between the two countries to learn from each other, exchange personnel, and enrich medical training experiences.
RCCbc: We greatly admire Australian rural medicine and feel we can learn a lot from you. Now that you’ve seen how the Canadian system is structured, do you have any suggestions about what issues we should be prioritizing?
Richard Murray: There are a lot of strengths in the Canadian system: regional medical schools, a strong and established culture and reality of extended skill set rural practice. There is clearly a big community of support for rural medicine.
Some of the things we might do together include examining formal developments around rural medicine in Australia for their applicability in Canada. For instance, the specific rural curriculum used by the Australian College of Rural and Remote Medicine (ACRRM), approaches to assessment using distance technologies, etc.
At the opening plenary of the SRPC conference, you participated on a panel that stated ‘rural medicine is elite medicine.’ Do you think that statement is accurate, and maybe daunting, for GPs?
In rural Canada, as in rural Australia, doctors are usually expected to provide care to in-patients in hospital, respond to emergencies, support other health care staff at a distance, and extend care to outlying communities. There is a difference in a rural scope of general practice or family medicine in breadth, in context, in independence, and other elements. I think that rural family medicine is the fullest expression of general practice.
The challenge is how do we recruit to, train to, measure achievement of the relevant abilities or competencies? There are aspects of this that Australia and Canada could use some work on together. I’m particularly interested in ways we might differentiate that broader [rural] skill set and market it because I think it appeals to different sorts of people. We’re increasingly realizing that people who end up being rural doctors tend to have significant differences in temperament and character. For instance, rural physicians are high novelty seekers, and tend towards lower harm avoidance. There are ways in which we can make rural practice appeal to the right people, and provide them with inspiration, mentorship, training experience, and pathways into a career.
How involved are rural Australian communities in rural physician recruitment?
It’s always impressive to see the level of commitment shown by local government, in terms of assisting with practicalities such as student accommodation or welcoming keys to the town, facilities. They recognize that this is an investment in the community’s future.
I understand that there is a formal support system in place in Australia for the spouses and families of training rural physicians.
The rural medical family network is part of the rural medical doctor’s association in ACRRM. There are formal structures that support spouses and children because we recognize that doctors often come to rural with families.
More studies are showing that supports, like employment for a physician’s spouse or quality education for children, is often more persuasive than financial incentives for recruiting doctors.
Organizations often look at recruitment as if simple, linear interventions are going to make a difference, when in fact, it is an inherently a complex system. You need a suite of incentives – making choices easy and accessible, responding to needs, accommodating both community as well as practitioner interests, renumeration – you need all of them. Making a good impression, giving providers a sense of being valued, and a sense of optimism about making a life – even simple things, like being met at the airplane and taken to a house that’s clean with milk in the fridge – can make a world of difference.
What other solutions do you think Australia and Canada can work together on?
I would like to see more exchange at the student, resident, and experienced rural doctor level. I feel that the work that we do together, will provide benefits that are more than the sum of our individual parts. Australian and Canadian governments are strengthening bilateral and economic ties, including creating mobility and mutual recognition arrangements for professions. What better example than the portability and mobility of rural doctors between our two countries? Often, rural doctors are adventurous sorts who would love a spell of work in the Northwest Territories or Northern Territory, and would see the opportunity to do that as a reason to pursue rural medicine as a career. The linkages we build will increase the brand, the attraction, the excitement and, indeed, the quality of a potential locum workforce and the sustainability of people’s lives in rural practice. I just think there’s so much commonality that it’s an obvious thing to do.