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Letters to the Editor

The Australian Journal of Rural Health © Volume 3 Number 4, November 1995

ilust. J. Rural Health (1995) 3, 195-197

Letters to the Editor

This letter has been prompted by the article enti-

tled ‘Education and training: Role of Rural

Health Training Units’ by Humphreys and

Nichols.1 My concern is that once again authors

who have considerable impact on the develop-

ment of policy are entirely medical profession

focused and blissfully ignorant of the needs of

any other professional group. Articles such as

this, although paying lip service to the notions of

multidisciplinary teamwork in the provision of

health services, perpetuate the erroneous myth

that the doctor ‘owns’ the patient or the patient’s

health. This is totally- unacceptable to health ser-

vice consumers and other health professionals

who strive to enhance the health status of ilus-

tralians who live and work in the rural and remote

area of Australia. Although I believe that roral

and remote area nurses might also have a case I

would like to represent the allied health profes-

sionals’ viewpoint.

I refer to a recent ‘soapbox’ letter from the

National Association of Rural Health Training

Units (NARHTU) newsletter of November 1994.

to recommendations from the NdRHTU confer-

ence (Canberra, 1994) which the authors ignored

and to recommendations from the first Australian

rural and remote Allied Health Professionals

Conference in 1993. Allied health professionals

are concerned that the current strtrctures and

functions of Rural Health Training Unit do not

accurately reflect the multidisciplinary- nature of

the health workforce. Although the rhetoric being

used speaks volumes, the lack of action implies a

lack of real commitment and understanding of the i special needs of allied health profsssionals living

and working in the rural and remote areas of

Australia.

A number of comprehensive and hi&l\- credi-

ble needs analyses have been published at local,

state and national levels relating to the education

and training needs of allied health professionals

in the bush. These studies have endorsed the

original concepts of the Rur-al Health Training

Unit to ensure the competent and confident prac-

tice by rural health practitoners. The support

functions as opposed to training functions should

be given priority, according to this research.

Given that there are an estimated 17 000 allied

health professionals from at least 12 different pro-

fessions in rural and remote Australia as opposed

to the 6000 rural doctors, it would make sense

that resources be shared equitably as mentioned

by Des Murray~ in his keynote address at the

NARHTU conference.

For allied health professionals the scarce

resources should be used to develop transferable

material or resources as opposed to ‘one off’

events without ‘flow on’ potential, which is the

most any Rural Health Training Unit has done for

the allied health professional group to date. The

concept of using existing rural practitioners as

mentors has proi-ed to be successful, and many

allied health professionals feel it is a role of the

Rural Health Training Units to establish these

support networks. It has been shown that training

needs are more easily identified after personal

contact with other similar professionals. Another

support function that can be facilitated by Rural

Health Training Units is the establishment and

maintenance of locum services: These are partic-

ularly requested by the group of ‘therapy’ profes-

sionals although radiographers also rank highly.

The funding, or ex-en proportions of funding,

allocated to allied health professional issues is

seen as not being equitable xith other profes-

sional groups and definitelr not in the best inter-

ests of rural communities. Opportunities for the

derelopment of generic and across discipline

training opportunities as well as profession spe-

cific education needs to be considered. The polit-

ical dominance of particular professional groups

and their abilit~~ to attract Cornmom\-ealth and

State funding to promote and support rural and

remote practice is an issue for allied health pro-

fessionals. It is important to note that allied

health professionals, from diverse medical back-

196 AUSTRALIAN JOURNAL OF RURAL IIEALTI-I

grounds, are increasingly being discussed, but at

this stage it is mostly the medical profession

speaking for and on behalf of them without ade-

quate consultation. There is a refreshing trend

towards the politicisation of these allied health

professions, so that one day it is hoped that their

issues will be addressed in consultation.

User pays approaches to funding options

remain a difficulty for rural and remote allied

health professionals who have been shown to

spend more money than their city counterparts on

professional development, with less effect, due to

expensive travel costs. Locum relief is critical in

relation to continuing education (as with medi-

cine and nursing). The issue of access to spe-

cialised technology to support on site professional

training has also been shown to be limited for

allied health professionals. There are many exam-

ples of allied health professional services being

seen by health administrators as a luxury and

therefore easily expendable in times of budgetary

crisis. This public sector example is also relevant

to the private sector where health insurance

rebates discourage the establishment of viable

private practices for allied health professionals in

rural communities. History has also shown that

entitlements for allied health professional educa-

tion and conferences is the first expenditure to be

cut in times of budget crisis. This is especially

significant when considering that most allied

health professionals in rural and remote ‘areas are

in the public sector.

Given that resources are scarce, it is essential

that Rural Health Training Units do not duplicate

services already available from professional bod-

ies or universities and rather complements these

activities. Often training resources and programs

that are suitable for metropolitan practice do not

meet the requirements of rural practice given the

decreased access to new technologies in rural

areas. The role of supporting and encouraging

research can therefore be enhanced with strong

professional association links.

A number of quick fixes have been tried by

Rural Health Training Units and organisations to

inspire action and these appear to have been

greatly appreciated and beneficial. At the least,

control over educational budget allowances is

empowering. There is, however, concern being !

expressed about the involvement of Rural Health

Training Units in developing methodology for

longer term solutions. One solution offered by

allied health professionals is that co-ordinators

who have experience in rural or remote allied

health professional practice be used to provide

credible leadership in rural health training units

activities. Another solution offered is to form ref-

erence groups or use successful models from

function multidisciplinary training units. In spite

of another recommendation from the keynote

address by Des Murray at the NARHTU confer-

ence that ‘suitable management arrangements

that reflect the multidisciplinary nature of rural

health services are included in State and Com-

monwealth frameworks for Rural Health Training

Units’ (D. Murray, unpubl. data, 1994), there is

little evidence of allied health professionals being

able to influence the direction of services from

Rural Health Training Units (even for them-

selves). A notable exception must be the Rural

Health Training Unit at Townsville.

In summary, allied health professionals do not

consider that they currently get a fair deal from

Rural Health Training Units. The reason for this

cannot be discussed in length here, but it is suffi-

cient to say that this group of professionals are

often seen as too complicated or too few to be

bothered with. United as a group, allied health

professionals are significant in their numbers,

and their needs are considered to be as great as

other health professionals choosing to live and

work in roral and remote areas.

Reference

I Humphreys JS, Nichols A. Education and train-

ing: Role of Rural health Training Unit. Australian

.lournal qf Rural Health 1.995; 2: 80-86.

Michael Bishop

I must take issue with Humphreys and Nichols1

in the article where they refer to the first gradua-

RETENTION OF RURAL DOCTORS:F. \I. D. HOYIL 197

tion of trainees from the Toowoomba Rural Health

Training Unit as occurring in 1993.

As one of the original intake of trainees into

that unit I can assure the authors that the first

graduation occurred in May 1992. The original

graduates were Dr R Banner (currently in private

general practice in Stanthoq2e and previously

medical superintendent with right to pri\-ate prac-

tice in Blackall) and myself (currentl!m full time

medical superintendent in Longreach). .4t that

initial graduation, certificates from the Cunning-

ham Centre and letters of con;Tatulation from Dr

D Lennox (then medical superintendent

Tooxoomba Hospital) and Dr D-4 JFallace (then

chairman faculty of rural medicine. Ro!-al -ius-

tralian College of General Practitioners [R-ICGP])

were presented. A second graduation was held in

1993 and Dr Bomler and m!-self were invited to

attencl as further certificates Jvere presented 1)).

the then Federal health minister Graham

Richardson along 7).ith a congratulatol7- letter

from Dr P Stone (then president R_1CGP).

The Rural Health Training Units, arp no]\- dell

established and continuing to prox-ide hi?h lexmel

training to a large number of intending rural

health workers including doctors. TZnfortunatel>-

the persisting problems of attracting health T\-ark-

ers (particularly tlortors) to rural areas still

remains. A considerable number of positions in

Queensland are currently filled hy second year

scholarship holders who have been sent.

Part of the problem lies I\-ith the recognition of

lxral training by the RACGP xho still refuse to

recognise any training except that provided

within the very narrow confines of the RACGP

Training Program (TP). The Directorate of rural

education and training of the RACGP is a very

recent inilovation and still lacks an? real power in

the RACGP. This is rviclent in the position taken

bv the RACGP which accredits me as a supervi-

sor for RACGP TP trainees for general practice

time but still considers me insufficientl!- trained

in general practice to be eligible for vocational

registration as a general practitioner.

Until these problems can be reconciled Trithin

the RACGP and the Rural Health Training Units

there will continue to be a perception that these

are second class establishments.

Reference

Dr Mark Marshall