The provision of general surgery in rural Australia: a narrative review

Paynter, Jessica; Qin, Kirby R; Brennan, Janelle; Hunter‐Smith, David J; Rozen, Warren M

doi:10.5694/mja2.52232

Cited by 5 publications

(1 citation statement)

References 64 publications

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“…Between PGY5 and PGY10, there was a net increase in non-metropolitan practice, mainly due to non-GP [18][19][20] Rural sites may need to think outside of the normal structure, such as taking more of a regional hub (or network) approach in order to meet many of the training requirements. These results highlight the importance of nonmetropolitan-based vocational training opportunities for non-GP specialties to address the specialist shortage in regional and rural areas.…”

Section: Discussionmentioning

confidence: 99%

Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities

Seal,

McGrail,

Bain-Donohue

et al. 2024

BMJ Open

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ObjectiveThis study aims to determine the associations between specialty type and practice location at postgraduate year 10 (PGY10), matched with PGY5 and PGY8 work locations, and earlier rural exposure/experience.Design and settingA cohort study of medicine graduates from nine Australian universities.Participants1220 domestic medicine graduates from the class of 2011.Outcome measuresPractice location recorded by the Australian Health Practitioner Regulation Agency in PGY10; matched graduate movement between PGYs 5, 8 and 10 as classified by the Modified Monash Model, stratified by specialty type (predominantly grouped as general practitioner (GP) or non-GP).ResultsAt PGY10, two-thirds (820/1220) had achieved fellowship. GPs were 2.8 times more likely to be in non-metropolitan practice (28% vs 12%; 95% CI 2.0 to 4.0, p<0.001) than graduates with non-GP (all other) specialist qualifications. More than 70% (71.4%) of GPs who were in non-metropolitan practice in PGY5 remained there in both PGY8 and PGY10 versus 29.0% of non-GP specialists and 36.4% of non-fellowed graduates (p<0.001). The proportion of fellowed graduates observed in non-metropolitan practice was 14.9% at PGY5, 16.1% at PGY8 and 19.0% at PGY10, with this growth predominantly from non-GP specialists moving into non-metropolitan locations, following completion of metropolitan-based vocational training.ConclusionsThere are strong differences in practice location patterns between specialty types, with few non-GP specialists remaining in non-metropolitan practice between PGY5 and PGY10. Our study reinforces the importance of rural training pathways to longer-term work location outcomes and the need to expand specialist vocational training which supports more rural training opportunities for trainees outside general practice.

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Section: Discussionmentioning

confidence: 99%

Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities

Seal,

McGrail,

Bain-Donohue

et al. 2024

BMJ Open

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Rural general surgical provision from the perspective of twenty‐two rural general surgeons: a thematic analysis

Paynter,

Qin,

Hunter‐Smith

et al. 2024

ANZ Journal of Surgery

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BackgroundAustralia continues to suffer from a geographical maldistribution of general surgical services with only 20% of general surgeons working rurally despite 29% of Australia's population residing outside major metropolitan centres. This qualitative study explored the impact of human capacity and infrastructure upon rural general surgery provision.MethodsThis qualitative study employed semi‐structured interviews of rural general surgeons. Participants were recruited via the Royal Australasian College of Surgeons (RACS) Rural newsletter and purposive sampling. All interviews were conducted between January 2023 and April 2023. Transcripts were transcribed, de‐identified, and thematically analysed.ResultsTwo female and 20 male rural general surgeons were interviewed from seven of the eight Australian State or Territories. Four main themes were identified which reflected the impact of human capacity and infrastructure upon Australian rural general surgery provision: (1) small hospital syndrome – and the impact, (2) the rural general surgeon identity, (3) infrastructure and disempowerment and (4) over‐reliance on visiting surgeons.ConclusionImproving access to equitable general surgical care for rural Australians requires appropriate infrastructure and a well‐trained, sustainable multidisciplinary surgical team (human capacity). A greater understanding of the issues may help drive rational, long‐term supportive solutions.

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A review of emergency laparoscopic cholecystectomies in Far North Queensland

Sawyer,

Buschel,

Tang

et al. 2024

ANZ Journal of Surgery

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BackgroundAccess to laparoscopic cholecystectomy is more limited for remote communities and Indigenous patients internationally. To date, studies exploring the incidence of gallstone disease and access to laparoscopic cholecystectomy in Australian regional communities are limited. This study examined the rates and outcomes of emergency laparoscopic cholecystectomy (EMLC) in Far North Queensland, specifically in Indigenous and remote populations.AimsWe retrospectively examined all patients who underwent an EMLC at Cairns Hospital between 2016 and 2021.ResultsOver the study period, 634 EMLCs were undertaken. The average annual rate of 56 cases per 100 000 was considerably lower than national estimates. However, rates of EMLC were significantly higher in remote communities and Indigenous patients compared with the remaining cohort. Patients from remote communities were more likely to have pre‐existing gallstone disease but were less likely to have been seen in a surgical outpatient clinic prior to admission. Despite this, surgical outcomes for EMLC were comparable to national and international standards.ConclusionThis study highlights the challenges in surgical healthcare provision for gallstone disease in a regional centre. The requirement for EMLC disproportionately effects geographically isolated communities and Australian Indigenous people. Addressing the healthcare barriers to management of GD in regional Australia should be a priority.

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The provision of general surgery in rural Australia: a narrative review

Cited by 5 publications

References 64 publications

Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities

Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities

Rural general surgical provision from the perspective of twenty‐two rural general surgeons: a thematic analysis

A review of emergency laparoscopic cholecystectomies in Far North Queensland

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