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Sustaining wellness in rural practice

Working in a rural or remote location can be an attractive option for some doctors. A pleasant lifestyle in an interesting location can be combined with a close working relationship with a small community and a high degree of autonomy seeing a varied case mix of patients.

However, the wellbeing of rural doctors can be threatened by a number of factors that can be difficult to control. Taxing on-call arrangements, high community expectations, limited opportunities to take recreational leave, and little opportunity for continuing professional development are some of the issues rural doctors have to deal with. Importantly, accessing peer support represents a particular challenge that can leave doctors feeling isolated and burdened.

The beyondblue 2013 National Mental Health Survey of Doctors and Medical Students [2] found rural doctors are more likely than any other doctors to suffer from mental health disorders, with 3.4% recording very high levels of psychological distress. Nearly a third (29%) of doctors working in rural, remote, or Aboriginal health said they were stressed by work hours.

“In the absence of good on-call arrangements and professional support, the unrelenting nature of after-hours care imposes an excessive workload, with negative effects both on GPs' (and their families') health and wellbeing, and on their opportunities to enjoy their rural location,” said the authors of a study published in the Medical Journal of Australia into the retention of rural and remote GPs[1].

Isolation is a key risk factor for poor health amongst all health professionals, not just those working in rural placements [3].

The key to maintaining wellbeing is to receive adequate workplace support. Structural health system changes including the recruitment of more rural doctors to provide a more reasonable on-call ratio, the provision of appropriate locum services and the development of better regional medical practice models have all been suggested as ways of easing the burden on rural doctors.

Rural landscape photograph

Nevertheless, for now rural doctors are still generally responsible for seeking their own support and a range of options available. There are several ways that rural and remote doctors are able to access continuing professional development (CPD), which has been shown to be important for improving doctors’ wellbeing as well as patient outcomes [4].

The Rural Health Continuing Education (RHCE) Program offers grants to enable rural specialists to undertake specific CPD activities, as well as project grants for specialist medical colleges to develop CPD initiatives tailored to medical specialists in rural and remote areas.

Coaching

A recent study of rural South Australian GPs who identified as being stressed, found that cognitive behavioural coaching both reduced their level of stress and their intention to leave rural general practice [5].

Mentoring

The University of Melbourne’s Rural Health Academic Centre has recently proposed a model of mentoring for rural doctors, which it says may allow them to grow, focus on personal goals and receive more support during difficult times [6].

Telephone support

For those who are not able to access these services, the Bush Support Line offers a confidential, free, 24-hour telephone service staffed by registered psychologists who have experience working in remote and rural areas.

State-base agency support

In addition, there is a wide range of support available through State-based agencies including the Rural Doctors Workforce Agency of South Australia and the NSW Rural Doctors Network.

  1. Humphreys J et al. Workforce retention in rural and remote Australia: determining the factors that influence length of practice. Medical Journal of Australia 2002. 176 (10): 472-476.
  2. National Mental Health Survey of Doctors and Medical Students, beyondblue, October 2013.
  3. The health and wellbeing of doctors and medical students – 2011, Australian Medical Association.
  4. Pond B et al. Helping medical specialists working in rural and remote Australia deal with professional isolation: the Support Scheme for Rural Specialists. Medical Journal of Australia 2009. 190 (1): 24-27.
  5. Gardiner M et al. Effectiveness of cognitive behavioural coaching in improving the well-being and retention of rural general practitioners. Australian Journal of Rural Health 2013. 21(3):183-9.
  6. Bourke L et al. Mentoring as a retention strategy to sustain the rural and remote health workforce. Australian Journal of Rural Health 2014. 22, 2–7.
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