During the pandemic, I received an email from a rural doctor who had retired but was brought back under the 2020 pandemic sub-register to assist with the COVID-19 response. This enabled him to provide much needed support to his general practitioner (GP) wife who was under a great deal of pressure in their family practice. Changes to the pandemic sub-register in April 2021 saw doctors restricted to ‘vaccination only’ (since changed to expand practice) and the doctor was no longer able to provide support, at which point he contacted me to see what could be done. For many rural doctors the lack of support in busy practices leads to stress and burnout. Locums can be helpful, but lack of consistency and turnover have been cited as issues for both patients and practices.
Each year in Australia we lose approximately 500,000 years of medical expertise as each cohort of doctors retires or forgoes their registration. This is a vast waste of medical wisdom and expertise. Many of these would be rural doctors whose departures place strains on already meagre workforces, alongside difficulties in recruitment of rurally trained GPs and registrar training slots.
Medical reserves of senior doctors exist in other countries where registration categories such as Emeritus, Active-Retired and Volunteer are available. Reservists assist in times of emergency (floods, fire, drought, cyclones or hurricanes, pandemics) and provide medical services to underserved communities (rural, isolated) and people (such as homeless and frail-aged). During the pandemic, medical reserves have been utilised in France and many American states to contact trace, test and vaccinate the population.
In 2021, AMA Queensland established a Senior Active Doctor Working Group (of which I was Chair). In partnership with the Australian Senior Active Doctors Association (ASADA), they developed a submission to Queensland Health on a proposed Senior Active Doctor registration category, the establishment of a medical reserve, and how senior doctors can benefit rural and regional communities through assisting (not supplanting) services where needed.
When thinking about the rural doctor who contacted me, it is clear that a step-down alternative to full retirement – enabling him to continue supporting his wife’s practice and their community – would have extensive benefit. In Australia, reservists could help alleviate the workload demands and associated burnout that are commonly reported by rural medical practitioners, for example by providing peer support, case discussion, assistance with practice tasks such as ordering and following up on tests, as well as designated services. Some activities could be done remotely by telehealth. Others might involve regular contact from volunteer reservists who visit rural and remote practices and assist where required, providing GPs with periods of respite from heavy workloads and much-needed collegial support.
Rural GPs looking to transition to retirement and continue contributing to their communities could assist new GPs in their communities by stepping down to Senior Active Doctor under the proposed registration category. This would provide rural GPs with the opportunity to continue serving their communities – without the pressures associated with full-time practice – as mentors, advisers and public health advocates, and to assist in the training of local doctors and other health practitioners (in support of the National Strategic Framework for Rural and Remote Health). Senior Active Doctors could also assist in the provision of outreach programs and services through federally funded programs.
These are some suggestions. I welcome feedback on these ideas and others that might inform ASADA’s policy on how rural senior doctors can be better supported, as well as the roles they might want to step-down into under an appropriate registration category. I also welcome our rural colleagues joining us in ASADA.
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