Why rural communities remain under-serviced by surgeons
A survey, published in the ANZ Journal of Surgery and led by Monash Rural Health’s Dr Jessica Paynter, has looked at the reasons why Australia continues to suffer from a geographical maldistribution of general surgical services with only 20% of general surgeons working rurally despite 29% of Australia's population residing outside major metropolitan centres.
The study involved in-depth interviews with 22 rural general surgeons between January 2023 and April 2023: two female and 20 male rural general surgeons from seven of the eight Australian State or Territories.
The study revealed four main barriers to having equitable access to surgeons across all of Australia:
- small hospital syndrome: the challenges faced by surgeons in smaller, rural hospitals compared to larger, highly-resourced hospitals
- the rural general surgeon identity: local communities’ expectations on surgeons to upskill and broaden their scope of practice was not matched by a formalized process to enable change in practice
- infrastructure and disempowerment: an inability to deliver efficient, gold-standard surgical care because of infrastructure issues eg inefficient IT systems, lagging innovation, and poor access to up-to-date radiological and pathological services required for surgical decision making
- over-reliance on visiting surgeons: while provided much-needed service provision, visiting surgeons also generated increased costs due to locum rates, complicated resource allocation and left complications for local surgeons to manage.
According to Dr Paynter, her analysis identified “limited opportunities for professional development amongst an overworked, exhausted and transient surgical workforce,” she said. “As a result, it became easier to create a culture of pure survival rather than a thriving environment that champions constant improvement.”
Study participants also identified negative interactions with hospital administration as an obstruction to their work. “Participants indicated that hospital politics is often more intimate and personal in smaller, rural hospitals. If not managed effectively, small hospital politics can ruin relationships and result in the loss of surgical services, ” Dr Paynter said.
On a positive note the survey also found that rural surgeons were strongly motivated by the impact that their surgical work had on underserved rural communities. “They believed that their surgical skillset had far greater reach in the rural setting compared to a metropolitan area. This need to make a continuous impact in their community was core to their identity as rural surgeons,” Dr Paynter said.
Read the full article, published in the ANZ Journal of Surgery
Rural general surgical provision from the perspective of twenty-two rural general surgeons: a thematic analysis