RURAL generalist doctors are those with the skills to work in both the hospital and general practice and are the lifeblood of rural health care.
They keep hospitals open, emergency services active and maternity units running - all while keeping the day-to-day health care needs of a community ticking-over.
There have been some recent reports of emergency departments in New South Wales being staffed only by nurses - assisted by doctors via telehealth during emergencies.
These hospitals simply haven't been able to negotiate contracts with doctors who are not only willing to provide the necessary after-hours and emergency care, but who also have the appropriate skills and qualifications to do so.
Not every doctor is trained in emergency care and smaller rural hospitals don't have enough work to keep emergency specialists on staff.
They need generalist doctors with a range of skills that can keep a variety of services available to the community.
This is what rural generalist doctors do.
They are general practitioners (GP) who, in addition to their general practice work, also provide emergency care at the hospital - as well as another advanced skills such as obstetrics, anaesthetics, surgery, scopes, internal medicine, advanced mental health care or indigenous health.
A rural generalist doctor is different from a GP.
The type of work they do is different and the clinical skills needed to work across both the general practice and hospital settings is different.
Recruitment and retention of rural generalists in country towns is essential to the maintenance of rural hospitals and the services they provide.
There is an urgent need for the roll-out of the National Rural Generalist Training Pathway, which will train the next generation of rural doctors with the skills and desire to work in rural and remote settings.
This is the key to addressing this critical need in the future.
We are encouraged by the recent appointment of associate professor Ruth Stewart as the Commissioner for Rural Health, tasked with ensuring the implementation of this Commonwealth initiative is carried out in full.
Telehealth can be used to provide additional support and services.
But that in no way replaces the need for face-to-face services.
In single-doctor towns, or those with a low number of rural generalists appropriately trained to work in emergency, telehealth can be used as a back-up for less serious hospital presentations to reduce the on-call burden of the doctors who are providing much needed services into rural and remote Australia.
Right now, using telehealth to support the rural generalists with back-up from emergency medicine specialists in a larger centre - alongside the management of lower-acuity presentations - is appropriate.
But each rural town and each rural hospital is unique.
The provision of the variety of health services needed in rural communities is a complex challenge and needs tailored solutions.
Another area of great interest to the Rural Doctors Association of Australia was the $3.6 million allocated in the October Federal Budget to providing innovative, local solutions to the provision of rural health care in areas that have been having problems providing the variety of services needed by the community.
These pilot programs will then inform the roll-out of additional initiatives in other areas that are also in need of some tailored solutions to other areas of need.
We are encouraged to see the Federal government turning its attention to this challenging issue and hope to see some further changes to its workforce programs that will see more government funding arriving at the coal-face - and actually improving service delivery.
