Change is the only constant in life. This includes rural medical training at all stages of the pipeline. This biggest change in rural WA is making the connections from the very beginning of training to post fellowship rural workforce.
Medical students have changed. There is an older postgraduate cohort entering into a competitive training environment, some with families and responsibilities, looking for certainty and guidance on career paths. Medical education has changed. More rural experience during medical school and higher numbers of rural students entering medical training has been proven to increase number of doctors practicing rural post-graduation. Increasingly these students and junior doctor know from an early stage in their training they want to stay rural, to build lives, buy houses, grow families give children a rural upbringing. The prospect of moving families multiple times during training or even coincidentally meeting partners and starting lives during the ‘city tertiary’ years of junior doctor training means many of these rurally inclined students often end up in urban practice.
And so the postgraduate medical experience, if it wants to keep these doctors rural, needs to change too.
Increased opportunities for students to remain within a region and continue their rural training to rural practice post fellowship has been the aim of the Regional Training Hubs as part of the integrated regional training pipeline.
In WA, the hubs are integrated into the Rural Clinical School of WA, which encompasses the whole state and has mentoring contact with students and junior doctors as part of its core business. It also sees the long term picture of increasing postgraduate rural training opportunities so trainees can remain rural for as much of their medical training as possible as is integral to rural doctor retention.
The WA Regional Training Hubs have had success in collaborating with colleges, health service providers and state government to facilitate paediatric, psychiatry and physician rural training positions which will give more scope for rural specialist training in Rural WA than ever before.
Rural generalism has always been the end point that RCS has been striving for with success document in this sphere. An increased number of students overall has resulted in increased number interested in rural generalism as a career and the challenge remains the middle section of the pipeline.
The junior doctor years lure away our rurally-interested students to begin their medical careers in the city and love, life and inertia keep them there. Whilst change is inevitable in life, inertia is its strongest opponent. Inertia, comfort, a sudden interest in training in a subspecialty of a subspecialist formed during a tertiary hospital rotation and complications of their new partner’s city based career are reasons we hear when mentoring. Those previously rurally-interested students become urban practitioners.
The next change within WA will be increasing the middle section of the pipeline to enable more of those rurally-inclined students to become rurally-trained junior doctors who meet rurally-based partners and buy a rural house and are the rural generalist workforce of the future.
WA Hubs continue to educate via junior doctor workshops, mentor via student contact with a rural-based medical workforce and facilitate discussions to enable the change in the pieces in the pipeline in WA to occur.