Loving the Job

I reckon the work as a rural doctor is the best that medicine offers. Just heard from a colleague with whom I did anaesthetics last year in NSW.

"Mate I love this job! In the past 7 days I've thrombolysed a 44 year old with a STEMI, resuscitated a 5 year old who had a fit in the local pool, drained a 2L pleural effusion off an ol' fellas chest, gassed 5 people on a gen surg list, managed a snake bite, released two carpal tunnels, resuscitated a floppy neonate after a ventouse and seen a whole load of people in general practise. I LOVE MY JOB! Hope you're having fun mate. This job just keeps getting better!"

No, he hasn't been at the drugs cupboard. He is expressing the simple joy of being a rural doctor with the skills to do your work. As I've stated before, I reckon that being a rural doc is one of the best jobs around - especially for those with procedural skills.

Sadly skills aren't all you need - you need the equipment to do your work well and you need structures behind you to ensure that your work is sustainable in what is, ultimately, a high-pressure job. For most of us, that means adequate locum relief or being paid for the work you do.

With regard to equipment, I've just submitted my paper on the availability of difficult airway equipment for rural doctors. Of the estimated 448 rural GP-anaesthetists out there, I've got responses from 293 - a 65% response rate, which is apparently quite good for an internet-based survey. So paper has gone in for submission...

I won't give the game away (wait for the paper, if it survives the review process) - suffice it to say that there are common themes amongst the rural GP-anaesthetist cohort - lack of funding for basic and advanced airway equipment predominating amongst respondents. 

I've tried to outline in my paper some suggestions for affordable equipment to help advance the cause - for under $4K a small hospital can purchase some of the intubating LMA AirQ-II blockers, plus a fibreoptic device to allow intubation through the iLMA (something like the flexible AmbuAscope 2 or the Levitan malleable intubating stylet). There'll still be change leftover to buy a KingVision videolaryngoscope - all of this gives a fairly robust kit for the 'occasional intubator' or GP-anaesthetist.

A&E Services & Contract Negotiations

Meanwhile, the State opposition Minister for Health has finally twigged to the inequity of country patients being charged for non-admitted A&E services that their metropolitan counterparts receive for free through Emergency Departments. Minister Hill is now on record saying that the 'only solution' would involve putting in salaried medical officers which would 'send GPs in rural towns broke' (The Advertiser, p15 9/3/12). He neglects to consider the alternative option - pay the oncall rural GP for A&E under existing fee-for-service arrangements, regardless of whether patient is admitted or not.

This solution would ensure patients attending the A&E with problems deemed inappropriate for routine GP would not face fees. It would mean the doctor is paid by the Health Dept without having to chase fees. Everyone is happy...

And it would be fairer to rural patients who already face significant health inequalities due to rurality.

This issue is all the more relevant as the existing contract between rural doctors and CHSA expired on 30/11/11 and has been postponed not once, but twice. I dunno about other rural docs, but I'm a little fed up of CHSA failing to come to the negotiating table and sending missives advising of a 90 day 'contract extension' on the last day of the existing contract.

It's not a good way to do business and seems symptomatic of a relationship whereby CHSA treats rural docs and patients as a hinderance to their bureaucracy, rather than a vital component of the health service.