Medicine in the mountains
By Dr Angela Stratton
In your head, picture rural medicine in Australia. What images come to mind? The red, dusty soil of the outback? Endless stretches of dry grassland?
For many junior doctors (including my younger self), this is how Australian rural general practice is imagined. It was not until I started training as a rural generalist (RG) that I discovered alpine medicine.
My pathway into rural general practice
My path to rural general practice was not as straightforward as it was for others.
I studied medicine in Newcastle and participated in the John Flynn Scholarship scheme in a remote town in Western Australia.
My placement was a valuable experience and I was quite altruistic (I wanted to save the world one rural community at a time), but whilst I was there I realised that remote rural medicine was not for me.
I wrestled with the cognitive dissonance of not wanting to be a city GP and yet being unable to see myself in the outback.
As part of my final year of medical school, I completed a primary care elective with a GP obstetrician in Albury. Here, my eyes were opened to the fact that rural procedural general practice did not have to be incredibly remote.
After this placement I went on to join the Australian College of Rural and Remote Medicine (ACRRM) in my prevocational years and completed my Advanced Diploma with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (DRANZCOG).
I relocated to Mt Beauty and Falls Creek as a GP registrar. It was here that I discovered the true meaning of rural generalism and my love of alpine medicine.
Rural generalists have an extended scope of practice according to the needs of their community.
Alpine medicine as a rural generalist
At Mt Beauty I am part of a team of eight rural generalists who run a small ten-bed rural hospital year-round, plus the Falls Creek Medical Centre during winter.
A typical day for me begins with a ward round with other rostered staff, which fosters collegiality and allows us to provide teaching to our GP registrars, interns, and medical students.
Following this, we see patients booked at the clinic. I feel privileged to have a true connection to my patients and community; it is really rewarding to be able to care for your patients in both hospital and primary care settings.
Winter is a special time of year at Mount Beauty (imagine skiing before work), but it does bring challenges.
There are no nurses, very limited resources, and the resort can become cut off from retrievals in bad weather.
As an RG you are required to do more—this in turn increases your skills and you find you continually grow and learn as a doctor.
All Mt Beauty RGs have a GP Radiology licence to take and interpret x-rays, which comes in very hand handy for all the cycling and ski injuries that we see.
We also have a close relationship with the local paramedics and ski patrol and can be called to assist with accidents or resuscitations.
You do not have to be an RG to do what I do, but my RG training ensures that I have the skills I need to go anywhere and deal with whatever comes my way.
Opportunities beyond the clinic
Rural generalism has also provided me with other professional opportunities that I had never considered.
In addition to my clinical work I have a special interest in medical education and am the Statewide Clinical Lead for the Victorian Rural Generalist Program. I have also been a medical educator for MCCC GP Training and part of the ACRRM exams team.
Being an RG has genuinely changed my life for the better. Job satisfaction is high, and the work life balance is not a myth (if you do not want it to be).
Rural generalism gives you flexibility and there is so much you can do.
Things I never would have done if I were not a rural generalist
- delivered a baby in a blizzard
- managed lots of trauma with no nurses
- medic at the Commonwealth Games
- obtain a radiology licence
- attend many road/cycle accident (pre-hospital)
- deliver meningococcal prophylaxis to 160 household contacts
- provide home palliation and trained to provide Voluntary Assisted Dying
- taught school-aged kids about sex and STIs
- taught elderly ladies about sex after cancer
- took my kids to work—a lot
- sat on a Board
- ran college exams sites
- deliver medical education
- presented at conferences
- go back to university
- had a third child.