A rotational supervisory model for dermatology care

The dermatology workforce in Australia is facing national workforce shortages, particularly impacting specialist dermatology services in regional and remote areas. In the Northern Territory (NT), demand significantly outstrips supply, with only one permanent dermatologist and one registrar providing both public and private services to Darwin and the Top End region. This has implications for equity of access, quality of care, economic impact of delayed treatment and, importantly, clinician burnout. It threatens the sustainability of the limited dermatology services in the area.

In 2021, the Australasian College of Dermatologists (ACD) applied for and received funding from the Australian Government Department of Health and Aged Care under the Flexible Approach to Training in Expanded Settings (FATES) program to implement a supervisory rotational system for specialist dermatology training. This model increases trainee supervision and service delivery capacity by adding visiting consultant dermatologists – each spending one to four weeks in Darwin – to build a quality, sustainable rural training centre.

Already, the project is having a positive impact on trainee experiences and on services available to local communities. As well as increasing service provision at Royal Darwin Hospital (RDH), the project has enabled an expansion of trainee-accompanied local and outreach services. So far, three outreach clinics to regions outside of Darwin have been completed, with the first-ever dermatology outreach clinic to Wadeye and Maningrida occurring in 2022. This means communities can receive the specialist care they need in place rather than travelling great distances to urban centres to see a dermatologist.

The increased consultant capacity provided by the project will allow Darwin’s only permanent dermatologist, Dr Dev Tilakaratne, to take a sabbatical this year to spend 12 weeks in Bristol, England, enhancing his surgical skills.

‘Because of this model, I’ll be able to provide more surgical dermatology training to the trainee than I’m currently providing, better supporting future service delivery and training,’ Dr Tilakaratne says.

By engaging other dermatologists to provide supervision and run clinics at RDH on a rotational system, this project is not only improving skin health outcomes for patients in the Top End, but also building capacity in Darwin and enriching the training experiences for current and future trainees.

The rotational model also offers visiting dermatologists the opportunity to spend time in Darwin and gain exposure to different dermatological pathology and sociodemographic care needs, building on their own skills and areas of expertise. Current visiting dermatologists have been enthusiastic about this and are eager to ensure this increased supervisory capacity and service provision are sustained longer term.

As one dermatologist stated, ‘This is a fantastic project, seeing how many specialists are putting their hands up.’

Many visiting dermatologists are doing repeat visits throughout the project, with some delivering dermatology education to Flinders Medical School. This is providing medical students with exposure to the dermatology career pathway and is key to building a homegrown workforce. Strong engagement in the project from the Australian Government, NT Health and RDH is helping to address the enablers and barriers to rural and remote service delivery and training in the NT.

Early outcomes of the project are positive, demonstrating the value of collaborative models that bridge the specialist workforce gap between federal and state or territory, public and private, and metro and rural.

Dr Tilakaratne is hopeful that, ‘Even beyond the end of this funding, because of the relationships built, we are significantly closer to building and sustaining the future of dermatology workforce in the NT. We may be able to secure some kind of ongoing funding and the interest of the visiting dermatologists who have been doing it, to want to continue.’