Category:Rural and remote medicine

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Introduction

A practitioner of rural medicine encompasses skills traditionally used in primary care, secondary care and occasionally tertiary care situations. As a consequence of geographic restrictions, a rural doctor is often required to act independantly of the usual supports available to doctors in other specialties.

A rural doctor generally has all the skills of a General Practitioner but with additions that extend into the hospital setting. Often, a rural doctor will see a patient in a general practice context and, having decided that inpatient care is needed, admit and treat the patient in hospital without assistance from other specialties.

Rural doctors have skills that are usually tailored to the needs of the community they live in. For example, a practitioner in a remote area with no hospital may have advanced resuscitation and airway skills for stabilising a patient for transport, but not practice obstetrics. Another practitioner may routinely practice general surgery in addition to general practice consulting and be on-call for obstetric care at the local hospital.

Both these types of doctors are specialists in rural and remote medicine. In Australia there is a recognised college for this group of doctors - the Australian College of Rural and Remote Medicine.

Historical Aspects

As medicine has changed significantly in the past generation, so has the need for specialisation and differentiation of doctors. The rural context is no exception to this. In times past, it was indeed possible to finish medical school, do one year of internship / house officer training, then leave the hospital system and "hang up a shingle". Indeed, there are many of these doctors around, albeit approaching retirement, who are excellent, skilled doctors in a wide range of areas, but still having no further qualification than a humble B.M.B.S.

In Australia, the geographical demands of the continent required a particular type of medical generalist, able to perform a wide range of surgical, anaesthetic and obstetric procedures.

Other countries which have relatively small, widespread populations, such as Canada, often recruit doctors with a wide range of skills in order to practice in rural and remote areas.

Paths to recognition

Currently, there are two official methods of becoming recognised as a rural doctor in Australia

  • Fellowship of the Australian College of Rural and Remote Medicine (which includes being "Grandfathered").
  • Fellowship of the Royal Australian College of General Practitioners, combined with a Graduate Diploma in Rural General Practice in at least one specialty area.

Minimum time to achieve a FACRRM is five years postgraduate study, whereas an FRACGP / Grad. Dip. Rural GP can be done in four years.

Due to political considerations, only the FRACGP / Grad Dip Rural GP is a recognised path to vocational registration, which is required for one's patients to gain access to the Australian Medicare system. However both Colleges offer a continuing medical education program which allows one's VR status to be maintained. Both schemes are run on a "points per triennium" model.

Specialty skill areas commonly used

In terms of recognition for special skills in the Grad. Dip. Rural GP the following specialty areas are recognised [1]:


  1. ↑ RACGP Grad Dip Rural GP info sheet

Some of the skills are in common with Military doctors.

Telephone_triage or even radio triage may be necessary.

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