An opportunity to practise at the top of their scope

For Rural Generalist doctors Chris and Kirsty Symmons, Longreach has provided a great environment in which to complete their JCU GP Training and stay for the long term.

“We said we would give it two years to start with, but it’s been such a great place to finish off our registrar training that we have decided to stay,” says Kirsty. “It’s now our fifth year here and we’ve decided to start a family with no immediate plans to leave. We both came here wanting an opportunity to develop our Rural Generalist skills while still doing GP work. Chris has his advanced skills in anaesthetics, and I have mine in obstetrics, so we both wanted to be in a smaller community where we could continue to use these skills in the hospital setting while also developing our skills in general practice. We both did our undergraduate medical training with JCU with a whole range of rural placements which prepared us well for this kind of experience.”

Both doctors say it has been the opportunity to work ‘at the top of your scope’ that was one of the biggest attractions for them to stay. “In Longreach, we have the opportunity to work in a wide range of health settings,” says Chris. “In addition to our GP work, we both work at the hospital in Longreach which is the largest hospital in the central west district. The nearest referral hospital is at Rockhampton and that is an eight-hour drive away with no commercial flights. Because we’re so far away, we have to be able to look after whatever comes in the door. The upside is that it forces us to work at the top of our scope, both in the hospital and community. It also forces us to work as a team.”

For Kirsty, Longreach has provided ample opportunities to practise and further develop her obstetric advanced skill training. “I did one year of obstetric training before I came out here and have enjoyed using those skills in the rural context,” she says. “Being so remote here means you have to be prepared to manage a wide range of pregnancy situations. I work very much as part of a team to provide antenatal care while liaising with tertiary teams including obstetric medicine, maternofoetal medicine and perinatal mental health. There have also been times when high-risk women have declined relocation to a larger centre for delivery. Working together as a team of midwives and doctors, many of the most complicated deliveries that I’ve managed have happened here in Longreach because there hasn’t been a specialist obstetrician to take over.”

For Chris, being in Longreach means he can fully utilise his anaesthetic advanced skill training, as well as extend his GP procedural skills in a number of areas. “When I was a registrar doing my training in Longreach, I had some great mentorship from the senior GPs here who were used to doing a lot of skin cancer checks for patients, as many people here tend to live outdoor lifestyles. I gradually learnt more and more about the advanced procedures you can do in this area that are still within the realm of general practice.”

“We’ve spoken to friends who are doing general practice in the city who refer even basic skin cancer excisions to specialist skin cancer doctors. Whereas being in Longreach has meant that I’ve been able to gradually increase my range of skills in this area, to the point where I’m now doing skin grafts and flaps, even on faces, which are procedures that most GPs would outsource.”

An important ingredient in the expansion of skills is also the support and availability of telehealth specialists. “Because it can be so disruptive and expensive for patients to travel to larger centres for specialist review, we try to arrange appointments by telehealth wherever possible,” says Chris. “We have amazing specialist support out here with a good mix of public and private specialists who will either visit or do telehealth with you. As a result, we get exposed to a much larger scope of practice. Although having to cope with such a diversity of work in a remote posting like Longreach can be challenging at times, you are working as part of a tight team and help is only a phone call away.”

Another valued feature of working and training at a remote and regional community is the strong continuity of care that exists between the GP clinic and the hospital. “We work across both the hospital and the general practice, which means we can see patients and admit them ourselves” says Chris. “We remain involved in their care at the hospital, discussing next steps when they get discharged back to general practice. This means that we are able to provide the best continuity of care that I’ve ever experienced.”

For GP registrars looking for diversity in their role, Longreach is certainly able to deliver on that. “For our work in general practice, we provide a whole range of care including chronic disease management, general medicine, skin procedures, aged care, mental health, antenatal care and child health,” says Kirsty. “In addition to our GP and hospital-based work in emergency and in the wards, we also do outreach clinics to surrounding communities. I also used to do a lot of outreach to communities where there was no female GP. I have also been providing GP visits to the local nursing home since coming here as a registrar, which is something I have come to really enjoy. The opportunities to utilise a range of skills have provided us both with a unique and valuable training experience overall.”

Chris now also combines his role with being a JCU GP training supervisor, while Kirsty is taking maternity leave. “I really enjoy supporting and encouraging the registrar’s journey in rural medicine, knowing that it can be hard and that there can be struggles at time, but wanting them ultimately to succeed,” says Chris. “I especially find it rewarding to care for and develop the next generation of rural doctors. The way we train here is a group practice model, rather than as a strict linear model. All of us here supervise the registrars and we all mentor each other and learn from each other’s different skill sets. It’s a mix of both formal and informal training. I know the huge difference it can make to know that you can just call on someone when you need support, no matter what the hour.”

According to Chris, Longreach’s ultimate secret weapon for registrar training is its size and remoteness. “Very few towns of the size of Longreach have the range of services that Longreach does, and we’ve got them because we are so remote. And that is what makes Longreach such a good registrar training opportunity,” says Chris.

“The hospital is just the right size; if it was any bigger than this you would end up being full-time at the hospital with not much opportunity to practise primary care. And if the hospital were any smaller than this, then you wouldn’t have a maternity service or the theatre service or some of the other inpatient services that we provide. To be honest, I think it would be almost impossible to find a more diverse job in medicine anywhere in Australia.”