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14 Mar 2018

BY AMA VICE PRESIDENT DR TONY BARTONE

It’s often said that generalist medical practitioners – generalists – have been an important and integral member of the rural medical workforce for decades. I wouldn’t argue against this.

But just what is a generalist? This isn’t an esoteric consideration given the work now underway on building the long-awaited national rural generalist training pathway.

To some, generalists are simply rural GPs with advanced training skills. The AMA takes a broader view appropriate for the times. Our preferred definition includes GPs, rural generalists and general specialists who maintain a broad scope of practice, which I think reflects the essential clinical and procedural services they provide for patients across Australia.

Many people in country areas are cared for by their local family doctor who runs the general practice and performs minor operations. They might also be treated by a general specialist who can provide the wide range of services that help regional populations to prosper.

Communities continue to rely on generalists for their medical care, though shortages are an ongoing problem. It’s apparent that greater numbers of generalists will be needed in both the city and the bush as Australia’s demography changes and complex and chronic diseases become more prevalent.

I’m really disappointed when Governments downgrade local healthcare facilities and put restrictions on the scope of practice for doctors and ancillary staff. Unsurprisingly, the generalists practising in the affected areas struggle to maintain their clinical and procedural skills.

Don’t get me wrong, credentialing is essential for ensuring patient safety and quality care, but decisions on accreditation arrangements for local facilities are often based on the application of unsuitable metropolitan models.

In the end, local communities suffer when generalists are forced to leave town to maintain their skills proficiency. I’ve heard and read about the repercussions for patients when they have to travel long distances for medical, surgical, psychiatric and addiction services (to name just a few) that they can no longer access locally.

The AMA is worried about these developments. Led by our Medical Workforce Committee, we released a Position Statement late last year outlining the credentialing, infrastructure and remuneration we believe is necessary to sustain a thriving generalist workforce that gives communities the medical care they are entitled to.

In Employment of Generalist Medical Practitioners 2017 the AMA advocates for:

  • regulatory and accreditation arrangements for rural health care facilities, including decisions to reduce the scope of practice to be determined by the needs of the local community and the capabilities of the local facility,
  • a clear evidence base to be established before services are restricted or removed when there are concerns about the safety and quality of care,
  • more integrated programs to help generalists maintain and upgrade their clinical and procedural skills, and
  • remuneration for generalists to be based on the nature and value of the work they perform.

Make no mistake; the medical workforce is being reconfigured to meet expected demand for services. How we train more generalists and get them to where they are needed is a central part of this process. See for yourself how they can be supported at: https://ama.com.au/advocacy/position-statements

 


Published: 14 Mar 2018