Rural generalist to pain specialist: easing the load

Some of the most rewarding career moves happen by accident, as Dr Hannah Bennett can attest. Dr Bennett, a 2012 graduate of James Cook University, had returned to Townsville after several years working as a rural generalist in Ingham and was looking to expand her skills in primary care.

She had met North Queensland Persistent Pain Management Service Director Dr Matthew Bryant, also a former rural GP, while doing her advanced skill in anaesthetics. “I came in with the idea to do it temporarily and ended up really enjoying it,” says the pain medicine consultant, who earned the Barbara Walker Prize in 2020 for achieving the highest mark in Australia for the fellowship exam. 

“I became much more aware of the lack of pain services outside metropolitan areas and decided to do my fellowship. Our pain service in Townsville is the only one outside of the southeast corner of Queensland. There's a severe lack of specialist pain services not just for rural and remote Queensland – First Nations people are underrepresented in referrals and that's not because they don't have persistent or chronic pain, it's just that they don't have access to services that are safe and culturally appropriate.

“We're trying to change that. We run a clinic at TAIHS (Townsville Aboriginal and Islander Health Service) and I go to Palm Island for a day every few months to do a pain clinic. We do a lot of outreach to Mackay, Cairns and Mount Isa, and look after patients as far away as Thursday Island.

About the specialty

“Pain management encompasses a lot of things. A big chunk of our work is managing patients with persistent or chronic pain, but we also assist complex acute pain patients, people who are experiencing pain from cancer or cancer treatments, in palliative care and other things like that.

“Persistent pain is a huge problem Australia wide. About one in five Australians experiences chronic pain. A majority of those are managed in primary care by GPs and allied health professionals, but there is a subset whose function and quality of life are so significantly impaired, they are unable to be managed in the primary care setting and need involvement from a specialist pain management service.

“We're not a purely medical service, we're a multidisciplinary clinic and we very much rely on that. We have our psychologists, psychiatrists, physios, OTs, pharmacists, nurses and doctors. Most of our patients will have involvement with, if not all, at least a couple of different disciplines as part of their management and journey through the service.

Pathways to pain medicine specialisation

“I did my intern year and RMO year here in Townsville and got to do some of the rotations that are prioritised for rural generalism, so I had good exposure to obstetrics, paediatrics and anaesthetics. I did a rural relieving term and worked in Weipa and Sarina as part of my second year.

“In my next year, I did my advanced skills training in anaesthetics. They were re-establishing maternity and birthing services in Ingham and recruiting GPs, anaesthetists and GP obstetricians, so I completed my GP training through the hospital and one of the Ingham practices. We moved back to Townsville when I was having a baby. 

“Pain medicine is a bit of an interesting specialty in that you have to have what's called a primary specialty or fellowship, so you can't just go from med school and do an internship in pain medicine. Traditionally, the pain medicine faculty sits under the Australian and New Zealand College of Anaesthetists, but you don't have to be an anaesthetist to do pain medicine – you could be a GP, a rehab physician, a palliative care physician, an emergency physician. It is quite intensive in terms of some of the underlying pain neuroscience and physiology and pharmacology stuff that you need to know from an exam point of view, but it is still heavily practically based in terms of patient management and communication.

“It's a mix between outpatient and clinic-based work, providing pain education to patients and the community in general, trying to upskill and teach other primary care providers, an interventional aspect where we do procedures and other injections to manage pain, and providing inpatient services. So, it's varied in terms of the things that you do day to day.

Making lives better

“Low back pain, for example, is the leading cause globally of disability in the world. That used to be just high-income countries, but it's even becoming more of an issue in middle and lower-income countries. We know that pain is more of a problem as people get older, and we've got an ageing population. About 80 per cent of people in aged care facilities experience chronic pain.

“Persistent pain causes lots of loss of work and financial stress and impact on people's day-to-day lives and so you can make a massive difference to people. Their function and their quality of life are what we're focusing on. The reality is that for many patients we aren't able to take away all of their pain, but we can manage it a lot better. We can get them back to doing the things that they want to do and need to do. You see people living a rewarding, fulfilling life despite their pain, as opposed to being really impaired.

Professional learning networks

“North Queensland Persistent Pain Management Service has set up a Persistent Pain ECHO Network to engage with primary care providers. Project ECHO is an international program that creates a community of practice locally with a hub and spoke model. Allied health professionals, GPs, anyone who’s interested, log in, we do a brief presentation on a topic and then someone brings a case forward for discussion. It gets input from people in the community as well as the expert panel about how we can better manage that patient. It's designed not just to be about helping individual patients but about improving the capacity within primary care to manage other patients.

Breadth of experience

“The best thing about training in a North Queensland regional setting is the broad range of patients in terms of age, pain type and condition. We get to see a lot and do a lot. Aboriginal and Torres Strait Islander pain management is a big focus of ours and that's also not something you necessarily get in a bigger centre.

Flexibility and support

“Townsville is a very supportive training environment. I had maternity leave in the middle of my training and there was the capacity to train part-time or full-time. You can complete all your training in Townsville because it’s rated as a level one facility. There's a core training stage, which is the first 12 months, and the practice development stage, which is the second 12 months. You can do your whole two years here, so you don't have to move until you can complete that. There are lots of different ways you can make that work.

Balance and lifestyle

“I work weekdays – no after-hours, no weekends. As a consultant, I'm normally on call for a two-week block every few months, but it's just being available for phone advice as the anaesthetic registrar covers most of the overnight things.

“I’ve loved Townsville from when I moved here from Brisbane for uni. It’s not as busy and fast paced. I love being 15 minutes from everywhere that I need to be. I like that I can walk from my place down to the beach. We do a lot of camping and fishing and swimming and boating out to the islands. There's so much on your doorstep here. It's just an easy life. We bought a house in an area with a good school and it's a great place to raise a family.”