[CARPA] Strategic planning for CARPA

[David Brookman]

Ladies & gentlemen,

I am a late blow in but I have been involved in Rural Health for almost
20yrs and spent most of the last few years encouraging students into rural
practice.

CARPA is unique because:
1. It is the only group that does not pay lip service to multidisciplinary
Care.
2. It is goal orientated rather than profession orientated.
3. It provides the only remote health professional advice in the country. 
4. It provides the only front line advice on local health needs for remote
areas and for aboriginal communities in particular.

It is hamstrung by having many of its employees hampered by government
policy and restrictions on lobbying, publicity etc.

There are many reasons why medical practitioners do not work in remote areas
(I cannot comment on other professional groups)
1. Fear - the current undergraduate training severely limits the capacity
and confidence of graduates unless they Specialise. They receive minimal
exposure to clinical work where they are required to think and act
independently. Hopefully the ACRRM graduate programs can repair this
deficiency and generate sufficient numbers of people.
2. Money - graduates now finish with a HECS debt between $100,000 and
$200,000 (unless they have sufficiently wealthy parents)and unlike other
graduates are employed in the government sector for most of their early
undergraduate years and are not provided with the perks seen in the private
sector. They can work off their HECS debt by working in rural areas at the
cost of losing professional networks so essential for obtaining training
positions.
3. Money - greed.
4. Social Networks - many medical graduates have established social networks
, many are married, some have children - this strongly acts against rural
work unless employment can be found for the spouse the likelihood of which
rapidly diminishes with town size.
5. Graduates now are not seeking a 30 year career in one place, they expect
professional mobility - this conflicts with the tradition of rural practice
where the towns doctors works in the one place for most of his life.
6. More than 50% of graduates are women, most have a wish to have children
and have to balance their biological need with training availability,
partner, social commitments and given the choice most will not seek rural
isolation.
7. Ignorance - despite the placement of students in rural clinical schools
there is still insufficient exposure to rural society.

Solutions to consider.

1.(National) Compulsory PG year 3 remote rural placements before entering a
training program - the only exemption being health and children. (It could
operate as a RRMA exposure score - people must have say 42 RRMA months
before they can enter a program ( equals 6 months in RRMA 7, or 12 months in
RRMA 4, or a mixture). The position must include at least 50% of time
working in a community position.

2. Scaled HECS write off (don't like this as it discriminates against poor
graduates in obtaining training positions).

3. Better facilities at remote health centres. (I-stat, X ray, Ultrasound,
{teleradiology}). Better aeromedical services in remote areas (i.e. more
money)

4. Compulsory 3 months placement for all specialist training programs in
their final year in rural centres providing roving outpatient clinics and
procedural services.

Obviously these proposals would require Federal Government will to drag in
the colleges kicking and screaming, and fork out the cash. But it was a core
promise.




-----Original Message-----
From: carpa-bounces at ozdocit.org [mailto:carpa-bounces at ozdocit.org] On Behalf
Of Bruce.Simmons at nt.gov.au
Sent: Thursday, 24 January 2008 8:31 PM
To: Central Australian Rural Practitioners Association
Subject: Re: [CARPA] Strategic planning for CARPA

"Fran Vaughan" <Fran.Vaughan at cdu.edu.au>@ozdocit.org on 23/01/2008 14:00:44
Thanks Fran

I'm not close to CARPA so difficult to comment. Guess that there needs to be
questions asked about what's needed to attract, support, train and retain
rural/remote staff and their families; and to provide appropriate,
integrated hospital and primary health care services in Alice, Tennant and
remote communities. We have a raft of service providers, research
institutions and support agencies. Question is how to make the best of them.
That's one question.
Guess that the other relates to the level and trend in energy and
participation in CARPA and other agencies.  That leads to the need for CARPA
to review and question its role but you/we may want somehow to get key
players involved from other key agencies?

Good cheer

Bruce

Good cheer

Bruce



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Subject:    [CARPA] Strategic planning for CARPA



Please see attached for notice of a planning meeting to discuss the future
direction of CARPA. I hope as many people as possible can come but if you
can't, perhaps this forum is a good place to discuss some of the issues and
the discussion can be tabled at the meeting.

Fran

 - Planning day flyer Feb08.doc
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