Finding the right skills and the right home in Emerald

For Dr Nichole (Nikki) Harch, growing up in the central Queensland town of Biloela would have a profound impact on her future direction as a JCU GP trained Rural Generalist. Now based in the Central Queensland regional town of Emerald and working as an ACCRM fellowed doctor in the combined role of GP, hospital-based Rural Generalist, and mental health clinician, Nikki’s love for a rural generalist medical practice continues to grow.

“I was in my last year of high school and about halfway through the year, there was a bit of an uproar in the town as three of our doctors were all retiring at around the same time. The town really banded together to try and figure out how they were going to replace these doctors. And watching the way that my community rallied around this issue actually had a great effect on my decision to study medicine.

“Seeing the importance that the town placed on having enough doctors just gave me a massive boost that this is what I wanted to do. I always wanted to contribute somehow to my community, and it seemed like studying medicine was going to be the best way to do it.”

“It wasn't until I was on one of my JCU undergraduate medical student rural placements that I became aware of what the rural generalist pathway could actually offer as a career choice for doctors. Seeing these doctors working in a whole range of different scopes made the rural generalism pathway really hit home for me and that’s when I knew that that's what I wanted to be doing.”

After graduating, Nikki undertook a four-year scholarship program with Queensland Health, with her final rotation taking her to Emerald where she continues to practice.

“I actually did my intern year and first year of residency at Redlands Hospital which is located on the outskirts of Brisbane, which was my one and only experience of being somewhere urban. After that, I travelled up to Rockhampton where I undertook 12 months of Advanced Skills Training in mental health. My final rotation was in Emerald and I have been there ever since.

“In addition to my role as a GP for the Emerald Medical Group, I work for the hospital on the emergency ward and also run a mental health clinic. I also conduct weekly outreach primary health care clinics to the surrounding community of Capella which has a population of around 1000.

“As a Rural Generalist I have to be prepared for whatever walks through the door and be able to adjust to that. It takes a particular mindset to do that flip and switch; you need to be a bit of a chameleon.

So, it makes an enormous difference to my mindset to be surrounded by like-minded colleagues. You end up being in a pretty tight knit group, because they're the ones that you can trust to pick up the slack if anything unexpected happens. Fortunately, we have a great community of medical professionals here in Emerald.”

Part of Nikki’s mission in her current combined role as a mental health clinician is to tackle the fallout and prevention of mental health issues, including taking the stigma out of talking about suicide.

“Mental health is an area of healthcare need in rural communities that just continues to grow. Although mental health can often be managed in primary care settings, unfortunately we're now seeing more and more acute cases that resemble something of a mental health crisis in these types of communities.

“Emerald itself has had some horrific fallout from mental health issues, particularly around youth and adolescent suicides which is just devastating for the whole community, in ways that I can’t really even begin to describe.”

“People shouldn't be scared to admit that they've had a suicidal thought; but they do need to be aware of when these thoughts become stuck that you can't push away, that it’s really important to get the right help. The first step is to take away some of the stigma associated with having the thought in the first place. If the work I do as a GP and mental health clinician can make people's journey a little bit easier or help them access the further support that they might need, then I’m certainly very happy to be doing that.”

However, due to the current shortage of GPs in remote, regional towns such as Emerald, some patients can have difficult accessing the immediate mental health help and support when they need it the most.

“Emerald does have a few psychologists and counselors based here, but they each have a waitlist of between three to six months. And although we are seeing more and more telehealth services being offered, for some people they are still needing that human interaction, particularly in the area of mental health. So for these people, having a GP they can access forms a vital step in their mental health recovery plan. But even my waitlist as a GP can be anywhere between six to twelve weeks, which is just too long. We have a dire need of attracting more GPs to rural and regional towns such as Emerald.”

In addition to the many lifestyle benefits that can be found living in regional communities such as Emerald, Nikki also says a factor in her decision to stay was the opportunity to work with some of the ‘greats’ of Rural Generalism, including GP obstetrician, medical educator and JCU GP Training Senior Fellow, Dr Ewen McPhee.

“I wanted to be able to work in primary care as well as in a hospital setting and knew that Emerald was a place with a fantastic reputation for achieving that. It has also been the most amazing privilege to be working among supervisors such as Dr Ewen McPhee and Dr Eugene Wong (former Director of Medical Services for the Central Queensland Hospital and Health Service). I've been incredibly lucky to be surrounded by amazing doctors who have who have walked the walk and who lead by example.”

“As a registrar in training, I also appreciated being surrounded by others who have done the path to ACCRM fellowship before me, and who understand what is required. It’s also been great that through the GP practice here [Emerald Medical Group], we have supported education time which we are able to take as half day releases, plus the medical educators here on-site who are passionate about what they do which just makes all the difference.”

Currently expecting her first child, Nikki says she is looking forward to putting roots down and raising her family while staying in Emerald for the long-term.

“Over the past few years I have been able to build relationships with my patients which just makes the work I do as a GP so much more rewarding. And because you've spent that time to build up the trust, it means that I am able to make a difference with things like things like vaccine hesitancy, for example. Another great aspect to my work as a GP is that Emerald Medical Group is a nonprofit medical centre with the profits going towards increasing health supports and services to the local community.

“I know my community and I trust my community, and I can definitely see the benefits of raising a family and growing my career here. As a recent ACCRM fellow, I have already had the opportunity to be involved with ACCRM’s Registrar Committee and start building my knowledge as a potential GP supervisor and medical educator. I am also a member of the Queensland Rural Generalist Training Advisory Group, and help out with the clinical skills teaching of the many undergraduate medical students we regularly have on placement here.

“Working as a Rural Generalist in Emerald has really expanded my scope, in both a clinical and non-clinical setting, which I’m sure will help set me up for other exciting opportunities down the track.”