The Expanding Role Of Generalists In Rural & Remote Health

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THE EXPANDING ROLEOF GENERALISTS INRURAL & REMOTEHEALTHPashen, Dennis., Murray, Richard., Chater,Bruce., White, Col., Sheedy, Vicki., De la Rue,Stephanie. , Du Reitz, Marnie.25th Feb 2009

Backgroundnn2007 - Australian Primary Health CareResearch Institute (APHCRI) funded 12Stream 6 Grants on “Generalism”.Systematic review: To map the historicaldemise of a rural procedural skills baseand potential for repopulating a skillsbase in rural medicine

Australian College of Rural and Remote Medicine

Findings Decline in ‘generalist’ specialists over the past 50years – extreme in rural areas Decline in GP proceduralists–––––Differential rebates- a disincentive to rural proceduralpracticeRural hospital and maternity services closuresLoss of a ‘critical mass’ necessary to provide proceduralservicesLoss of access to procedural training for GPs/RuralDoctorsIndemnity crisis

Evidence supporting RGs Rural hospitals are as safe as majorsecondary and tertiary hospitals Investment in primary health care and‘generalist’ medical services may bemore cost effective, efficient andequitable for rural communitiescompared with specialist and subspecialist medical service providers

Evidence supporting RGs Specific training and career pathwaysfor ‘rural generalists’ has beenimplemented in Queensland. Mid-level practitioners like physicianassistants, practice nurses and nursepractitioners can extend the reach ofmedical generalists and specialistservices.

2007 New College Fellows 72 Cardiothoracic Surgeons 47 Cardiology Physicians[MTRP 12th Report. Feb 09]Australian College of Rural and Remote Medicine

Policy Implications Expand the clinical teaching capacity of the healthsystem in regional areas Establish regionally based mechanisms forvertically integrated training including generalistpathways. Create opportunities and infrastructure forarticulated ‘generalist’ pathways with clear trainingand career structure within hospital andcommunity sectors

Policy Implications Fund education and training initiativesrequired for safe delegated practicearrangements Promote the role of generalists bydeveloping policy of inclusion withinhospital role delineation and privileging &credentialing processes

Policy ImplicationsnFunds pooling mechanisms at theregional or district level : would support flexible and sustainable healthcare models (in rural and remotecommunities) that bridge the primary careand hospital care continuum.n This could support more generalist trainingfor rural practice.n

Policy ImplicationsnFund trials of mid-level practitionersIn autonomous practicen In delegated practicennEnhance the viability and sustainability ofrural and remote medical generalistworkforcennTraining and ongoing supportRemuneration and professional recognition

Policy ImplicationsnAddress indemnity costs: Act as a barrier to rural models of care.n Reduce the effect of metropolitan specialistcolleges in creating a “road-block” in ruralprocedural practice.nnFacilitate integration of other disciplinesinto generalist primary health care,including nursing, medicine, IndigenousHealth Workers, Allied Health

Australian College of Rural and Remote Medicine

Future ConsiderationsnnnExpansion and geographical spreadn Hospitalists in NSWn RGs in WAExpansion of scopen Rural Generalist Stream – EmergencyMedicineExpansion of trainingn Identified RG training facilitiesn Identified RGs within system to act aspreceptors

Questions?Australian College of Rural and Remote Medicine

APHCRI PUBLICATION2007–2008: APHCRI Stream 10The Expanding Role of Generalists in Rural &Remote Health: A Systematic n 1 final.pdfAustralian College of Rural and Remote Medicine

Findings Decline in 'generalist' specialists over the past 50 years - extreme in rural areas Decline in GP proceduralists - Differential rebates- a disincentive to rural procedural practice - Rural hospital and maternity services closures - Loss of a 'critical mass' necessary to provide procedural services - Loss of access to procedural training for GPs/Rural

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