A Royal Australian College of GPs (RACGP) visit to Karratha in Western Australia's Pilbara has highlighted opportunities for remote supervision to meet the challenge of building the GP workforce in rural communities.
The trip coincides with the commencement of a new GPs in training under in-person and remote supervision in Karratha.
RACGP Rural Chair Associate Professor Michael Clements and RACGP staff visited GP training supervisors at:
- Panaceum Karratha, a remote supervision GP training site
- Sonic Health Plus Karratha, which offers in-person supervision for GP training
- Karratha Hospital, which provides remote supervision GP training
- Mawarnkarra Health Service, an Aboriginal Community Controlled Health Organisation (ACCHO) that provides in-person supervision GP training.
Karratha is a mining-focused community 1600 kilometres – a two-hour flight or 16-hour drive – north of Perth. The rapidly growing city sits in the traditional lands and waters of the Ngarluma people, near the Dampier Archipelago, which has been called the world's most prolific prehistoric rock engraving site.
However, Karratha's rapid growth has led to a "dire" shortage of accommodation, with new arrivals who do find a house facing among the highest costs in the country, with a median rent almost double that of Perth. With its population expected to grow by 35% by 2030, the city also needs more GPs.
Associate Professor Clements said while remote supervision has helped place GPs in training in the community, access to accommodation, childcare, and travel are significant barriers.
"The RACGP's remote supervision of GPs in training at appropriate accredited practices means we can have more GPs training at more remote communities," he said.
"Remote supervision can help to ensure Karratha has the GPs it needs, but these future GPs also need to be able to access housing and the services young workers and families need like childcare.
"Karratha has a lot of young families coming in, so it needs more GPs to ensure those families can truly settle here. Access to a GP can be as much of a bottleneck to a community's ability to grow as access to other services and housing.
"It's not just the cost, which we've been able to help mitigate through RACGP placement incentives that allow GPs training in rural and remote areas to access funding to cover housing, moving, and living expenses, like childcare.
"What's also needed is access. A rural or remote community shouldn't miss out on a future GP because they're willing to move there with a spouse and children, but they can't be sure they'll be able to access suitable and affordable housing or the childcare they need.
"GPs in Karratha have told me it's access to childcare and housing that's been the biggest barrier to attracting future GPs to train here and hopefully join the community long term."
One GP in training to make the move to Karratha is Dr Nicole Wong, who joined her civil engineer partner in the city last week to train as a GP at Panaceum Karratha under the remote supervision of Geraldton-based GP Dr Keith Figueiredo.
"I worked with my RACGP training coordinator to find a placement in Karratha," she said.
"My partner and I knew we wanted to live in the country, and my first week has been great. Karratha has far more young families than other rural areas. Almost all may patients this week have been women and children, which is a contrast."
Dr Wong developed an interest in rural general practice through a placement during her final year of medical school and joined the same supervising GP's practice in the coastal town of Dongara for her previous GP training placement.
"In hospital you can feel like a face in a crowd, but as a rural GP, you are part of the community," she said.
"You build continuing therapeutic relationships and you're a true family doctor. A parent will bring their child in one week, and the next week, you'll see them for their consult. You build trust.
"And especially in a place with so many young families like Karratha, it's easy to see yourself practicing here for years, taking trips to camp in Karijini or the Bungle Bungles.
"If you grew up in the city, you need to experience rural life to see your future there. In my last placement in Dongarra, we had medical students rotating through like I did four years earlier, and you could see they loved it.
"General practice means being able to build long-term relationships, but being a rural GP takes that to another level."
Her training supervisor Dr Keith Figueiredo said to attract more GPs to train in Karratha and join and serve its growing population of young families, they need access to accommodation and childcare.
"There have been doctors who are competent, suitable and willing to work in the country, but that they couldn't get childcare or suitable accommodation has meant they can't train here.
"If you don't have access to the general practice care you and your family need, young families can't join the town. Good GPs are an essential building block for any community, and they need housing and childcare to make that happen."
Dr Figueiredo knows that challenge well. His Panaceum practice group is headquartered in Geraldton, but has a long history of connection with and support for rural and remote communities in the in the Karratha region.
He says he sees remote supervision as part of Panaceum's practice commitment to Karratha. Throughout Dr Wong's first week, he has been helping her get to know the local people, systems, and referral pathways, but next week he'll return to his Geraldton practice and support Dr Wong as a remote supervisor.
Dr Figueiredo says he's confident she'll thrive at Panaceum Karratha.
"Nicole's doing brilliantly, I think I've got a great registrar here," Dr Figueiredo said.
"She's very competent and the right fit, and someone who wants to work in the country. I think she'll be great for the local community going forward.
"For me, the key to remote supervision is setting GPs in training up for success. They need to feel supported. That means being available for a text or call anytime they need advice or reassurance, ensuring they know the software and referral pathways, and making sure they feel part of the community.
"You need the right GP in training, but it's a fantastic option to connect GPs into communities where they're needed."
One way Dr Figueiredo's group maintains community across its three practices are weekly online tutorial sessions for fellowed GPs and GPs in training, where GPs present on a clinical topic to colleagues, such as managing uncertainty, mental health, having difficult conversations, menopause, or the latest resources and practices for breast cancer checks.
"We cover all sorts of topics GPs may find useful, but it's also about building collegiality, being part of a team, and offering each other support. That's essential for all practices, but I think that's especially the case for remote supervision of a GP in training."
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