Women in Rural Medicine

Hello, I’m Norman Swan. Welcome to this very special Rural
Health Education Foundation program. It’s on women and rural medicine. There are more women
than men training in medicine, there’s more women than men
going into general practice, particularly in the country, and particularly international
medical graduates. And there are issues which are specific
to women making this choice. I’ll be joined by Jenny May, Chair of the Rural Doctors
Association of Australia Female Doctors Group, and several other women GPs who are passionate about
their rural practice. What are the statistics? Statistics are that,
for medical students, about 58% of graduating
medical students are women, and we know that, entering general
practice training programs, the number of women
goes up to about 65%, so getting up to two out of three
general practice trainees are women. We need more female doctors
in country areas because country people want
female as well as male doctors. There often are real issues
that might be happening in families that can be spoken about
to your female GP ’cause the women on the farm
are also gonna have issues that maybe they can’t go
and talk about to the male GP if he’s friends with their husband. There’s a lot of challenges in getting
doctors into rural and remote areas. I work in an area
that is relatively close to Melbourne. Depending on the traffic, you can easily
get there within a couple of hours. But even there,
we can’t attract doctors. They don’t seem to want to come
and do the style of medicine which we do. Which is very sad, because I think it’s a very exciting place
to practise medicine. You know, for 12 years,
I did flying clinics out to places like Boulia
and Birdsville, and you’re flying over really some of
the most beautiful parts of Australia. You know, I used to think sometimes,
looking out of the aircraft, ‘I’m being paid to do this!’,
and it was absolutely beautiful. WOMAN: How are you? NORMAN: Now let’s meet Jen Delima,
who currently works in Alice Springs. Hi, Steve. You want to come through? NORMAN: She initially left Sydney
to work in a remote community in Central Australia. JEN: Kintore is 540km
due west of Alice Springs. It’s a RRMA 7 area. We had to catch a charter plane
out there, a little four-seater plane. And when we first went out to
have a look at the community, Alice Springs, or Central Australia,
had a big wet. So Kintore had not had any communication
with Alice Springs for two-plus weeks, which meant that there was no food
that had gone into the community, no money, no provisions. So we were the first plane
that had arrived in there and with us came the money tin
for the people to be paid, to be able to go to the shop
to buy food. There was a lot of people,
the whole community there, speaking a different language. I had landed in another country. And I was scared! My first impression of that place was
I was terrified and I wanted to get back on that plane
and back to Sydney, quick! But the plane had left
and we were stranded for at least another 36-48 hours
before the plane would come back. I’m thankful, very, very thankful, because we then met the community. Our son had time to just
play and enjoy himself while we were talking to the elders. And, at the end of that 36 hours, all three of us knew that
we were coming back. The community were very, very welcoming. They couldn’t facilitate more
than they did. Socially, work-wise, some of the women
there took on to be my mentor. Without them, I’d be lost. ‘Cause so many times I’d start off
in the wrong direction and it would be,
‘No, this is how we do this, this is how we’ll do this.’ They were my great advisers, and they may not have
had ‘medical training’, but they made life easy. My greatest fear was
would my emergency skills stand me in good stead? Could I actually manage without all
the props of an emergency department – all the facilities, the amenities,
the other staff. Could I do it? Would I ever be able to go to
a proper Third World environment and survive and be useful? I’ve always been a city person, so general practitioner was
the general practitioner in the city who did the start of things,
never got their fingers dirty, never got to do things, and so that could never be me. But going out to the community, the generalist medical practitioner
does everything. You’ve got the emergency medicine stuff,
which sets your adrenaline on fire, but then you’ve also got that patient,
their background, their home. You have the potential to do
a door-to-door service. You’re involved in the transport, you’re involved in
their social situation, you’re involved
in their financial situation, you’re involved in
every aspect of that person. You’ve got Rotary tonight? – I’m going to Rotary.
– Mm-hm. Paul was studying
with the School of the Air, but that requires an adult
to be a tutor with the child, and take them through,
especially through primary school. And that was Peter’s prime role, so he was Paul’s tutor. Paul had not been doing that well
in Sydney with his studies. And this child just blossomed. Within three months, he had blossomed, he was learning with such enthusiasm, and the two of them were
just working so well together. I think it’s a great opportunity
for children and it takes them outside
of their comfort zones as it does for most people that take on
a new position or whatever. So Paul was readily accepted into a group of young
Aboriginal boys and girls, and they’d just disappear for hours, and quite often we wouldn’t see them
from sunrise to sunset. When we quizzed them
as what they did all day, they were just roaming around the bush
and the sandhills, and… you know, eating native foods
and berries, and even to the point of catching birds
and having them for lunch. Yeah, it went really well. PETER: It had a very
positive effect on him, and also, I think, now that he’s 16, we’re seeing a high level
of independence in him. Um… and self-resourcefulness. And I… I’d put that down to,
you know, those sort of experiences. I think we realised
that we were going to be… ..never returning to Sydney as our home probably within that first year
of being out at Kintore. For our family,
it was where we needed to be, the space we needed to be,
the lifestyle that we wanted. Um… for Paul,
I couldn’t better his schooling. I suppose, for me, that was number one –
I could not better his schooling. Career-wise, for me it was… career-wise it was where I could…
there was… the world was my oyster. Um… the permutations, the combinations
of practice were just… and have been just enormous. NORMAN: Eventually, Jen settled
with her family in Alice Springs. So is that an early morning meeting
or is it later in the day? JEN: The whole day,
so that’s the whole day. Now I’ve actually slowed down and
so I’m doing drug and alcohol medicine, so addiction medicine
and sexual assault medicine. Um… and between
those two clinical roles, I’m involved with education
of medical students and GP registrars, some of them
as remote GP registrars. So they’re out on the remote communities
in RRMA 7 areas. And I’m regularly teleconferencing
with them… Hello, Peter. How are you?
How’s your week been? ..as their support person, their mentor
and also as helper with their training. OK, Peter, I’ll fax that through to you.
I’ll mark it up. In the big picture, the finances are not at that level
of what the city person would earn. And I guess you do… I know that OK,
I would be earning differently if I was in that city environment. But… the balance on that
is the lifestyle that I’m enjoying. Um… the balance is
the career challenge. (Birds chirp) PETER: Alice Springs offers everything. I’m definitely not impressed by traffic
and the humdrum push of cities. I’d much rather live in a small
community and have an identity as well, you know, where you go into a shop
and someone remembers your face. JEN: The ability to use your time,
every moment of your time, is valuable time. Every activity you’re involved with
can be a quality activity, rather than sitting in the car
for 2.5 hours driving. I have a bicycle as well. I’m getting myself coordinated
in cycling, and, you know, it’s lovely to be able
to cycle to work, and there’s no smog, and as I’m not a hugely confident person
in these sporting arenas, um… for me to be able to do that
is a huge step outside of the box. Right, Steve. How have you been? – Good, thank you.
– Good. JEN: For someone who really wants
to practise medicine in its purest form, that is be a health healer/carer, this is the environment
that allows you to do it – to look after your patient
as a whole person that links with their community. – Sleeping well?
– Yes. JEN: You can’t do it in any other
environment, I don’t think. This is where people are in need
and I can make just a tiny difference, bring that humanity, bring my skills,
bring whatever little I have to offer. So you get that…
the city has lots of doctors, lots of services,
lots of everything in comparison. And this is where you’ve got that match between what you went into university
to study, to do, and you can do it. What do you think are the key issues for women thinking
about general practice or women in general practice
in rural areas? For women in rural practice,
there are a variety of options, really. I think the other really important
message is that being a general practitioner in a rural
area is not a decision you make for the rest of your life. But it’s something
that you might want to consider, and certainly, many of us have had very
enjoyable and challenging careers working in rural areas. Isn’t that part of the problem? That
people see it as a four-year option and when the kids get to high school,
you go back to town? I don’t see that as a huge problem. I think coming to a rural area
for four years – often people come for four years
and then they stay and they think of
other ways of doing it. But I think coming for four years, having the experience
of living in a rural area and the experience
of living in a rural community, four years is not a bad chance
or a bad time. Obviously, personally,
if you do enjoy being down the road, living in the inner city to the drone of
the traffic and aeroplanes landing every 60 seconds, then you’re going to miss that, because rural areas
are definitely quieter. And I guess it depends also
on your partner or spouse – if they’ve got a job that is
untransportable to a rural area, even for a short period of time, obviously those decisions
are very difficult. Are there a preponderance
of husband and wife practices? Anecdotally, there are, but there are equally
a large number of women who elect to go to country
and rural areas as breadwinners, as the major partner
bringing in the income, and often are happy to have a partner
who’s happy to help with childcare and even work part-time. My husband was a teacher originally. He elected… we decided that
he would be the main person at home, and I would go out to work. And so he stayed home,
brought up the children, and has seen no need
to go back teaching. I actually went to medical school
in Newcastle, met my husband
who came from Tamworth there, and did some of my training
in Newcastle, some of my residency in Newcastle, and then moved with him
back to his hometown after we had our first child. – Did he do medicine?
– No, he’s a civil engineer. So we sort of waited in Newcastle until
he’d organised work that suited him and moved back to Tamworth
to be closer to some family support when we had a little child. I work with my husband.
He also is a GP, rural doctor. So we moved to Camperdown 18 years ago
when we had just one child. My husband came to the rural practice because he wanted to
work in the country. He wanted the breadth and independence,
I think, of rural practice. There’s a considerable number
of female doctors who are married to other doctors. Which I guess, if they’re both GPs or they both have skills that
are utilised in a rural area, that makes it easier for them. Although in other ways, it can be more
difficult with on-call, because it means within the family they’re getting twice
the amount of on-call that you would do if you’ve
only got one doctor in the family. Most of the other female doctors
within our practice are actually married to doctors
within the practice as well. And if you’re single? If you’re single, well,
there’s lots of options. – Lots of blokes?
– Lots of blokes. And lots of choices. Living in a rural area doesn’t mean
you never come to the city. You’d be surprised at
the Frequent Flyer points that numerous of our
rural GPs can clock up in participating in things in the city
as well as living in a country area. Apart from living in
a different kind of community – it could be a regional centre
or a small town or remote practice – is it really that much different from
being a woman in general practice in the city? There are some very specific issues
around on-call, there are some specific issues
about being able to work either alone or supported vicariously
from other people if you’re living in a very small
community that are very different, and the challenge of the type of
practice is sometimes quite different. But the mechanics of general practice
are the same, whether you’re living in Sydney
or Bourke. So what models are out there? There’s a range of models, and they vary
from obviously in remote locations living on-site, but also some
fly-in, fly-out models that we’re seeing increasingly
to service more remote locations. One of the practices to consider
is Sheilagh Cronin, who is providing a fly-in, fly-out
service to Cloncurry in Queensland. – And she’s based…?
– On the Sunshine Coast. I practise in two locations, really – I spend some time working in Cloncurry, which is an outback mining town. It’s near Mount Isa. Over the last three or four years,
I spent most of my time there, but recently
I just work there part-time. The rest of the time I work on the
coast, on the Sunshine Coast, which is nearly 2,000km away. Cloncurry’s had a major problem
with doctors over the years. And… The reason I actually went there was that my husband
had started a business there which involved him visiting Cloncurry, and we just thought
it was an opportunity to try and do something with Cloncurry. So, basically, with some friends,
some medical friends, we decided to tackle Cloncurry and see if we could solve
the medical workforce problem there by applying principles which
we knew would work to actually attract young doctors. From a situation where, three years ago, there was one locum doctor
trying to look after a hospital in the community of 5,000 people,
totally on his own, being on-call day and night,
going almost crazy with tiredness, we now have a situation where we have between four and five doctors
in Cloncurry. We have a brand-new facility,
we teach medical students, we have registrars. That’s what we’ve done. Doctors are working
differently nowadays. In fact, in our Cloncurry practice,
we have several doctors who fly in, fly out. The fact is
is that if you do provide good housing, proper on-call rosters so that people
are only on-call maximum one in three, you do provide training and
you do provide excellent facilities, you can actually attract doctors.
I think we have proved that. If we come into some
of the larger communities – we might consider something
like Alice Springs, working in an
Aboriginal medical service – Aboriginal medical services
and similar services are good models often for women
who don’t wish to pay large amounts or buy real estate in rural areas,
understandably. Because obviously it’s a walk-in,
walk-out model, where you can negotiate often
a salary or a percentage or a way of practising or being
remunerated for your practice that works better for you, particularly
giving you more flexible hours. I’ll tell you about a practice
that I used to be in with my husband and another female practitioner in
Tom Price in Western Australia. The three of us worked part-time.
The three of us worked 0.5 each. So we did provide an on-call service. It was a one-in-three
on-call service for the hospital, but at no time were we expected
to be in the surgery at all times, doing the job. You’re right –
when the chips were down, all three of us would be at the hospital
if there was an emergency. But the expectation was that
we would support each other and the community would keep
their expectations reasonable that all three of us could sustain
living in the town. And we were able to live in that town
for four years under that arrangement. And are there industrial issues? For example, if you’re going to go into
somebody else’s practice? There are, Norman, and what
we know from the statistics is that women have longer consultations
and they earn less than men. So you need to go in
with your eyes open, working out what value
you put on your services, the way you practise and the skills
you’re going to bring to a community. You might be better on a salary
than fee for service? You may be, or you may want to negotiate
a fee-for-service arrangement with a baseline or with an understanding
of those skills that you’re bringing to
that practice environment. What else do you think
are key negotiating points if you’re at the point
of choosing a practice? What should you be looking for,
and what sort of things, apart from the ones you’ve mentioned,
should you negotiate? Most women are looking for flexibility. Women remain primary child-carers, so it may be that you do want
to go to the sports carnival or that if there is an
appointment or something to be arranged for someone,
you want to be there. So inherent flexibility, school
holidays, those sorts of issues, which are difficult
with on-call arrangements are the sorts of things that you might
be bringing to the table as key things to negotiate. – ‘Cause everybody wants those off.
– Everybody wants school holidays. The other difference which we probably
should’ve mentioned earlier with the metropolitan practice is that you get to do much more
procedural work. You can, and that is the challenge
in terms of many rural practices. – It’s also part of the fun.
– That’s right. And it’s part of the choice, that being
able to provide a procedural service, be that obstetrics, anaesthetics,
surgery or extended emergency work, is a huge challenge, but also a service
to your rural community. You can go to work and really not know
what’s going to happen for the day. Even though you know
you might be set out to have just routine appointments
at the clinic, the people who come to see you
can have a wide variety of issues that you’re going to deal with. Or it may be that something completely
unexpected happens and you end up doing something you
really wouldn’t imagine you’d be doing at the start of the day. So I think that’s been
one of the surprises and one of the things that keeps me
going in a rural area. In accident and emergency, a lot of people seem to not like that, standing, thinking, ‘OK,
the ambulance has just called, I’ve heard that there’s somebody coming
in who’s chopped off their hand. What am I gonna do about that?’ But I actually find that
really stimulating. You know, it’s amazing what
you can remember, actually, when you’re standing there. (Laughs) And it’s a great feeling when you finish that job,
and you can stand back and say, ‘I did that. I did that well, I think.’ We do minor operations – removal
of skin lesions and so on. None of us are GP-obstetricians
or GP-anaesthetists, but we do provide VMO care for
our patients in the hospital setting for palliative care,
we have nursing home patients and we admit to the local hospitals
for simple illnesses. All of us also have other areas
of interest that we work in, so we work in general practice, but
we have other specialist interests. So one of my colleagues, Carmen,
she’s a medical educator, part-time, so she works with the registrars
in the region. She’s also a lactation consultant
with a special interest in that area. Gillian Rawlings,
who’s the other partner, works again in training
medical registrars, but also she works
on management committees and provides her expertise in that area. And I happen to work
in sexual health and with S100, prescribing rights in HIV
in that area as well. Doing a general practice placement
last year in Leeton, the GP, she did anaesthetics,
she also did obstetrics. So one day we’re in surgery while she
was doing anaesthetics for the surgery. The next day she was
delivering some babies, and the next day she was back
in her practice seeing patients. And just the diversity about
that range of experiences and skills that she had –
she was highly skilled and had done many extra courses
to better develop those skills. I just think that’s an exciting thing
to be able to do. I believe there’s
a preponderance of women in international medical graduates. Yes, both Australian medical graduates
and international medical graduates entering rural training schemes
are more likely to be women. NORMAN: Well, let’s now go to
a rural practice in South Australia, where there are two women GPs, one of whom is
an international medical graduate. ANNETTE: Barmera’s about
250km north-east of Adelaide on the Murray River. Barmera has a huge, beautiful lake,
Lake Bonney, which you can yacht on, you can
windsurf, and the birds are… Well, we take the birds for granted,
but everybody else notices the birds. It’s a population of about 4,500. We service about 6,000, ’cause there’s
quite a few small towns around us, plus the Riverland’s actually five towns
all around about the same size. Sometimes we see people from other towns
and they see our patients as well. We have 3.25 full-time
equivalent doctors here. Two full-time male doctors. I work about three-quarters time and our other female doctor
works about half-time. We also have a registrar at the moment. We often have two registrars and we have
a full-time student all the time. – Here’s the flu injection.
– Alright. OK, to the nurses. Good morning. ANNETTE: Elizabeth’s
our half-time doctor. She came with her husband as an
overseas-trained doctor from Kenya. She came about seven, eight years ago. When we did the interview
to come over to Australia, they did ask us what exactly we wanted. Did we want to work in the city,
rural country, and about how big a population
would we be happy to work in. We had not much idea about Australia,
but we gave them an idea. And when we did come for
a look-around to Barmera, we met Dr Newson, who took
the day off to take us around. And then all the staff in the clinic,
they had a lunch waiting for us. So they really were welcoming
and they were ready to give us, the two of us positions
and be flexible enough, ’cause we had two little children. That was something
they really stressed – that they would
give us time to settle in. Child care was a problem,
so they helped us find child care. And then schooling –
we were shown the different schools available in the area, and then housing,
where we would have to stay. They had organised a unit for us, so we went and thought
about it overnight and we liked what we had seen,
what they had offered us, and when we went back,
we decided Barmera would be it. Elizabeth and Raphael,
honestly, I don’t think anyone ever thought about them
being overseas-trained doctors. They’re excellent doctors, so the town
was just happy having them. That was actually quite a surprise. We didn’t think
they would accept us that easily. They were quite welcoming – they came in
to see who are these new doctors, ’cause we’d been put in the newspaper that we are coming
in this little village. So they already knew, wanted to know
more about us, very welcoming, and somehow continued being our patients since the first day
we started seeing them. They still keep coming back, so it’s really been lovely. Very few minor incidences
with very few people, but they’ve also turned around – in fact, they end up becoming
your good friends. Is that all?
No other medical problems in the past? – No.
– Have you got sore ears? – No, not anymore.
– OK. ANNETTE: I moved here
about 18 years ago. Before that, I was working in the UK. And there was four doctors here. We were a busy practice
with a very busy hospital. At that time, I did a lot of obstetrics.
I used to do about 50 deliveries a year. Since that time, more of the services have been
concentrated in the regional hospital, which is 20km away. Obstetrics has been closed in Barmera,
theatre’s been closed, and accident emergency is now only open between 8 in the morning
and 6 o’clock at night. And we do a GP after-hours service
until 10 o’clock at night, and then after that, everything
is diverted to the regional hospital. I was Annette’s first patient
when she arrived in Barmera. The day before she was supposed
to start, the doctor that I was to see wanted to sneak off
and Annette took it on. – I can’t even remember that. Yeah!
– I spent a few days in hospital. – That was organophosphate poisoning.
– It was. (Chatter) ANNETTE: Because we’ve lost
quite a few services we’ve had to think about
how we might attract doctors, and we felt the best way was to start to develop a more family-friendly
and flexible practice. So what we’ve tried to do is make it that anybody who comes
to work in our practice can develop and work
any way that they like. But I suppose females just prefer
to work more limited hours. We earn a little bit less,
but not a great deal less, and I certainly earn as much
as the men do. Whereas if they want to come here
and earn more money, and work harder,
then there’s plenty of work. They can also do accident-emergency work
in the regional hospital that’s only 20km away. And we’ve made it flexible
in the surgery, so we all work hours which are flexible. – Mm.
– So… which works very well. Otherwise we wouldn’t be here. I wouldn’t be here
if it wasn’t family-friendly. It is very family-friendly. We put a big emphasis on that. ELIZABETH: ‘Cause I’m part
of the practice I’d want to work as much as everybody
else, but I just couldn’t. No, you might just need to take
some time over the school holidays, or the children will get sick. So having a very flexible practice
does help. So you’ve been keeping well
since I last saw you? – Yeah.
– OK. OK. ELIZABETH: I’ve really changed my
working hours since I came to Barmera. Still plenty, or have we run a bit low? – No, no.
ELIZABETH: That’s all settled? As the children have grown, my working
hours have really changed most times. But now they’re more stable,
now that they’re in school. At the moment, we probably
have got a little balance, ’cause I’m not doing as much
emergency medicine anymore. Did you carry your ballet bag? So I’m not as stressed or rushed
as I used to be. Because that used to be a bit hard,
that used to really take a toll on us, and that was not good for the children. You have a good day. All the best.
Bye-bye. Generally we are happy where
we are at the moment, in our life. We’ve become citizens
in the last two years, so we feel quite settled. We always think that it’s better to have
doctors who stay here a long time than doctors who work incredibly
long hours and stay a short time. So that’s why we’ve tried
to make our practice one that people can choose
to work shorter hours or longer hours if they want, depending
on what stage of life they’re at. – Do you still work?
– Yep. Sunday evening – go get the ironing
done for the school uniforms. ANNETTE: Elizabeth only works
school hours, which is fine with us, and the only time she has trouble is
sometimes picking kids up from school. But often the receptionist or one of
the other doctors’ wives or something, if they’re picking up their kids, will
bring them all back to the surgery, and we might have up to ten kids
at our surgery after school. We’re considered the number one place
for kids to come after school. We just run out of biscuits sometimes. We encourage people to take at least
a week’s holiday every three months, so that means every three months,
you get a break. And then once a year,
we take three or four weeks off, so we can have a long holiday, and over Christmas, we encourage
everybody to take four or five days off. It might be if you’re working Christmas,
you get the New Year period off. You’re gonna be good and stay there?
Good dog. Yeah, a few plants.
We’ll get a few plants out here. We’ve… Well, I have grown in the city,
but I didn’t mind rural sort of setting. Raphael had done both, and we just thought for the children, we’d like to bring them up
in the rural country. It’s a fantastic place
for kids to grow up. It’s just there’s so much to do. I grew up in an area like this,
which is why I love it so much. You know, you can be out in the bush,
you can have animals, you can be swimming,
you can play sport as much as you like. So it’s just a really good,
healthy way to grow up. ELIZABETH: We’re supposed to get
another chook, we’ll get another chook. I might try and do that
for you tomorrow. We discussed once, many years ago, about why people came and did…
came into rural medicine, and I think it’s because,
I came because I love the lifestyle. That’s the reason why I’ve stayed here. (Dog barks) ANNETTE: I live on 8.5 acres
of heritage-protected land, which is like living in the middle
of a national park. It used to have three big lawns
which we’ve taken out, and we’ve put in a swimming pool
which actually is water neutral. I have no streetlight
so my skies are beautiful and my… well, as you can see,
the weather’s just magnificent. Because I’m single, I actually like
going back to Adelaide a lot. So every second or third weekend,
I actually drive back to Adelaide. And if you do the maths, because it only
takes me seven minutes to get to work, I’ve worked it out that I could drive
to Adelaide every weekend, and still be driving less than someone
who drives half an hour to work. People always think it’s a long way
to travel back and forth, but actually I drive a lot less
than most people in the city do. I always describe myself
as a city girl in the country, ’cause I do like
all of the city luxuries. I go to Melbourne every couple of months
and I go to Sydney twice a year. So, you know,
the way we’ve set up the practice, you don’t miss out on anything. And it’s just a really good life. If a woman’s watching this
who’s a GP registrar in the city but thinking that the country
might be good, you might wonder – what’s the balance
between fear and fun, if you like? There is no doubt that
there are some times when the amount of sweat under
your armpits is overwhelming when you find yourself
in a situation where, ideally, you would be handing it on
to someone else and you can’t, you know? The reality of the geography
or the circumstance are that you need to provide
the primary care there and then. But I have to say that
that is a situation in which usually you’re never completely alone, and often you’re standing with a senior
nurse or allied health professional. Let’s face it – you do the best you can. I guess the other thing
about women in practice is most women aren’t scared
of working in teams. In fact, I think they do it quite well and rural general practice,
and often remote general practice has been a team effort for a long time. So this sense of professional isolation
and lack of support can be counted and is being counted
in many of the models that might interest people
considering rural practice. People like to be treated
in their own community and that’s what we aim to do. So if we identify that there’s a need
for clinical knowledge to enable somebody to be
looked after in our community, we go off and learn that. A couple of months back, I thought, ‘I don’t think…’ They’re talking about
new stuff with chronic renal disease and I don’t really know that
I’m up to date with that stuff, so I picked up the phone and talked to
our local Division of General Practice professional development
manager and said, ‘Can you get somebody up
to talk about chronic renal disease?’ Within a month,
we had an event in Camperdown with a really, really good… Yeah, it was a really
good educational event. And they’re small, so there were four
of us with the one renal physician who really ran a question
and answer session for us. Say a town like Moree, which is
too far away from anywhere else not to have a birthing service,
not to have access to emergency surgery, there are some very good collegiate
models of men and women working in general practice. And it’s the sort of place that
we can encourage registrars and we can support registrars
to learn procedural skills and not feel that sense of
total professional isolation. We’re a community and we know
that we need to support each other in order to continue to work effectively
in that community. And other people coming in
and seeing what we do and how we support each other, they seem to be surprised
at the level of support of the doctors for each other. If you’ve had to deal with
a difficult situation, such as dealing with a birth
that results in a stillbirth, the support that you get from your
colleagues has been tremendous. We have good support
also from the specialists in Warrnambool and Geelong. They’re an hour away, but we have
a strong relationship with them. So that if I’ve got a problem, I just
pick up the phone and talk to them. And, you know, sometimes
I send emails with a thing that I think they probably won’t be able
to answer straightaway, but yeah… So I feel well supported. I work a lot with the Royal Australian
College of GPs, I work a lot with
the Rural Doctors Association. Flinders University
has full-time students up here and they have a presence up here. Teaching the students is great, and
we have registrars here all the time. So Sturt Fleurieu
are up here all the time, giving them education
and educating us at the same time. So taking on the teaching of people has meant that the organisations
that support them support us as well, keeps us fresh. We haven’t really talked about the fact
that women’s careers in medicine are very much attuned
to life stages, aren’t they? Very much, and for most of us,
there is this interruption or a change in the way you practise
when you’re having your family. So, for many of us, we did our training,
then we went to a rural area, then we’ve interrupted
or done it differently while we’ve had small children, and then it looks different with
primary school aged children and then there are challenges
with high school aged children. So it is very much a life-stage
phenomenon and that’s what
I was alluding to earlier. I don’t think you have to go rural with a plan of being entrenched
in a community for the rest of your life – I think there are life stages where
living rurally works very well. But I was really talking about, you
might be part-time for a period and then full-time, and then
come back to part-time. You won’t necessarily have the same
career in different stages of your life. That’s right. I think not having a definite path
is also important, because I think one thing
that happens is, in our lifetime, the path that we choose tends to change, and we need to have an open mind
to where that may lead us. I think regional centres
offer the opportunity for female practitioners in particular to have supportive environments
around them so that they can practise
in a variety and a diverse way. But at different times, I have done work
in smaller communities because that suited what
I was able to do at the time. I would then choose, when my children
were young, not to do that sort of work. Women often feel that they come
to a threshold decision when the kids are about 11 or 12.
You’ve got two kids. There’s the whole issue of high school.
What decisions did you make? Interestingly, I think
what influenced me there was that my husband had grown up
in that particular town and he had actually been schooled
in the local public school system and had done particularly well
in that system, so had confidence in the State system. We’ve chosen to school our children
in the local State school and have been extremely happy. Our daughter’s having a gap year,
but she’s off to study law next year. We have taken the solution of sending the children boarding
for secondary school. For the older two boys,
that was a great success. As I said, Grace is saying she didn’t
realise what a country girl she was and how she misses
the country environment. Our results from our local high school
here were excellent last year. In fact, with the extra points
you get for being rural, we had people who actually,
if they got all the rural points, would’ve got over 100. You’ve been looking… observing women
in rural general practice for quite some time. What’s failure and what’s success? Can you definite it as easily as that? If you can,
what predicts an unhappy experience and what predicts a happy experience? Look at the community –
do they play sport, do they do the things
that you want to do? Do you feel safe? Does the community have ways
of you interacting with it that make you feel comfortable? Is it a flyable or driveable distance from the significant others
in your life? Are there particular issues
for single women thinking about rural general practice? Again, I think it would be the network
they form when they come. And also if they were going to practise
as a solo practitioner it would be around
their involvement in the community and their involvement with others
to help give them that support they would need to maintain and sustain
practice in a rural community. Their own safety may come into play. In our practice, we have certain rules
around safety meaning. We tend to see after hours. Our patients
are asked to come to the practice. We’re practical.
Rather than doing home visits… We do do home visits where necessary, but where it is practical, the patient is asked to come to the
practice from a safety point of view. So those issues would
come in for a single woman if she was practising in
a solo environment. Another fear I imagine
that women might have if they’re gonna go to a small town is that the boundaries
between work and family are hard to define. What’s your experience of how women
have dealt with that? Norman,
that’s a really key issue, I think, for people considering rural practice. – I call it the ‘frozen peas problem’…
– ‘Cause that’s all you eat? Accosted over the frozen peas
in the supermarket about a work certificate
or about an issue. It’s a problem about living
and working in rural communities and defining boundaries. But I think it’s a skill and something
you need to think about, but it’s something that
many of us have been able to negotiate and manage quite well. I have friends within the community that are very good at
acknowledging boundaries, and I can be, at times,
not as good as my friends in picking up when boundaries
are being encroached upon. So, lines like,
‘That sounds very important and something that we need to look at. How about you ring my surgery on Monday
and make an appointment.’ So being up-front, being aware that,
when I’m starting to feel uncomfortable about something that someone
is asking me, to actually make that statement. So be up-front? And recognise if you’re
feeling uncomfortable, it’s a sign that
what you’re discussing shouldn’t be talked about
in that environment. If people asked me to do things
when I was off-duty, I found that my friends used
to divert them away. But I think if you just set the limits,
people are very good. Once they realise that when you’re out,
you won’t be helping them medically, they don’t ask you anymore. There was one time recently
when I was at the supermarket and somebody was asking me
something medically. Actually, the girl doing
the checkout, she said, ‘She’s not at work.
Don’t ask her anything medical.’ But there’s another aspect
to that balance, which is also the balance between the time you have to
spend at work and on-call, and being able to devote to your family
and making those boundaries clear. How tough can that be when
you’re in an under-doctored town and there’s moral pressure on you
to do more work? Norman, you’re absolutely right –
it is a pressure and it is something
you need to weigh up, but what you also need to weigh up
and negotiate with the community is your longevity. You can’t sustain an environment
where the choice that you’re making is too great, so you’re working more
than you want to work. You’re working more than you think
is good for your family, your spouse
or your personal circumstances. One of the problems with rural is people
do feel pressure to work, ’cause there is always a lot of work
to do, but that’s everywhere. That’s why you’ve gotta make
a decision yourself how much you do and stick to that. So we encourage women to negotiate
with their communities. It may be better that they’re on-call
three days out of seven and stay in the community
than they leave. And those boundaries can be negotiated, and part-time work,
and the understanding and support for part-time practice
in rural areas is growing. It was really nice to arrive in town and have my bosses at that stage saying, ‘Choose when you want to work, and, you know, you can bring
the baby in to have feeds. How can we help?’ So it was lovely, yeah. Do you have a life outside medicine? Absolutely! I do, and I think that’s one
of the things we talked about when we set up our practice – we are part-time practitioners, but our aim was to have
a sustainable form of practice. And because we do work part-time,
it gives me time to work in areas of medicine outside it, but also to do things like bushwalk,
spend time with my family, which I really enjoy, spend time
with my church, which I really enjoy. When you look back on your career so far in rural general practice as a woman,
what are the best bits? The diversity, that I’m able to practise
the skill-base set that I learnt in medical school. I was surprised that I was able to do
and still able to do the diversity of practice
within a regional centre. So I have the back-up
of the local hospital and when I’m on-call,
I’m not necessarily dealing with acute choking children, but I’m still able to care for
my palliative care patients. I’m still able to admit someone
with pneumonia to a hospital and watch them through
the course of their illness, so that has been one of the highlights. I’m passionate about rural health in
that I think there’s so many rewards when you work in a rural area, in terms
of that you get to know people over a longer period of time
and you can build relationships. It’s not a person that comes in
and you never see them again. You actually get to know
them and their family and have a better understanding
of the context of their life as well. I think the rewards are
just the pleasure to see that you’ve solved a problem and made a really big difference
to a community. We’ve thoroughly enjoyed
being in the country. We don’t regret it at all and when
we keep looking at our options of where we want to be, we don’t
want to go back to the city – we want to stay within
our rural community. We’ve got a great house. I can’t, um… You know when you look through
those real estate things? I look through and think, ‘Why would
I move there from here?’ (Laughs) And it’s a lovely area, and we’ve got lots of friends here,
so we will retire in Camperdown. The other highlight for me is managing patients
from birth through to now, because I’ve been in practice
long enough some are having their own children,
and seeing that generational care is actually extremely rewarding. Being a rural doctor
is a wonderful thing, and you can have a great life as
a woman doctor in a rural community. Captions by
Captioning & Subtitling International Funded by the Australian Government
Department of Families, Housing, Community Services
and Indigenous Affairs.

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