In 2019, it was estimated that around 28% (7,000,000) of Australians live in regional, rural or remote locations.1 Those living rurally report increased life satisfaction and increased connections with their communities.2
‘Rural’ is defined in many ways, including geographically (size and distance to other places). The Australian Institute of Health and Welfare defines rural as all areas outside major cities.1 Rural towns in Australia are geographically diverse with varying histories and demographics. Practising as a rural GP may be quite different to practising as a remote GP due to the practice location, practice demographics and case presentations. Remote communities are typically smaller, more isolated and have higher percentages of Aboriginal and Torres Strait Islander patients.3
Australians living in rural and remote areas have unique health concerns that relate directly to their potential social isolation, socioeconomic disadvantage and distance from health services.4 Nationally, residents living outside a capital city in Australia are more likely to die from cardiovascular disease.5 Health risk factors include higher rates of obesity, higher alcohol consumption and a greater percentage of smokers than metropolitan counterparts.
People living in rural and remote areas are more likely to die at a younger age than their counterparts in major cities, with higher rates of accidents involving motor vehicles, agriculture and mining. They have higher rates of potentially avoidable deaths, under the age of 75, from conditions that are likely preventable through primary or hospital care in major cities.1
Recruiting and retaining an adequate rural health workforce is a challenge.6 Currently, the majority of our Australian trained medical graduates working as rural GPs are of metropolitan origin.6,7 Governments continue developing strategies to ensure that people in rural Australia have good access to medical care, with regular reviews of the effectiveness of workforce distribution policies.7,8 Incentives, recruitment of overseas-trained doctors, allocating medical school places for students of rural origin and increasing training in rural locations have all been trialled to address our maldistributed medical workforce, with mixed success.7,9
GPs are important for resilient and healthy rural and remote communities and are essential for a coordinated and efficient health system.10,11 Delivering quality healthcare to rural patients can be both rewarding and satisfying, with evidence suggesting that rural GPs enjoy high levels of job satisfaction.12 However, practising medicine safely in a regional, rural or remote setting may require a wider scope of practice, depending on the practice context, and non-GP specialist services available.10,11,13 A rural GP is more likely to deliver procedurally based care and may also practise extended skills in mental health, Aboriginal and Torres Strait Islander health, palliative care, emergency care, obstetrics and other areas of medicine.8,9 GPs practising in rural locations might need to adapt their skills over time to meet their community’s changing healthcare needs.
Rural GPs report challenges related to geographical isolation, reduced access to non-GP specialist care and increased after-hours care provision.11 Practising rurally requires a support network as there are potential challenges around self-care, professional boundaries and work–life balance.12,14
A rural GP often acts as a healthcare team leader and requires sound communication and IT skills, including familiarity with telehealth care.4 Telehealth is an increasingly useful tool to enhance and support the role of rural GPs, especially in more remote contexts, notwithstanding the potential limitations of telehealth in certain situations.15 Travelling to receive care in urban areas is not always an acceptable option for rural patients.
Rural general practice is a rewarding place to work and train. It affords the opportunity to teach and provide positive learning experiences for the next generation of GPs. Positive experiences in primary care in medical student training can have a positive influence on future career choice in rural practice.16 When training rurally, there is the opportunity to be more hands-on, see a greater breadth of common conditions and develop increased procedural competence.17 Additionally, there is the potential to recruit future doctors to work regionally, rurally or remotely.