Rural generalists are general practitioners who provide primary care services, emergency medicine and have training in additional skills like obstetrics, anaesthetics or mental health services.
The National Rural Generalist Pathway recognises the extra requirements and skills of rural generalists and supports them to meet the diverse health needs of regional, rural and remote Australians. Rural generalists give these communities access to a broader range of specialist medical services.
About the initiative
In December 2018, the National Rural Health Commissioner advised the Australian Government on the development of a National Rural Generalist Pathway. In response, the 2019–20 Budget committed $62.2 million to implement a training pathway for rural generalists and provide additional training places for GPs in regional, rural and remote communities.
The specific training for rural generalists will ensure that GPs and registrars have the right skills to practice in rural settings and can address the shifting needs of regional, rural and remote communities.
Life as a rural generalist: providing healthcare to rural and remote Australia
RUTH: I’m Ruth Stewart, I’m the National Rural Health Commissioner and I’ve been a rural generalist for over 35 years now. It’s the best job in the world.
Rural generalists are equipped to work in rural and remote settings. We really need very skilled clinicians working in remote communities. The National Rural Generalist Pathway is a training program for doctors so that they can end with the skills and competence – and confidence – to work in a rural or remote community, anywhere in Australia. So that governments and health departments, hospitals and clinical practices will recognise the scope of practice and those qualifications as being the signifier that you have the skills to work here.
In setting up the pathway, we’re seeking recognition of rural generalism as a specialised field within general practice. That’s a bit the same as cardiology is a specialised field within internal medicine. So, you’re still a physician with an expertise in internal medicine, but your specialised field is cardiology. Well, I’m still a general practitioner, but I have a specialised field of rural generalism.
PRESTON: I’m Preston Cardelli. I’m one of the provisional senior medical officers working here at Thursday Island. I work as a trainee rural generalist and my skillset is that I’m a training GP registrar with an advanced skill in anaesthetics. I’m able to provide support in a critical care situation and also help out with aeromedical retrievals if needed.
I grew up in a rural area. I always knew that I was going to live in a rural and remote area as much as I could. I knew that I wanted to be a rural doctor because it meant that I could return back to where I felt like my foundations were. And through my medical student rotations, I was able to meet people who were working in the role of a rural generalist. Just fascinated and inspired by the stuff that they do day-to-day because it’s amazing, they do such a wide scope of practice. That’s why I wanted to be a doctor that could manage lots of things, that’s why I chose rural medicine.
RUTH: Rural generalists work in what we often refer to as a resource-poor environment. We don’t have CT scans, MRI scans, we don’t have a coronary catheter lab just onsite. If someone has a heart attack, we need to be able to stabilise them, to consult with our specialist colleagues who are at a distance, not just down the corridor, and deliver the care that’s needed now and decide whether this patient needs to be transferred for further care. And that’s a really important thing about rural generalist training – if you turn up in that environment, you train for it, you know what to do when stuff happens because stuff happens. And if you are a person living in a rural and remote community, you want to know that the doctor who you’re just about to meet knows what to do when stuff happens.
PRESTON: The days in the life of a rural generalist up here, probably very different to a lot of other places. My role, I could be doing anything from adjusting a medication on someone for a long-term treatment plan to retrieving someone and putting someone in a coma in an outer island or delivering a baby. You know, it’s just such a wide scope.
RUTH: Yes, some of those emergency situations that I intervened and saved a life, and you know they come but it’s those times where it’s not as easy as just doing one thing. Where it’s being with someone through the course of their illness and the management of it that can only occur if you provide continuity of care.
PRESTON: I think some of the most rewarding parts about being a rural generalist are the fact that you get to be involved in the community. Torres Strait Islander people are very cultural and very family-based and to be invited into someone’s wedding or funeral is a really big deal, and I don’t think that I would get a chance to be involved in something like that if I wasn’t living and working in a remote area. What I would tell myself 6 or 7 years ago when I first embarked on the journey when I first signed up, it’s everything that you’re expecting it to be plus a whole lot more.
RUTH: Innovation, when you approach it as a rural generalist, you can enable the delivery of care in your community that is equal to what anybody in Australia can get. It just looks different. I never have to wonder whether the work I’m doing is helpful. I know every night when I go to sleep that I have made a difference to people’s lives and that is such, such a wonderful and privileged experience.
Why it is important
Rural generalists are an important part of our regional, rural and remote health workforce. They broaden the range of locally available medical services for rural Australians. This helps these communities to access the right care, in the right place, at the right time, as close to home as possible. Growing our rural generalist workforce will reduce hospital admissions, reduce the use of locum services and limit the need for patient travel.
The national pathway aims to:
- formally recognise the role and skills of rural generalists
- improve the coordination of rural generalist training
- increase support for rural generalists
- increase opportunities for doctors to train and practise in both hospital and primary care settings in regional, rural or remote communities
- keep doctors working in regional, rural or remote communities.
Meeting our goals
We are working to meet our goals through several key activities.
We are funding the Australian general practice colleges to apply to the Medical Board of Australia to recognise rural generalist medicine as a distinct field of general practice. The GP colleges are the Australian College of Rural and Remote Medicine (ACRRM) and the Royal Australian College of General Practitioners (RACGP).
Rural generalist coordination units have been established in all states and the Northern Territory. These coordination units will:
- coordinate the training pipeline for rural generalists
- assist doctors in their transition between their postgraduate clinical and training components within both hospitals and primary care.
Rural Junior Doctor Training Innovation Fund
We have expanded expanded the existing Rural Junior Doctor Training Innovation Fund to support 200 new rotations each year in rural primary care settings. This expansion targets postgraduate year (PGY) 1 and 2 doctors with opportunities for PGY 3-5who are on a rural generalist pathway or interested in becoming a rural generalist.
Rural generalist training
From 2021, the ACRRM will deliver up to 100 extra rural generalist training places through the Rural Generalist Training Scheme (RGTS). Rural generalist training also continues to be available through the Australian General Practice Training (AGPT) program.
Who we work with
The National Rural Health Commissioner supports the rollout of the pathway. The commissioner also consults the rural health sector to make progress on other key elements of rural generalism.
The GP colleges are leading the application for national recognition.
The coordination units in each state and the Northern Territory assist doctors on a rural generalist training pathway.
We have established a governance structure to further implement the pathway and to consider the remaining recommendations.
All the coordination units have now been established and have funding arrangements in place until June 2023. We work in partnership with these units to continue to support rural generalism.
Junior doctor rotations started in the second half of 2021, with all 200 rotations expected to be delivered in the 2022 training year.
You can contact the coordination unit in your area for more information on joining a rural generalist training pathway: