Prof. Bruce Chater is a rural generalist, Head of the Mayne Academy of Rural and Remote Medicine Clinical Unit in Queensland, Australia, and the Chair of Rural WONCA.
Episode summary:
01.15 Prof Chater tell us about his professional background and how he became interested in rural health
05.50 What has he most enjoyed about living and working in rural area and what has been challenging?
11.20 Prof Chater tells us how he has contributed to the development of rural practice and rural medical education in Queensland
16.40 What is it like to be in rural practice for 40 years and how do you step down and hand over well?
24.45 How has he maintained the enthusiasm to keep advocating, improving his practice, and teaching students?
31.00 How has he been involved in advocating for better healthcare for rural communities?
40.25 How was Rural WONCA established?
47.15 What have the key achievements been for Rural WONCA over the past 30 years?
51.05 Why should rural clinicians become part of Rural WONCA?
58.30 What are your top 3 tips for people thinking about a rural health career?
1:01.45 Looking to the future
Key messages:
Rural practice is a chance to have broad skills. I tell my students - Do you want to know more and more about less and less or do you want to spread your wings and be a generalist?
When training the key part is that you go to a good place and that doctors are matched well to rural places.
The best part about living rurally is the community. What you see is what you get in small communities. The community is genuine and you get to know the people.
Continuity of care, comprehensive care and the capability that you can bring to that. You can do a lot in rural areas.
Challenges: lack of local education opportunities for children, getting things across to urban bureaucrats - “geographical narcissism”, clinical challenges and “clinical courage”.
Clinical courage - it is about having to step up and do the right thing for someone in your community and it might be about using a skill you have not used in a while. The key element of clinical courage is having a good network of other rural doctors to support you in those situations. Knowing that if you do not do something this person might die.
Doctors were isolated and were not a force for good, they had to organize and get together. He was the founding convenor for rural doctors in Queensland and Australia. This led to the formation of the National Rural Health Alliance in Australia.
Through the College of Rural and Remote Medicine worked on developing a curriculum for rural medicine.
Set up a Statewide clinical network within the Health Department.
Developed a model for funding rural hospitals that could be implemented in Australia.
Currently also a Professor of Rural and Remote Medicine ensuring there are students in rural areas and making sure there is research about rural areas.
Has recently retired and handed over his practice and local hospital to a new doctor - this was a test of the theory and practice he has been advocating for.
It is important to have an exemplar practice, rural practice should not be somewhere where you are making a massive income, but you should be well remunerated. You should help people that need help.
In Australia there is a mix of public and private practice, he has done a mixture of both and found that this has worked well. Those that can afford to pay for the service and those who can not pay have a good safety net.
Be a solution not a problem to the health system.
The key has been to get lots of students and young doctors into the practice.
Do all the students come back, no, but it is about getting some of them to be inspired to consider rural practice. You can not be what you can not see.
The doctor that has taken over his practice came out as a student and then as a registrar and finally said can I take over the practice.
Rural generalists must provide general practice, in-patient medicine, emergency medicine, public health and some other special-skill for the community. It bans the boring.
You have to protect the next generation. With the doctor that has taken over practice, he spent three years teaching the clinical side of the practice and another three years on how to interact with the health system, interact with management, and have a group of staff.
It is important to not be on call all the time.
He has looked after his community and they have looked after him.
Burnout comes from complete overwork, but it also comes from not being able to express our humanity.
They close the practice for half a day every week to talk about their difficult patients, everyone finds that very satisfying.
It is important to make sure that the service is equitable across all areas.
If you can provide good services then people will stay in rural areas. It is about trying to bring to policy makers the understanding that this is an investment, if they do it well they will have happy people, healthy people, and productive people in rural areas.
You’ve got to be there to be heard. It was important to build a collegiate group that could advocate, then getting the rural communities on side and getting the politicians on side.
Give the politician the problem, but also provide a solution to the bureaucrat. Then it is about thanking them for recognizing the solution.
Recognized that this was going to be a long process. They needed to build an evidence base.
It does not come quickly or easily. You need to be persistent and continue to be there.
Rural WONCA has developed policies and declarations as well as the Rural Medical Education Guidebook to support rural clinicians.
Rural WONCA was established in 1992 as a Working Party on Rural Practice.
Top tips:
Give it a go. If you don’t try it you will never understand it.
Be prepared. You need to be prepared properly for rural practice. If you are not trained for it you will crash and burn.
Find a place where you will be supported to learn.
Email: bruce.chater@theodoremedical.com.au
Thank you for listening to the Rural Road to Health!