The Pandemic President

Pictured: Dr Sarah Chalmers at the RMA22 Conference in Canberra, October 2022 (Image courtesy of ACRRM).

When the COVID-19 pandemic hit in early 2020, the rural medical workforce needed to rapidly respond and adapt. Guiding on-the-ground efforts were seasoned rural generalists like Dr Sarah Chalmers, President of the Australian College of Rural and Remote Medicine (ACRRM). Taking the reins in late 2020, the JCU Senior Lecturer ensured the rural voice was heard in policy and strategic discussions that guided Australia’s health response to the pandemic.

After completing her presidency term during the College’s RMA22 Conference in October last year, Dr Chalmers reflected on her time in the role, what she loves most about rural generalism and where her focus has shifted to now.

Thank you for your time Dr Chalmers! Firstly, how did the opportunity to become ACRRM President come about?

Over the years, I’ve had some amazing mentors through ACRRM, like A/Prof Ruth Stewart, Professor  Lucie Walters, and Dr Maria Cowie. They’ve lived and breathed rural generalism for decades and were encouraging me to consider the role. It wasn’t a particular ‘life goal’ for me, but it has been an extraordinary experience and I wouldn’t change a thing!

 What was it like as president during COVID-19 and how did ACRRM respond to the pandemic?

COVID-19 had been around for six or so months when I came in, but it was still quite an extraordinary time. I've been referred to as the ‘pandemic president’! It was back in the particularly scary stages of the pandemic when we didn't have a vaccination program, Australia still had closed borders and there wasn't very much domestic travel going on.

There was certainly a lot of ‘rolling with the punches’ to adapt our college and registrars’ training during the pandemic. A benefit of being rural is that we were already well-experienced in delivering exams for registrars remotely. The other specialty colleges rely heavily on face-to-face, and we were the only college that had an uninterrupted exam cycle, which is something we are very proud of.

ACRRM had a big part to play in the vaccine rollout, alongside the Rural Doctors Association of Australia (RDAA). Advocating for rural communities as part of this process was a big part of the first year of my presidency.

Another significant COVID-related change to navigate was the introduction of Medicare rebates for telehealth appointments. Rural and remote doctors have been using telehealth for a long time, so we did quite a bit around best practices for ramping up the scale of telehealth and we produced some great resources to support practitioner education on telehealth services.

Outside of COVID-19, what else did an ‘average’ day look like for you during your time as ACRRM President?

The president's role is centred on advocating for rural health and participating in policy and strategic discussions. So, we were looking at some of the big questions facing our profession; how do we get more medical students to consider rural generalism? How do we encourage better teamwork between rural doctors and other health practitioners? How do we inform and direct national policy?

There was a large body of work around the 10-Year Primary Care reform project, which has gone on to become the Strengthening Medicare Task Force. It's so important that rural voice be represented in these strategic and it has been a huge honour to speak on behalf of my colleagues at these forums.

Beyond being president, my role as a rural generalist didn’t stop, and neither did my roles as a wife and a mum! Whenever someone gets to do something like this ACRRM opportunity, there is always somebody in the background keeping everything ticking away at home. I’m very thankful to be married to somebody who is so supportive and to my children who had to sacrifice a bit of mum-time during my ACRRM presidency!

You’re also keeping busy with your work at JCU, what does that entail?

I work in the undergrad program as a Coordinator for sixth-year students and as a JCU GP training supervisor, supporting GP registrar in the workplace. With my Advanced Specialised Training in remote Aboriginal and Torres Strait Islander health, I focus on talking to students and registrars about the practicalities, learnings, and opportunities in this kind of medicine.

We’ve got some amazing students coming through. Since I started work on Palm, we have had two incredible individuals on Palm Island who took advantage of as many opportunities as they could and really flourished in a remote setting. The best thing is when I hear the health staff and patients speak highly of them; you can see they’ve become an important part of the team.

It's great to be part of JCU’s program because it resonates with the kind of career I've had. I see it as an opportunity to contribute to the future and be a role model for students to show them where a career in rural generalism can take you.

From your opinion, what’s a key characteristic of a rural generalist?

One of the important traits rural generalists need is clinical courage. Rural generalists are very adventurous and adaptable people and given their locations and limited access to resources, they kind of need to be!

I think that when it comes to teaching clinical reasoning at medical school, we should be teaching students about clinical courage; how to take considered risks safely. That might help more young doctors consider making the move outside the hospital system and experiencing the joy of primary care in general practice, particularly when it comes to rural and remote areas.

So, now that your presidency term has finished, what’s the next focus for you?

I’ve recently commenced a Medical Superintendent and Senior Medical Officer (SMO) role on Palm Island (Bwgcolman), north of Townsville. I was made aware of the significant workforce shortage out there and it lined up well with the end of my busy president's schedule.

I am excited by the opportunity to connect with the community of Palm Island. For the last few years I have been in fly-in-fly-out (FIFO) positions, which has left me feeling ‘community-less’. My previous experience of 15 years working in remote areas in Arnhem Land has been good training, but Palm Island is a very different context and I know I’ve got a lot to learn. It’s a great privilege to be able to work here; I’ve already learned a lot about different ways of approaching health from the people of Palm Island.

You were recently at ACRRM’s RMA22 conference, the first in-person since COVID-19. What were your key takeaways from the three-day conference?

I felt very uplifted by the whole conference. The RMA Conference is a wonderful celebration of all the positive things rural doctors do for the health of communities across Australia. The inclusion of students and registrars is something that doesn’t happen in other specialties and it’s great to see in the rural generalism tribe.

If I had to choose my favourite moment, it would be the ACRMM Fellowship Ceremony. It was by far the biggest fellowship ceremony we've ever had, and it was just an incredible experience. There’s a lot of talk around our workforce crisis and sometimes it can feel a bit hopeless. This ceremony was proof there is a younger generation of doctors who understand the need for more general practitioners in rural and remote communities and are taking up the challenge.

What would you say to medical students and junior doctors to encourage them towards rural generalism?

Rural generalism is an incredibly satisfying job that can cover any of the specialties they might be interested in. You can start a day assessing a woman in early labour and organise retrieval to the nearest birthing centre, then spend time with a palliative patient and their family working through end-of-life care choices. You can manage a few broken limbs, counsel an axious patient then thrombolyse someone having a heart attack in between. Really, you deal with any clinical situation that your patient presents you with.

We’re seeing a lot of stories now where GPs are not feeling very appreciated. Rural communities are very good at showing their doctors how much they appreciate them! You are part of a community, and you can provide that next level of care because you’re living there in the same context as your patients.