With the federal government’s budget announcement that $800.3 million would go towards improving the health of Australians in rural and remote areas, one country doctor has given an insight into the highs, lows and critical decisions that come with caring for our rural communities.

“People in the city, they think that when a car accident happens in a country area, we just send in a flying doctor, but it’s really not that simple”, Dr John Hall told HealthTimes. Along with working as a rural generalist obstetrician in Queensland, Dr Hall is also the president of the Rural Doctors Association of Australia (RDAA).

“As a rural doctor, I've been in many situations where we haven't been able to get retrieval services to an accident straightaway. And in some cases, they’ve been delayed for 48 hours while you're managing and looking after a critically unwell patient in a country hospital.”

“One of the cases that I had where the retrieval service couldn't come, we ended up actually having to do a splenectomy on a patient whose spleen had ruptured in a car accident. Normally, in these sorts of cases, the patient would be flown to a major centre to have a trauma surgery.”

“But on this day, there had been really bad weather and electrical faults at the airport, so they basically couldn't take off.”

“And we had a lady dying in front of us who needed urgent surgery. So long story short, we ended up doing the surgery and got the spleen out.”

“By the time the lady left our care, she had sixteen blood transfusions – we'd almost replaced her full blood volume.”

“She was then put in an induced coma, and was retrieved after the operation, and had a very good recovery. She came back about six weeks after and thanked the staff – because if we didn’t have the skillset to do what we did on the day, she would have definitely died.”

Dr Hall has many more stories like this which typify the diverse skills and experience that rural doctors must have to care for their patients.

“One of the things we push at the RDAA is structured training and support, to make sure that doctors who work in rural hospitals do have those acute care skills, that they can respond to emergencies if need be.”

“But in the modern era with the centralization of healthcare unfortunately, there are fewer doctors coming out with skills that could actually do that, like take a spleen out and manage that high level critical care work.”

The RDAA is working hard to address this issue with the establishment of the National Rural Generalist Pathway.

“This structured training program will try to ensure that more doctors that work in rural areas have those higher level emergency skills, critical care skills, surgical skills, and also obstetrics and maternity care.”

Dr Hall said that obstetrics was one of the key areas that rural doctors must be upskilled in.

“A lot of emergencies that require high level skills are urgent birthing and complicated birthing cases, where if there wasn't a doctor on the ground, a lot of babies would die in rural areas.”

“And that's been borne out in some of the data as well, where we’ve seen worse outcomes in rural areas where they don't have access to skilled midwives and doctors who can provide birthing services.”

A feature that sets rural medicine apart, according to Dr Hall, is the unique “cradle to grave” care that country healthcare workers provide.

“One thing that's really rewarding is this cradle to grave approach, where you can actually get to manage the whole person and the whole family in a real sense”, Dr Hall explained.

Rural doctors, midwives and nurses can provide patients with true continuity of care – which research consistently demonstrates is crucial to improving health outcomes.

“I've got colleagues where they've delivered a baby, and then 25 years later, they're delivering that grown-up baby’s baby”, Dr Hall said.

“That's what I call continuity – where you deliver a baby, and you're then the GP in the community who gives that baby the vaccine during their health checks, and manages that child when it gets pneumonia, and then tends to their broken arms and legs when they're teenagers.”

“We intimately know our patients, and that doesn’t just improve the satisfaction of our work, but it improves the efficiency of the work too.”

“I've gone on call-ins for an emergency in a country town, and one of the first questions I'll ask the nurses is ‘what's their name?’”

“That’s because you know the patients so well, and you can have their medical history at the tip of your palm. You can really quickly get on top of what's going on with the situation.”

“That depth of knowledge of that continuity care, particularly if you're in one place for any period of time, is really good for the community.”

Dr Hall said that the advice he would give to doctors wanting to work in rural practice is simple: it will be one of the most rewarding jobs that you can do in medicine.

“It's a generalist approach, but you can work at a fairly high level across a number of different specialties. And the value that you can add in a community where they don't have access to a range of doctors is significant and rewarding.”