In Australia, a lack of rural specialist surgical services and maldistribution of services are significant factors in rural health inequity.
The Royal Australasian College of Surgeons (RACS) recognises the need for all communities to have equitable access to quality health care, irrespective of geography. Two surgeons making a huge impact through their tireless advocacy in this area are Associate Professor Kerin Fielding and Dr Bridget Clancy.
Associate Professor Fielding is Chair of the Rural Health Equity Steering Committee, a member of the Rural Surgery Section, and a RACS Councillor. She is an orthopaedic surgeon and a teacher at Notre Dame University in Wagga Wagga, New South Wales. Associate Professor Fielding’s family came off the land in central New South Wales and she was drawn back to it for the quality of life and the diverse professional opportunities.
Dr Clancy is Vice Chair of the Steering Committee and Chair of the Rural Surgery Section. An ear, nose and throat surgeon based in Warrnambool, Victoria, Dr Clancy spent half her childhood in the country and has a deep connection to rural living.
Both surgeons have stepped up to advocate strongly for change, which starts with more specialist training happening on home turf.
Associate Professor Fielding says, ‘At the moment, specialist training is about 90 per cent in the city, 10 per cent rural. I want to flip that; for students to do 70 per cent in a rural area and 30 per cent in the city, so their base is here and this is home.’
Dr Clancy says, ‘People who have connections to rural or have spent a lot of time training in rural, are the sort of people we want to attract. To take an urban person and expect them to thrive in a rural area without social supports is not a recipe for success. We've got to start selecting the right people early and give them opportunities and experience’.
Both Associate Professor Fielding and Dr Clancy have spent their careers advocating for equity in rural health. They’ve achieved significant milestones such as working to increase engagement within the surgical and healthcare communities, using advancements in digital health technology such as telehealth to improve patient outcomes, and working to shift the perceptions surrounding rural health professionals.
The RACS Rural Health Equity Strategy is built around four pillars: Select for Rural, Train for Rural, Retain for Rural, and Collaborate for Rural. The strategy is designed to be tailored to context, flexible on process, and focused on outcomes.
Sustainable solutions to rural health inequity are long overdue in well-resourced countries such as Australia. ‘We may not be able to achieve everything in the strategy, but it's time to get serious and talk about the health of our Australian population,’ says Associate Professor Fielding.
Dr Clancy says, ‘The Australian Medical Council gives us approval to train surgeons for excellence and community need, but there can be no excellence if 30 per cent of the population aren’t getting access to surgical care or are getting delayed access and poor outcomes. There’s no excellence unless we're focused on community need’.