AMBULANCE SERVICES play a key role in the Australian health system, as the primary providers of pre-hospital clinical care, emergency care and specialised transport. 1 Although at present there is a strong focus on broad health system reform, and health workforce reform specifically, little attention has been paid to the place of prehospital clinical care and the paramedic workforce that provides these services. Despite their significant role in the health system, there is no strategic national approach by government to the development of ambulance services or the paramedic workforce.In this paper, we review current and emerging trends impacting on the paramedic workforce. We examine changes in patterns of ambulance service provision and the nature of clinical work undertaken by paramedics, as well as developments in education, training and career pathways. We focus on the current situation in Victoria to illustrate and identify a number of important implications of current changes, for the profession, service and training providers, and policy makers.

Women make up less than a quarter of the rural general practice workforce and an even smaller percentage of the specialist rural medical workforce. As a result their experiences are not well articulated in research on rural medical practice and their needs are not well represented in policies and programs for rural doctors. The incoming cohort of rural general practitioners has a majority of women and it is essential that the practice styles and needs of women doctors are understood in order to attract and retain women in rural medicine. This survey identifies some of the effects of family responsibilities on the work practices of female rural doctors and the changes needed to the structure of rural practice to include the way women work.

ObjectivesTo investigate the major stressors affecting GP registrars, how those at risk can be best identified and the most useful methods of managing or reducing their stress.Design, setting and participantsCross-sectional postal questionnaire of all GP registrars in one large regional training provider's catchment area.Main outcome measuresThe Depression, Anxiety and Stress Scale (DASS), a specifically developed Registrar Stressor Scale consisting of five subscales of potential stressors, plus closed questions on how to identify and manage stress in GP registrars.ResultsSurvey response rate of 51% (102/199). Rural difficulties followed by achieving a work/life balance were the principal stressors. Ten percent of registrars were mildly or moderately depressed or anxious (DASS) and 7% mild to moderately anxious (DASS). Registrars preferred informal means of identifying those under stress (a buddy system and talks with their supervisors); similarly, they preferred to manage stress by discussions with family and friends, debriefing with peers and colleagues, or undertaking sport and leisure activities.ConclusionsThis study supports research which confirms that poor psychological well-being is an important issue for a significant minority of GP trainees. Regional training providers should ensure that they facilitate formal and informal strategies to identify those at risk and assist them to cope with their stress.

In Australia, half the medical students are women. There is increasing evidence that women engage with medicine differently from men, and medical workforce planners are being required to consider the implications of this change, particularly in areas of medical need. Between 1996-2001, the Australian government provided funding for teaching about issues for female rural doctors to encourage female students to consider rural medical practice. This was extended to include teaching about gender issues for doctors. Introducing this teaching has required building credibility for the topic among funders, faculty and students, training tutors, and meeting the need of students for an intellectual framework within which to think about gender and medicine. Teaching about gender requires conscious leadership by senior academic women. This paper describes an initiative in the rural curriculum for medical students.

The most important and frequent effect of abortion was to make women feel more competent in managing their lives. The skills required to locate and access an abortion clinic against a backdrop of general social disapproval, expanded their sense of themselves as actors in their own lives. Their stories, as well as networks of support, enabled them to integrate abortion into their sense of themselves as good women.