Rural generalists ‘with, in and for’ their communities

From medical students to mentors leading primary health care in the small outback community of Barcaldine, rural generalist doctors Priscilla and Welwyn Aw-Yong exemplify the intent of JCU’s integrated training pathway.

The pathway begins with the undergraduate medical degree and continues into medical specialty training, with each program sharing aspects designed to inspire a workforce willing to train and practise locally. A connection with community is forged early on, with undergraduates experiencing at least 20 weeks of rural and remote clinical placements, and continues through to postgraduate specialist training in general practice and rural generalism in the region. 

When the Aw-Yongs were deciding where to pursue their GP training, a second-year rural placement in Barcaldine during her undergraduate degree came straight to Priscilla’s mind. “I got a very positive impression of Barcaldine in the four-week placement, so that’s what we applied for,” Priscilla says. “Just seeing the way the practice was run and watching the doctors and how they work; they were relaxed and approachable to us students. I think that’s what drew us to Barcy.”

The JCU graduates moved to Barcaldine in 2018 and quickly became embedded in the community and advanced in their training and careers. With plenty of training and development opportunities on offer in rural settings like Barcaldine, it wasn’t long before the students became teachers. Now a JCU GP medical educator, Priscilla works across the hospital and Barcaldine Medical Centre providing care to patients and training junior doctors on the JCU GP training pathway.

Likewise, Welwyn has made the most of the advancement opportunities on offer for rural generalists. After fellowing through JCU with ACCRM in 2020, Welwyn now works as Acting Director of Medical Services at Barcaldine Hospital and Multipurpose Health Service in addition to his work at the local GP practice.

The couple’s story is a familiar one in towns across JCU’s 11 GP training regions, where graduates have become integral to their communities’ health, providing continuity of care and stability.

JCU is Australia’s only university delivering both undergraduate medical education and postgraduate general practice training. By selecting values-aligned students to undertake the undergraduate program, 70 per cent of whom are from rural and regional areas, JCU is increasing the likelihood of graduates choosing medical practice in those areas.

Peer-reviewed research shows almost half of JCU’s first 10 cohorts of doctors are practising in regional, rural and remote Australia. Just as importantly as addressing workforce maldistribution, more than half of JCU’s postgraduate year 5-14 medical graduates have chosen to become general practitioners, rural generalists or generalist specialists.

Of the 758 GP Fellows JCU has produced, approximately two-thirds have stayed on in the North Western Queensland training region. JCU’s training pathway is purposefully designed to produce doctors who are passionate about rural health. 

Broad scope of practice is a major drawcard for GP registrars who choose to train in rural Queensland. Rural GPs see a wide range of presentations, perform a range of procedures and provide other services to improve the overall health of rural and remote communities.

Welwyn loves the diversity of his combination of roles. “Barcaldine is the type of place where you have to think on your feet. Sometimes there might not be anybody else; you can’t just refer them ‘down the road’,” he says. “You do all these investigations and emergency procedures yourself, particularly as you get into advanced skills training. You have this really broad scope of practice and that is very rewarding.”

Priscilla, who completed internal medicine advanced skills training, says her aim as a medical educator is to build a strong relationship with GP registrars. “We’re sharing their successes, the light-bulb moments, and the challenges. On top of teaching, I see the role as providing mentoring and pastoral care elements as well. Living and working rurally, while rewarding, isn’t all rainbows and sunshine. We’re in it together.”

"The broad scope of practice as a rural GP is complemented with a focus on building long-term relationships with patients. “One of the best things about being a rural generalist is that you care for your patients through a whole journey. When they’re well, having a check-up at the GP clinic, when they’re unwell, and often looking after their families, parents and children. That’s a big part of what I think is amazing about GP,” Priscilla says.

Now in their fifth year at the hospital and general practice, the Aw-Yongs are helping provide the town with something it desperately needed in its access to a GP: stability.

“When we arrived in Barcaldine, one of the first questions you get from patients is ‘How long are you going to stay here?’. Then it was ‘I’m surprised you’re still here’. It goes to show that communities like Barcy get used to doctors leaving,” Welwyn says. “I think our biggest need is having doctors willing to stay on a more permanent basis. We haven’t had many who left in our time here, which is good. It makes a big difference when your patients see you here for a longer time, putting down roots in the community.”

By pursuing GP training in a rural setting, as the Aw-Yongs have done, doctors discover supportive and close-knit communities. “People work together and feel passionate about the town, and that draws you in,” Priscilla says. “Coming from big city backgrounds, we’ve been struck by how friendly everyone is here. People actually stop to say g’day here, even if you don’t know them. It’s very easy to meet people in Barcy.”