The belief that non-GP specialists are inherently safer and more useful to the health system than GPs is a concept that has served rural Australia very badly over the last 50 years. It has resulted in widespread loss of services in the bush, coupled with severe workforce shortages. That belief still appears to drive government policy and the actions of health bureaucrats, despite the platitudes we hear from them about the central place of General Practice in the health system.
This lack of interest in rural General Practice has resulted in the failure to provide high-level training in hospital skills for GP graduates, and hence the workforce crisis we now see.
Keys to the success of the Queensland Rural Generalist Pathway have been adequate salary and access to the necessary training posts.
Rural doctors have long argued for a change in approach, and have had a significant win with the establishment of the Rural Generalist Pathway (RGP), though this is but one battle in a longer campaign. Eventual success requires a change of attitude from health service bureaucrats in particular, and a better balance between sub-specialists and generalists.
Every recent workforce review concludes with the advice that our health system has too many of the former and not enough of the latter, and this has consequences for the workforce in rural Australia.
It is worth restating the generalist paradox, that while sub-specialists perform a specific task better than the generalist, in the real world, patient outcomes are better where generalists are central to patient care.
A significant step towards rebalancing the workforce will be parity in pay and conditions in the rural public hospitals.
We also need to see action on private GP incomes, but that is a fight for another forum.