Changing the conversation to attract more doctors and nurses to rural Australia
There’s a perception that rural healthcare means second-best or second-rate. Whereas the opposite is actually true. Rural medical students often out-perform their city-based counterparts on standardised tests. Most rural patients are better off being treated closer to home in their rural location (unless they have a very rare condition). And rural medical practices can often be better at adopting new technologies because of their smaller, more agile teams.
So why then, is it so difficult to attract and retain doctors, nurses and other health care professionals to rural and regional areas?
Hear from:
Dr Bridget Clancy - Ear, nose and throat surgeon based near Warrnambool, VIC and Chair of the Rural Surgery section at the Royal Australasian College of Surgeons .
Rebecca Bradshaw - child health nurse and founder of Rural Child Health, based in Jackson, QLD
In this episode we dive into some of the systemic issues from the housing and childcare crises, to sexism in the medical profession. But we also look at what we as individuals and rural communities can do better to help make health professionals feel welcomed and supported.
Follow Ducks on the Pond on Instagram. This is a Rural Podcasting Co. production - we help you tell your own story. Love this podcast? You might also like: Two Smart Blondes and Town Criers.
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Dr Bridget Clancy: 0:05
The expectations they had of the GPs that they wanted to recruit was to be available 24 hours a day, seven days a week.
Rebecca Bradshaw: 0:13
If I get a 50 to 60 year old mum who comes in and goes oh Bec, yeah, just a bit tight in the chest. Full attention, right?
Kirsten Diprose: 0:23
Hello and welcome to Ducks on the Pond, brought to you by the Rural Podcasting Co. Kirsten Dipperose is here with you and this season is sponsored by Buy CC Fine Jewellery. Thank you so much for your support and actually we have our last episode next Thursday, july 17. So if you'd like to enter the draw to win a gold ring the Piper ring from Buy Cece Fine Jewelry, then you had better get cracking Head to the Ducks on the Pond website and enter the promo code DUCKS7. So D-U-C-K-S-7. That's the number seven to go in the draw. All the details are on the website and you can only enter until July 14.
Kirsten Diprose: 1:08
So we know healthcare in rural areas looks different to the city and we often hear the bad stories. But did you know rural medical students outperform urban medical students in standardised tests and that in general, rural health care gets better outcomes and it's cheaper? And that's despite patients often being worse off when they finally get to see a doctor than in the city. And yet we still have the problem of not having enough doctors and nurses in our rural and regional areas when I live, I generally wait about three weeks to get an appointment to see a GP, and I know there are many other areas like that. So in this episode we get both a doctor and a nurse's perspective of the issue, and clearly it's not simple. There are some systemic issues, such as the housing and childcare crises making it harder for people to live and work in some regional areas, but there are a lot of other things at play too, which we'll really dig into in this episode, and some of them really aren't that hard.
Kirsten Diprose: 2:21
So this episode's really not just for people in the health profession. It's for anyone who cares about their community and, as you're about to hear, it all begins by viewing our doctors, nurses, physios and healthcare workers as humans. First, sounds kind of revolutionary, doesn't it? But from an outsider's perspective, I know I'm guilty of focusing on the healthcare system, which can be frustrating at the best of times, but when you start to think about the people and the sort of community they want to live in and the opportunities that they might want to have, you really start to change the conversation around attracting and retaining healthcare professionals. So let's begin with Dr Bridget Clancy, who has the fanciest title I'm going to try and say it Rural Otolaryngologist Head and Neck Surgeon, which is commonly known as an ear, nose and throat surgeon. Based in Warrnambool Bridget has also served on several health care boards and she's been part of the creation of a rural health equity strategy. She lives on a farm in dairy country and has always had a passion for rural life.
Dr Bridget Clancy: 3:43
Dad was from a farming family but his dad was based in the city and mum was a very city-based person. But after they married, to get promoted dad had to move around rural areas so he was a state primary school principal. So they moved to all sorts of tiny country towns in Gippsland and Northern Victoria, spend a lot of time around Ballarat and the smaller towns outside of Ballarat, but mostly in Beechworth. And then, when I was born, dad got the big promotion to a Melbourne school. So mum had followed Dad's career. She was a nurse but at a time when once you were married you were dismissed. So she had a lot of small businesses that she could manage with the seven kids that she had.
Dr Bridget Clancy: 4:25
We lived in an outer suburb of Melbourne when I was little and then mum and dad retired to Kerrang, which is in Northern Victoria, and I from there boarded in Ballarat, which was a beautiful time in my life, so I still hold Ballarat very fondly. And then one of my best mates from school in Ballarat introduced me to one of his best uni mates and that's my husband. So Dave and his family his dad's a first generation Australian migrated after the war from Europe and farmed around in several parts of Victoria. Dave was born in Drung, which is out of Horsham, and then they've been farming since the 80s around Cobden, narragud, cobreco area and that's why I'm in South West. Wow, you've really been all over Victoria and landed in the South.
Dr Bridget Clancy: 5:12
West, yeah, and then with my training when I did university, the only place to do medicine in Victoria was in Melbourne and I always picked country rotations or country placement. It was harder because I put myself through uni. I self-supported myself, so I really needed to work four or five days a week, but the country rotations and placements was where you got the best skill development. So I have lived in a lot of parts of Victoria and other parts of Australia as well.
Kirsten Diprose: 5:41
Did you know that you'd end up in the country as your sort of permanent living place after all the training years and the locum years?
Dr Bridget Clancy: 5:50
Yeah, definitely I purposefully trained myself specifically for rural work. I've always felt most at home in the country and I love the city, but in small births and my quality of life living in the city has never been as good as my quality of life living in the country. So I was really deliberate in what skills I needed and the independence I needed. I knew I wanted to train myself for working in a position where I didn't have a full service quaternary referral hospital service and I always wanted to get the skills I needed to take them where they were needed the most. I thought that would be in the outback. So I did a lot of medical school time in Northern Territory and WA because I think I watched a lot of TV when I was younger. I watched a lot of A Country Practice and the Flying Doctors when they were this sort of really groovy series in the 80s and all the actors were so fabulous and all the doctors and nurses were so capable.
Dr Bridget Clancy: 6:49
But I took a bit of a sideways move because I met a really inspiring ENT surgeon when I was doing a placement in Shepparton. His name was Michael Dobson, a terrific person, and his lifestyle and the way he and his partner were raising their kids. I thought it was a total package. I wanted to do the specialty he was doing. The complexity of ear-hose, throat and head and neck anatomy really got me in, but also I liked the way that they were living their life and raising their kids. So instead of becoming a rural generalist, which is like a GP with extended skills in the outback, which is where I was headed, I completely changed and decided to become a surgeon, and a very specific kind of surgeon.
Kirsten Diprose: 7:22
Yeah, I think it's interesting that you mentioned a couple of TV shows as being crucial to your thinking about where you wanted to practice, because we're talking about how to attract and retain people. Do we need more TV shows? I'm thinking what's out at the moment.
Dr Bridget Clancy: 7:42
There was one that was out a couple of years ago. Roger Corsa was the star and I thought this is exactly what we don't need. It was essentially the trope that he was a brilliant but flawed city cardiac surgeon with a big drug habit and as his punishment he got sent out to a rural area to practice and his reward for good behaviour would be coming back to the city. So for me that just ties into stereotypes that urban is better and rural is second best. But the evidence shows that rural healthcare is excellent. So rural medical students outperform urban medical students in standardised tests. So essentially they get higher marks at med school.
Dr Bridget Clancy: 8:28
Rural healthcare gets better outcomes and it's cheaper, even though patients are often sicker when they get to a doctor rurally because they might have had delays in distance. So there are some very specific types of healthcare where care in a city is definitely better. It's not because that care is in a city, it's just because that city has a facility that's specialised. For example, if your child has a really rare disease, then that child really will benefit from being treated at a children's hospital. But for most kids' diseases, treatment close to home in a rural area is much better, and we know that people recover better when they're in their home environment, particularly surrounded by friends, family and connection to country, particularly for Aboriginal and Torres Strait Islander people. But you know what it's like for rural kids. They just want to get home to the farm. So we just people need to be treated where they live, as close to home as possible. So I thought that TV show was just. Please don't send us your flawed, drug-addicted doctors and it was just such an unfortunate show.
Dr Bridget Clancy: 9:32
It was the complete opposite of what I'd been inspired by, which were really impressive people who had more skills, not less skills, and were deploying those skills in areas that were quite tough to work in.
Kirsten Diprose: 9:43
So we know that a lot of the perceptions are wrong, but what's it actually like for doctors and nurses? Is the environment actually conducive to making them want to stay?
Dr Bridget Clancy: 9:56
We do know that, particularly at the College of Surgeons, our trainees rate their rural training posts or rural training time more highly than their urban training time. So we know that rural healthcare is a great environment to train in general. Some of the benefits and the reasons why our trainees like to train rurally is rural patients tend to be more receptive to students and say yeah, absolutely, you've got to learn, I'm more than happy for you to be involved. They do tend to need more help and more assistance in terms of patient navigation, understanding the health system, being connected with services, whereas in the city, as a specialist, you could say I've finished treating you, now you go back to your GP. But in a rural context, rural doctors are often needing to be patient coordinators and patient navigators because patients have got to travel and be connected with services, sometimes a long way away. Some rural areas are very well resourced and some are very under-resourced, and it can be much more stressful to be in an under-resourced area. We know that some doctors are predisposed to work in smaller areas where work is more challenging, because they've got a sense of what's called rural self-efficacy, meaning I can do this, I can practice effectively in a rural area and rural clinical confidence, so that ability to do your best for the patient with the skills and the resources that you and your team have got at that point in time, while advocating for them to get to where they need to go. The other part that's really satisfying is living in the community you're caring for and that you're embedded in a community that cares about each other.
Dr Bridget Clancy: 11:30
I think one of the toughest things to deal with is the on-call burden. So years ago when I was on a board of the health service, I know that our fellow board members in our community were wondering why they couldn't attract more GPs to our very small town so it's a town of only a thousand people. But the expectations they had of the GPs that they wanted to recruit was to be available 24 hours a day, seven days a week, and none of them could even conceive what that would feel like. I think farmers, particularly farmers who've got livestock, understand what that means that you can't be away for more than a certain number of hours because if the water pipes burst your stock won't have water and you'll have stock losses. So that responsibility not many people really understand and I think for doctors and nurses really the on-call burden can be really tough on their own health, their ability to get enough sleep, their ability to get enough exercise or even to go to the toilet when they need to. Healthcare can get so busy and I would like the community to understand that sometimes what they think is reasonable is unlivable and is a reason why people won't go to rural areas or to very small rural areas, is a reason why people won't go to rural areas or to very small rural areas. Because everybody needs, everybody wants to have health and vitality, and if you're on call and getting called out two or three times a night and you haven't slept for more than three hours in a row for three or four years, we all know what it's like when you've got a newborn baby Imagine that is your career for 35 years. You can't think straight, you're more likely to make mistakes, you're more likely to die in a car accident and just be really sad. So I think we need, I would like to see more conversations with community so that we could say look, we want terrific healthcare workers, but we can't work them to the ground. We need to figure out how we can have models of care where you might go to the emergency department and be presented with a telehealth screen to an ED or an emergency department in Melbourne to get some advice. Because we need to take the load off the people that are here and are committed to working. We want to preserve them.
Dr Bridget Clancy: 13:38
I remember when I was new to town and I was pregnant and I got a lot of slack from the community for being pregnant and they were. I won't say some of what people said to me, but it was essentially outraged that how dare you? You know we thought we were getting a surgeon and now you're just going to go off and have kids. And I know my legal rights as a woman and it was very frustrating, very sexist. Someone said I wish we'd gotten a male surgeon and I wasn't recruited.
Dr Bridget Clancy: 14:07
I came here because my home's here, there was no recruiting happening and there was no one competing for the role. We've tried to recruit another ENT surgeon in our region for 20 years and haven't been successful. So the on-call burden is a big disincentive for people to come. I just wish the community would understand that. I know that when you're vulnerable and you're sick, you just want someone to look after you, but sometimes that could be a GP, that could be a nurse, that could be any member of the healthcare team. We need to start being more open to having different models of care that doesn't rely on certain doctors, certain specialists, certain nurses being so specialised that they have to be on call for people all the time. It's just not safe.
Kirsten Diprose: 14:47
Who is making this decision? That someone is going to be on call for this specialty?
Dr Bridget Clancy: 14:53
So there's a couple of ways it happens. Generally the hospital's responsible for rostering and we know that anything more than being on call for more than one in every four days is unsafe, and working more than 50 hours a week is unsafe, and my basic hours as a surgeon when I trained were about 80 to 90 hours a week and when I was practicing as a surgeon in Warrnambool, 50, 60, 70 hours a week and on call every day. And it's so harmful to your health it's really terrible. But to be able to do one in four you need five or six surgeons sharing that load and we don't have five or six surgeons of my kind in our area. We've barely got five or six surgeons of my kind in our area. We've barely got five or six general surgeons or orthopedic surgeons.
Dr Bridget Clancy: 15:36
Also, a lot of my team in the operating theatre were on call. So the nurses in the operating theatre in rural areas they don't just do a day shift, they do their day shift and then they're on call all night. So if a person needs a caesarean section in the middle of the night, the nurses get called in too, just like the doctors do. So the burden of on-call for rural nurses is pretty tough as well. Whereas in cities they're on shifts, they might be on night shift or day shift or evening shift, but in rural areas on-call is a big burden.
Kirsten Diprose: 16:10
Another issue that healthcare workers in rural areas can face is career progression or the lack of specialisation. For most surgeries or specialists you have to travel to a large regional centre or the city. The Warrnambool region was really lucky to have its own ear, nose and throat surgeon practice, largely because Bridget married a farmer whose business had to be located there. I'd like you to meet our next guest now, rebecca Bradshaw, who's a nurse and really found the role of her dreams as a child health nurse, but when she moved to a small town realised there weren't many of these roles available. Let's meet Bec.
Rebecca Bradshaw: 16:53
I was born and raised in a small beef and mining town called Marra in central Queensland and then went to boarding school like lots of rural kids, but always come home and then, even when we went away to uni, we still come back, always still connected. No matter where I go, I find myself back in rural. We live in Jackson now, which is little and rural, but it's funny how it just seems to call you back, I think. So where's Jackson? Geography's not my strong point and my husband laughs at me. I'm a right or left of McDonald's, not an east and west person, but we are east of Roma, which is in central western Queensland and we are about an hour 15 from there. So we're a small little town of 45, I think it's not real big at all. Yeah, and how long have you lived there? We're coming up to three years now at Jackson. Does it feel like home? Yet it's a really beautiful little community. We are really fortunate. One day when we're adults, we'll buy our own farm, but for the moment we're fortunate enough that we live on somebody else's and that feels like home.
Kirsten Diprose: 18:04
So you're a nurse by trade, but you've really specialised. Tell me about what you do. You're a nurse by trade, but you've really specialised. Tell me about what you do. So I started as a registered nurse and then I specialised in paediatrics, which is children, so birth to 18 years old, and I specialised in the well babies. So some people who specialise in paediatrics and kids go into the paediatric units at the hospital with really sick kids. No, thank you. Far too hectic, far too life-threatening for me. I focus on the well babies.
Rebecca Bradshaw: 18:32
So originally, when I first done my graduate certificate so it's a graduate certificate in pediatrics I chose to go down that pathway because the small country town we were living in at that point had no birthing was a non-birthing hospital, which is fine. Lots of rural facilities are, unfortunately but we had this beautiful influx of babies and mums with new babies and we had such little child health support. We had a visiting child health nurse come from the other town the three hours a week, I think and so giving them the support that they needed and wanted was just there was a massive gap. So I was like I can't catch the babies so I can't do my mid, but I can certainly love the babies when they're outside and the mamas. So I went and done my child health graduate certificate and we helped close that gap in that service in that town a little bit, because we then had a mums and bubs group. We then had regular child health services for a whole day each week and I was really fortunate that the director of nursing at the time was really supportive of that. So that kind of took off like a wildfire, which was great. And then we went down to the coast and lived down there for a little while while my husband done his adult apprenticeship in diesel mechanic which was an incredible experience as a child health nurse to see how they do it differently, what services are available while my husband done his adult apprenticeship in diesel mechanic, which was incredible experience as a child health nurse to see how they do it differently and what services are available. And so then we moved back rurally and there was no jobs. There was no jobs for me as a child health nurse because they're limited positions as they are rurally, and more often than not they're occupied by people who have been in those positions for quite a substantial period of time and probably aren't going anywhere until they hit retirement. So the job opportunities for me to do what I love was minimal. I was back to doing acute nursing, which is great, but it didn't fill my cup up.
Kirsten Diprose: 20:24
Rebecca Bradshaw says making sure a nurse or healthcare provider can tap into their passion is vital in keeping them in a role or in the community and also helps to prevent burnout. And it was actually a conversation with a friend during the COVID times that made Bec realise she could do what she's passionate about as a nurse. She just needed to be a little bit creative.
Rebecca Bradshaw: 20:49
And I rang a colleague of mine and I'm like I really miss it. Tell me all the things, tell me all the babies and the mamas that you're seeing and talking to so I can live vicariously through you. And she's like Bec, I haven't seen anyone face to face. We're doing telehealth because this was the middle of COVID, right, we're doing telehealth. I'm like what she goes, yeah, I thought if what she goes, yeah, I thought if you can do telehealth to people who live down the street from you, I can do telehealth to people who live three hours from their local town. I was like hung up the phone. I rang my best friend. I'm like I've got the best idea. We're making a business out of this and I'm going to reach all the rural numbers and that's what we're doing. So I made my own job.
Kirsten Diprose: 21:23
Bec founded her own business called Rural Child Health, which helps rural mothers from anywhere in Australia. She also still works part-time in the Queensland health system.
Rebecca Bradshaw: 21:35
So, like any mum or caregiver who takes their child to a clinic for a well-baby check, we do growth and development milestones. We make sure they're meeting their milestones. We look at other parenting support around concerns or challenges you're having, like breastfeeding or solids or formula or toilet training or behaviors, transitions to kindy, bringing home a new sibling, transitioning to motherhood. So probably 40% of what I do focuses on the tiny little human, and then a good 60% of what I do is how can I help you, as the caregiver and the mum transition to parenthood, ride this wave, the seasons of motherhood that are just sometimes really tricky, and how do we best fill your toolbox up so that you can, a enjoy motherhood and, b feel like you're doing it well, Because, honestly, so many of us just go. I don't even know if I'm doing this right.
Kirsten Diprose: 22:31
I remember trying to read a baby manual, like a book about babies, before I had my first child, and it didn't make sense to me, so I was like I'm just going to put this to one side. And then, when I had the baby, I had three of them and I'm reading everything, but I couldn't even understand it until the baby arrived. Yeah, and what's interesting is I always say I was such a better parent before I had babies. I totally knew how to parent until I had children. Yeah, and I laugh. I feel like I love my big boy. He is just such a gift, but holy dooly he.
Rebecca Bradshaw: 23:08
The experience of motherhood my first time around broke me to a thousand pieces, and then I had to put it all back together, and so what I say now is where the cracks are is where my light shines through.
Rebecca Bradshaw: 23:18
Right, because and I'm a better child health nurse because of it because if I had have had the baby that slept and didn't have reflux, and that wasn't high needs and that didn't all the things, I would have been an awful child health nurse.
Rebecca Bradshaw: 23:31
I would have been like, oh, it's really not that hard actually, because sometimes we all have that little bit of sass about us. And then I experienced motherhood with my glorious big boy and all of his challenges, and I went, yeah, okay, people aren't lying when they say they don't actually crying Cause I just thought they would stop eventually, but mine felt like it never, ever stopped, he never, ever slept. And so I was like, okay, this certainly brings a new lens and a whole new bucket of empathy and understanding when I deal with parents now, which I'm grateful for. The fact of the matter with our hospital systems is that they're all under pressure in terms of, particularly in rural and regional areas, we may not have the staffing. We've got housing crisis everywhere, which makes it even harder for nurses to come into an area and find a good house for instance.
Kirsten Diprose: 24:25
So, how do we overcome some of these issues to make sure that we've got the nurses and the doctors and the other trained professionals that we need. And so it's so multifaceted.
Rebecca Bradshaw: 24:37
There's just so many turning cogs and contributing factors and it's not. If you come to me with a sore knee, I'm not going to just fix your knee, I'm going to. How does that sore knee affect your life? How's it affect your mobility? Can you walk up and down your stairs? Can you get in and out of the shower? How long has it been sore? For All of the things? Right, I think trying to work out how we can solve that problem around that attraction and retention of rural healthcare workers is somewhat similar. If we just go, we just need to throw more money at them, pay them more and they'll come. We're just putting a bandaid over it because we're not looking at. Are we supporting them in the workplace? Are the staff that they're working with adequately skilled and up to date so that the whole team work well and are supported, particularly in an emergency situation? What kind of skills is that healthcare professional bringing in? Can we support them? We've got an obstetric trained GP who comes out Fantastic, but if we're a non-delivering hospital. They're actually going to lose their skills because they don't get to practice it, and so then they come out. Do we have a house for them? What's the education system like? Are they planning family themselves? And if so, so what does their access to services look like for their family? Do they have chronic health conditions? Can they access the chronic support they need? It's just there's so many facets to it that I think it's not never a case that we just need to pay them more.
Kirsten Diprose: 26:06
No, and sometimes you hear, oh, we need to keep people here in the region that they grew up in, and sometimes I wonder. I feel like it's quite natural for someone who grows up in any area to be honest. You grow up and you go, oh, I can't wait to get out of here, see you later, and I think that's actually quite normal. And then often people come back. If you do make sure you've got those supports and incentives in place or whatever it is that makes you come back, people have family and you often realise where you grew up wasn't actually so bad after all. So they do come back, but it might not be till late 20s or early 30s
Rebecca Bradshaw: 26:47
yeah, 100, and so I you see so often and this is probably a little bit off tangent, but metaphors work well for me. It helps my brain understand life.
Rebecca Bradshaw: 26:58
You have a look at these multi-generational, like intergenerational farmers, right, and the stereotypical here, the young fella grows up going I can't wait to leave, I want to go work in somewhere else, I don't want to work for a day for the rest of my life, blah, blah, blah. So they go and all down them have big blue. So they go and then they do 10 years out and then they come back, you know, because they've got experience, they've got maturity, they've got some life experience. They've learned that not everyone's that hard to get along with or that easy to get along with. They've got some people, skills around conflict resolution right. They've got all these other tools in their toolboxes and then they come back and what they bring with them is new ideas, new ways of doing things, patience and understanding hopefully all of those things right. And then that family unit and family farm kind of flows along a bit better then right, because what can happen is you're a very different person at 30, with different opinions and values generally not always values, but compared to when you were 20, right, because of all of those things.
Rebecca Bradshaw: 28:02
And so if we don't let them and encourage them to go out have a crack at the big hospitals in the orthopedic ward, go do 12 months overseas in third world countries delivering babies, all of those incredible life skills and learning experiences enrich them and make them better for us in our community when they come back, because otherwise they'll always be Mrs Bradshaw's grade three student. They always will look 12 to their community and sometimes it can be really hard for them to be taken seriously when they are young and new practitioners and novices, particularly if they might have found themselves in a spot of bother, as teenage kids do in their local town. Those biases and judgments can be hard to get rid of. Yeah, I'd never really thought about that, but you're right, that change in perception can be really difficult. So then, how do we make it really attractive for them to move back when they're? It might be 25, it might be 30 or later. It might be 25, it might be 30 or later.
Rebecca Bradshaw: 29:10
Yeah, I think we need to look at again what's their passion?
Rebecca Bradshaw: 29:18
Is what lights them up, something that they can do 50% of the time in their role in our rural facilities or rural communities? And if it is. Let's hone in on that, because no one wants to be working 80 hours a week in a job they don't like doing because they're not going to do it well, and we need to look at making sure we don't burn them out because, as wonderful it is when they come back, everyone wants that doctor appointment. They want them on call all the time. They're the ones they see down the street. As a community we need to give them a little bit of breathing space and respect their personal life as well. Those lines get quite blurred in our rural communities because we're all close-knit.
Kirsten Diprose: 29:55
Yeah, no walking up to someone on the street and just lifting the side of your shirt and saying can you just have a look at this? Well, we might laugh, but Dr Bridget Clancy says she really had to be very strong and intentional about her boundaries as a doctor when she first moved to Warrnambool.
Dr Bridget Clancy: 30:14
We have to be really careful that we maintain privacy and confidentiality, both for our patients and for ourselves, and that we maintain boundaries. Boundaries means if I'm in small business, I can sell a dress, I can provide tractor maintenance to a friend. I'm not going to have a conflict of interest, it's not going to affect my judgment that they're my mate. But in medicine relationships affect your judgment significantly. For example, I've got lots of nieces and nephews in the area, godchildren, and I would never operate on one of my godchildren because I just could not be undistracted and clinically crisp with it. If one of them's really sick and I need to do something in an emergency to get them right before I pass them on to someone else, then I'll do that. But I need to have those conversations and say look, my judgment's going to be affected by this close relationship we've got. I've got to keep you safe, and that might mean not you or it might mean treating you in emergency. But then immediately, as soon as possible, hand you over to somebody else. And I have those conversations pretty frequently.
Dr Bridget Clancy: 31:16
And another example of confidentiality is one of my kids will say can I have Rachel over for a sleepover?
Dr Bridget Clancy: 31:23
And I'll say not for two weeks and our family knows that.
Dr Bridget Clancy: 31:27
That means I can't tell you why, but it's not appropriate for Rachel to be in our house at the moment, and that might be because I've just operated on her, so we're in a pretty small region and because I'm a specialist I'm the only one of my kind in this area all of the kids come to me for their surgeries.
Dr Bridget Clancy: 31:41
There might be times when the kids were little, when I was doing reading for their parent reading assistants in class, and I'd look around the room and think, yeah, three quarters of these kids I've treated. But it was also a good opportunity to talk to kids and educate them about privacy and consent. So if a little one or even an adult comes into my consulting room and we know each other socially or I know they know my kids or husband, they might say how do you husband for me? And I'll say I'm not going to because everything in this room is private and if you want to tell him, you can, but I never talk to my family at all about anything that happens. So that's the benefit of being immersed in a community that you care for, but also being really careful about privacy, confidentiality and boundaries so that everyone's getting what they need in the safest possible way.
Kirsten Diprose: 32:27
How do you have those conversations with, perhaps friends who you know that the health system can be really frustrating to navigate sometimes, and here you are, someone with expertise. You just want to say, oh, can you just get me in for an appointment? How do you deal with that?
Dr Bridget Clancy: 32:44
Yeah, I think I know I have offended people at times because their expectations about networks and how things work didn't fit with the ethics of medical practice. So for a lot of healthcare, particularly public healthcare, it's all done on a needs basis, so the most urgent person gets treated first. So you might hear stories of people who've gone to the emergency department and they say I waited eight hours and then ended up leaving. But what they don't realise is there's a separate entrance for the ambulance where all of the car accident heart attacks that people come through and if that's been really busy and then somebody in the weight room doesn't see all of that and doesn't understand the triage system. And sometimes I might get a call from someone saying could you come and see me in emergency because I'm sick of waiting and I'm a specialist. I don't work in emergency. If I get called to emergency you're going to be very sick if I turn up there because most of the team down there have got the skills to do what they need to do. But I can't change someone's place in the queue.
Dr Bridget Clancy: 33:43
Early on. When I first came to Warrnambool I know people would ask me if they would be able to get done earlier on a public wait list because there was a family connection They'd gone to school with someone that my husband knew, or pretty tenuous connections and I had to say no, that's illegal, that's fraud and they're not the sorts of words you use in a town where you're trying to make friends, where you're trying to fit in into a rural environment. But I haven't been able to be that kind of friend to people. I've had to preserve my reputation and for all of the community to know that everything's fair. We do things by the book.
Dr Bridget Clancy: 34:16
I don't give medical certificates to people that are not my patients. If a staff member at the hospital says, could you write me a certificate, I say I can't do that unless I'm a treating person. But doing that at the start and feeling like I knew that I was offending people, I feel like that gave me the ability to build a reputation of integrity and trust. And if you can't trust your doctor, you just don't get good healthcare. You need to be able to come into a consulting room with a doctor and know that absolutely everything that happens is confidential and everything is going to be done right. So I feel like that I had to lose some goodwill at the start to develop that relationship. I don't know how that comes across to someone who's non-medical, but it is really important for me. Stay with us.
Kirsten Diprose: 35:01
We'll be right back after this message from our sponsor.
Ash Molloy: 35:08
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Kirsten Diprose: 35:45
Now back to our episode. You mentioned before about your experience as a surgeon when you had children. My GP has had children recently and is now down to three days a week. How dare she. I'm being facetious, but you know, is there something in that? Do we still have some sort of hangovers from the days when the only doctors we had were men? Essentially, do we need to have more flexible arrangements and make that more common Now?
Dr Bridget Clancy: 36:17
I guess the first thing to say is that the more diverse the workforce is, the better health outcomes we're going to get. And women are socialised culturally to listen more, to be more careful, to be more risk averse, to look out for non-verbal cues, to spend more time with people. So people should be wanting a woman doctor because there's great evidence that they get better outcomes At a society level. Women definitely shoulder an unequal burden of home life and childcare. Even in families without children, women still do two or three times as many hours housework a week compared to their male partner if they're in a heterosexual relationship, and that holds even if the male partner doesn't work. So we are so strongly socialised that it's a woman's responsibility to run the household and look after kids.
Dr Bridget Clancy: 37:05
A really tough part of attracting healthcare workers to rural areas is the lack of childcare. When I had my kids and where we live, there was no childcare centre so we had to pay for in-home care. There is the Rural Doctors Association of Australia have got a policy where they want to see childcare co-located with rural hospitals, because we've got nurses that can't work to full capacity. We've got doctors that can't work to full capacity because they wait two or three years for a childcare position. So it's quite common for nurses and GPs and specialists who are women to not be able to work full-time, even if they wanted to, because they just can't get childcare.
Dr Bridget Clancy: 37:46
It's everybody's right to have a child and we can't expect that. We go back to the days when most doctors were men and that they had a wife at home who would look after everything childcare, the whole lot. That's just not realistic. It's not how the world works anymore. But if we had childcare attached to health facilities and to hospitals in rural areas and that childcare was flexible enough to allow the usual nursing shift that starts at 7 and evening shift that finishes at 10, or to have the available care so that if a doctor gets called in after hours there's someone to look after their child, that would make a big difference to how much health service is available.
Kirsten Diprose: 38:25
Do you think that's?
Kirsten Diprose: 38:26
viable. I think that's a great idea, but we are just struggling to get people to work in childcare. We know the pay is not good. There is work being done on career progression so that a person who works in childcare can perhaps over time go into other sort of caring education roles, but there is such a difficulty in attracting people to child care. Is it possible to have in-house care for rural areas?
Dr Bridget Clancy: 38:54
I guess if we take a focused in view, is it viable. Everything costs money. If we take a really zoomed out view, how can we afford not to have great early childhood education for our children? If we want to be the kind of country that can cope with the changes that are coming, if we want to have kids that can get into good jobs in rural areas, then if we are not spending that money on childcare and early childhood education, we're not going to get what we want. We're going to continue a cycle of rural people having less opportunities to complete high school and to go into further education.
Dr Bridget Clancy: 39:31
We really want to be training our kids to become the health workers for our communities in the future and the only way they're going to become nurses and doctors and allied health professionals like physios is if they have great childcare, great primary schools, great secondary schools and then have the ability to train in health fields in rural areas.
Dr Bridget Clancy: 39:51
We know that people who are from rural areas, who've got experience working and training in a rural area, are much more likely to come back to that community to work or to serve in another rural community. So I would say we must do this because, although it's going to cost money, it's going to have an enormous payoff in the future. I'm sometimes frustrated that, although I know everybody has to work within a budget and federal governments and state governments and councils, we all have to work within budgets but we know that for every dollar spent in healthcare, there's an enormous return in productivity for that worker and a reduction in loss of productivity for that worker being off work or for their family having to travel with them for care. So healthcare is an investment as well as a cost.
Kirsten Diprose: 40:35
What about that attraction piece? Is that important too, about making sure we're getting people to come to rural areas, perhaps people who are not from that area to start with?
Dr Bridget Clancy: 40:46
Yeah. So our research has shown that to build a rural workforce you need to do multiple things at multiple points along the career pathway. You can't start with a fully qualified health professional who's loving living in the city and then say, now let's try to get you to the country. It doesn't work because we mainly make decisions based on our sociocultural unit, meaning where our people are and where we want to be. So we're starting too late if we're trying to attract people who are already well established in urban areas. What we know is that if we give positive rural training experience to doctors and nurses and allied health professionals, that they are two to three times more likely to become a rural doctor, and that holds for urban people. So if you're an urban student who comes out to do rural placements, particularly spending at least a year in the country, you're two to three times more likely to become a rural doctor. But it's even more effective if we take rural origin students into health degrees and the government's got a definition of rural origin which is five years continuous or 10 years cumulatively before you enter university. So if we select for that and then we also give some positive experience during medical school and then if after they graduate, they do their early career training in rural areas. All of that adds up and they can, I think, for general practitioners. If they've got those three things in a row. So rural origin, rural training and rural work experience they're 40 times more likely to be a rural GP.
Dr Bridget Clancy: 42:23
So there's really great ways that we know that we can build the rural workforce. We don't want to just take rural kids, because we know that urban people with positive rural experience are more likely to become rural and we need to focus on the positive experience part. If you've got a negative work experience, you're not going to work again. We are rational beings. We're not going to go back to a place that didn't serve us well. So part of that positive rural work experience is having a healthy culture, healthy workplace environment and safe, sustainable hours. So getting people to come to the country and then making them work 24 hours a day and burning them out, they will not come back and they'll tell all their friends that this is too hard, it's not safe, it's not good for my health or the health of my family and one bad experience can really turn a trainee off their entire profession.
Kirsten Diprose: 43:12
Rebecca Bradshaw says trainee doctors and nurses really need to be in a supportive environment,
Rebecca Bradshaw: 43:20
because that doctor might be able to intubate and put arterial lines in and do all those really incredible life-saving things. But if the nursing staff aren't comfortable and competent in supporting that doctor, he can't do that on his own. There is no I in team in a rural emergency department, and so if the whole team can't support the doctor's skills and the doctor doesn't have appropriate mentoring, then everything comes undone quite quickly as well. And unfortunately, that's where lives are really at risk is when that happens, and we don't want them to come back and have a death because of systems failures, that swish cheese event and then they don't want a doctor anymore and then they just leave to professional. They go back to the city where they're more supported and mentored.
Kirsten Diprose: 44:08
I know that doctors do, locums and nurses move around a little bit too in their training days. How do we attract people from outside a region, or is that not something we should be trying to do?
Rebecca Bradshaw: 44:22
Oh, we should be. We absolutely should be trying to do that. We need to as community, though when we do that, remember that they have no idea what our lifestyle is like. Like they've got no concept of three o'clock in the morning seating because the rain's coming. Like they've got no concept of like it's not uncommon. We get lots of locum doctors come through and I love them. They're fantastic because they bring a whole other aspect and lens of medical knowledge with them, but they very much need our nursing support of oh, mate's coming with fevers and this and that and they go okay, it might be influenza and I go, it could be. It could also be leptobucillosis Q fever, and they look at you like I'm speaking another language because that's not any of the diseases that they've been exposed to in the metro space, which is not their fault. We just need to realize that if we're going to bring all of these non-rural background people out which would be wonderful we need to make sure that we support them and help them understand what the differences are in our rural background.
Rebecca Bradshaw: 45:31
If we get a farmer who walks in, fully stereotypical. But if I get a 50 to 60-year-old farmer who comes in and goes, oh Bec, just come to say g'day and just see if you wouldn't mind checking this leg out for me Like dude, or he comes in and he goes, yeah, just a bit tight in the chest, full attention, right. But if they have got off their tractor and they have driven themselves to hospital and they have said to a kind of young female hey, actually I'm not a superhero, we 1000 need to be investigating that immediately. Yeah, you gotta be sending them to the hospital, to ed generally. And so we get that, because we know what our rural farmers are like. But we also need to support our non-back, non-rural background doctors to be like, hey, no, you really need to go see him before he just gets up and walks out because he's sick or waiting. We've done really well to get him here. Can you just pop over and say hello for us?
Rebecca Bradshaw: 46:30
And so we need to make sure that, instead of giving them a hard time of oh, how do you not know that, we gently expose them to what our rural lifestyle looks like, which isn't Farmer Wants a Wife and the romantic novels. It's not that. Yeah, that's a great point For anyone. That's not that. Yeah, that's a great point
Kirsten Diprose: 46:55
For anyone.
Kirsten Diprose: 46:56
That's not in the health industry. Because I think a lot of us care deeply about health, myself included, but I'm not a health professional in any means, but I'm someone who cares about community and you can't have a good community without having an adequate health service. How can we, as just members of the community, help support our health professionals so that we do make it better for them, so that they can stay here and enjoy their jobs? Yeah gosh, that's a beautiful question. I love that because that that in itself, if you've got a community who even care about that, you're already halfway there, okay.
Rebecca Bradshaw: 47:30
So a couple of things we can do is, when a new doctor or health professional comes to town, introduce yourself, but keep telling them your name because chances are they're not going to remember. Introduce yourself, say hi, let them know your favourite part about the town. Hey, did you know we've got soccer tomorrow night at 5 o'clock. You're welcome to come down down. There's a sausage sizzle, there's a scent sale next weekend, the qcwa barbecues on the third friday of every month, whatever. Tell them about the community stuff, because they have no idea what and a lot of that. Community knowledge is just community knowledge. It's not on a billboard somewhere. That's here's the calendar and this is where all the stuff is, so it's not overly easy for them to find the information to join in the community.
Rebecca Bradshaw: 48:15
The other thing is we get a lot of locum doctors that come out and visit and English isn't their first language. Kudos to them for coming out to a rural place when English isn't your first language. So just give them a little bit of grace. Okay, tell them I can't understand you. Can you please repeat that? Ask the nurse to come in with you. Chances are we're pretty good at that by now deciphering and interpreting as such. So give us a way. One of us will happily come in and sit on your consultation or your appointment and help bridge that language barrier, because that's a huge, a huge barrier barrier, I think, for a lot of our rural communities and our non-rural background health professionals that come out, see if you, or take someone with you. If you're elderly, take a younger person with you so they can hear a bit better and understand and help translate. But I think just those general human kindness things go a long way if you're friendly enough enough with them.
Rebecca Bradshaw: 49:10
Hey, we're going to do some mustering. We're going to do some. Well, mustering is probably a bit tricky, but we're going to process some cattle on the weekend. Do you want to come out for an hour and watch us put them through the yards. These people have never seen that number of cattle or that number of sheep, or patted a horse before, or patted your pet, pet duck, like whatever it is. That's your menagerie. Maybe that's just us we have menagerie. Bring them out, let them enjoy and experience that rural lifestyle so they can see why we love it so much, so they will fall in love with it too I don't know I don't know if I'd invite someone out to the farm.
Kirsten Diprose: 49:45
My husband keep them there for five hours and they'd be doing hard work in the backyards running the stock up in no time.
Rebecca Bradshaw: 49:52
But the beauty of that is if they can just see what we do, they don't even have to be involved because obviously we want them to keep them safe.
Rebecca Bradshaw: 49:59
But if they can just see some of what we do on a daily basis and how big these tractor wheels are and how long those spanners are the shifted spanners and that are, so when you know and how long those spanners are the shifted spanners, and that they then can understand oh, mate had the tire lever and it flicked off and smacked him in the chop. So we're not talking about a sedan tire lever that's this big. We're talking like big, heavy stuff. So they can just understand our lifestyle a bit better. If you've got that opportunity, most of them will jump at it.
Kirsten Diprose: 50:28
I love that advice from Bec because it's something we can all do to help someone feel welcome. Dr Bridget Clancy is tackling some of those systemic issues with her strategic brain, really encouraging doctors and specialists to be trained at rural education hubs and hospitals. She's also tackling that perception issue around rural areas, that that, yes, while we currently struggle with equitable health care, rural life is actually really great.
Dr Bridget Clancy: 50:58
Often when I'm giving speeches internationally and nationally about rural health equity, I've got to start with the data that shows that 30% of Australians are rural and remote and regional, but only a certain percentage of health care is provided in those areas and that we get worse health outcomes on all these different metrics. And I do get really sick of that deficit discourse. So I'm now trying to make sure that I also talk about something called the happiness paradox. So internationally, in all developed countries or wealthy countries, rural people are much happier than urban people and it's called a paradox because, on the one hand, rural people are much happier than urban people. And it's called a paradox because, on the one hand, rural people have a lot less access to resources like healthcare and education and that sort of thing, and to get to some of those resources is a long drive. But paradoxically, rural people are always happier. And in Australian and New Zealand studies, the unhappiest people are in Auckland in New Zealand they're the least happy New Zealanders. And Sydney, and I've just come back from a week of working in Sydney and I think it's gorgeous, but I'm so relieved to get home. So the physical beauty of where we are. So the theory is that because we're in such proximity to green space and nature and that we can do particularly physical activity in natural environments. That's an enormous health benefit for us. But also we've got high social bonding, so you can have lots of connections and know lots of people, but they're not very deep connections, whereas rural people tend to have fewer connections but they're much deeper and we tend to have a much stronger community bonding ties, higher volunteerism, more sort of organised events where everyone in the community is welcome. So I'm trying now to talk more about a strengths-based discourse for rural, where it is fantastic and it's such a relief to drive back into town.
Dr Bridget Clancy: 52:42
Urban people will often have rural places that are close to their heart. Either their grandparents farmed or they might ski or surf or enjoy hiking, and I say all these gorgeous places that you think of, that's where I live. That's where I live all the time. That's not a holiday destination for me, this is my real life.
Dr Bridget Clancy: 53:00
So if you're a younger person or even a mature person in rural areas and you're thinking of training in a health field, I would absolutely recommend it. We often talk about what's hard, but that's because we're problem solvers and we want to figure out what the problem is and what we can do to improve it. And I know, compared to my sisters who did corporate careers, that I have always had a strong component of my work that gives me a sense of wellbeing, because when you're being kind to people and when you're providing something to them that really matters at a time in their life that's really tough. You get this beautiful sense of wellbeing and that's a really important part of the career. But it's also very intellectually stimulating and we all would love for our kids to have careers where they can still enjoy that fantastic rural lifestyle and be around family and friends, but have really stimulating, well-paid careers, and I feel like health is a great way for us to get there.
Kirsten Diprose: 53:54
Just on that. Is there that message or understanding that you can still have a great career in the country, because in so many other careers there's still this idea that you've got to make it in the city and if you haven't, then you're going to miss opportunities or you're not as good as your job than others? Is there still that there?
Dr Bridget Clancy: 54:14
is that. But I also know that because I worked where I worked and I was married to a farmer and we live in a very small town. I drive a fair bit of distance to work in and find a town big enough to work in. I actually think that was the basis for some of the innovation that I've done and some of the research that I've done and the advocacy work. If I was in a city hospital, I would have looked at the world in a different way.
Dr Bridget Clancy: 54:36
I think it is good to spend a bit of time in the city when you're young. It's quite fun and it'll also teach you that things are just as good in rural. So there's an idea called the halo effect, that if you're working in a big city hospital with a big reputation, you think you're a better doctor than you are because you don't have to test yourself. Everything's laid on for you, all of the services are there and all of the people to help give you advice. But if you go and work somewhere rurally and test your skills, you start to really know if you're any good. So I think doing a bit of both when you're young and moving about and having some fun and meeting some great people is wonderful. So I think that if you're worried that you will never feel like you've made it unless you've been in the city, go to the city for a while, just scratch that itch. And I particularly I wanted to work in a big trauma centre, wanted to work somewhere really big, so I knew I'd done it and I had to do that.
Dr Bridget Clancy: 55:24
For my training there were no options to train rurally. But the great thing with health training is you can move around a lot during your training. That's quite encouraged. But so many people come back to rural and I know our trainees say they can't believe how efficiently my theatre runs. They can't believe the results we get.
Dr Bridget Clancy: 55:39
I know a lot of the equipment that I had in my private practice was better than in the public clinic at the Alfred Hospital because I invested in good equipment. We were early adopters of lots of technology so I'm skilled in some types of operations that some city surgeons haven't started doing yet, and that's because if there was a business case and a health case, our local health services were happy to invest in the equipment. So I think being rural, we're more agile because our teams can be smaller and we developed a lot of trust in each other. We don't need to think that we can only get a really high flying career in the city, and I think it's. Often. Being located in a rural area allows you to look at the world a bit differently and to come up with those innovations that if you're living in the same place with a lot of other people doing the same things, you're not going to differentiate yourself.
Kirsten Diprose: 56:24
And that's it for this episode of Ducks on the Pond. Thank you to our guests, dr Bridget Clancy and Rebecca Bradshaw of Rural Child Health. You can find Bec on Instagram at Rural Child Health or contact her via her website. Thank you for listening and thank you to Buy CC Fine Jewellery for sponsoring Season 7. Next week will be our last of this particular series and we'll be announcing the winner of the buy cc fun jewelry giveaway, so get your name in before july 14. Head to the ducks website for details. This is a rural podcasting co-production. Check out our other podcasts town criers and two smart blondes. Are you wanting to start your own podcast? I can help you there too. Head to ruralpodcastingcocom for more information. My name is Kirsten Diprose and I'll catch you again soon.
