Dermatologists weigh up the pluses and minuses of rural practice


By Michael Woodhead

16 Feb 2021

Dermatologists providing services in rural regions experience a range of rewards and challenges depending on the stage of their career and their commitment to living within the community.

A survey of the perspectives of eleven rural dermatologists and six dermatology trainees was carried out by Dr Bethany Croker, a Dermatology Advanced Trainee at Hunter New England Local Health District, NSW, to try inform the long running issue of workforce shortages for regional specialists.

It found that having the freedom to choose to work in  a rural area was a key factor in impressions, with those who sought a rural lifestyle or grew up in a rural area tending to be passionate about working rurally.

Other said they preferred rural practice because they wanted to escape the pressures and frustrations of metropolitan areas such as being  stuck in traffic.

However, those such as trainees who had little or no choice about working in rural dermatology described downsides such as the challenges of working over long distances.

“I didn’t actually get to pick where I was going and it was quite significantly stressful I think for everyone involved,” said one respondent.  “Initially I would drive out to [rural area], I thought that was getting a bit dangerous because I used to get really tired and I have fallen asleep a couple of times on the road and thought it was a huge risk …”

Other described problems with the lack of infrastructure and support services in rural areas, as barriers

“I had to find rooms, I had to find staff, I had to liaise with the local GPs, I had to buy equipment … I won’t say it was easy, I won’t say it was difficult, but it had its challenges.”

However others noted that while they had initially been reluctant to be posted to a rural area, once they experienced the work they had a change in perspective and began to enjoy the work and lifestyle.

“It was the best move we made, it’s a great place, we brought up our children here. We are really part of the community, made a lot of friends,” said one dermatologist.

Some dermatologists said they chose to do outreach work in rural areas through a sense of duty to under-served areas, but this came with challenges such as taking longer to make local connections and provide continuity of care.

“There are more phone consultations, a lot more phone follow-up, ‘how are you going’, because I can’t review them. …,” commented one dermatologist. “ You kind of rely on the GP to triage it better, rather than waiting for me to come in [particular number of] months.”

Trying to build relationships … working with the local people on the ground …you’re in their home territory, on their ground. … It probably took me a year or two to find my feet and try and work out what was going to work best for the local population and m,” said another.

However a common theme was that patients and regional communities were very grateful for the medical care provided by dermatologists in rural areas, and there was a greater sense of being involved and appreciated.

“We have very close relationships with all the GPs in the area … they can contact me any time if they have any queries,” said one.

“[And] when I go into [shopping centre] if I don’t see ten of my patients walking down the aisles, I’m not very observant because they’re all there. “

The paper, published in Rural and Remote Health, concluded that the persectives and tension highlighted in the feedback could be when developing strategies to address dermatologist workforce maldistribution.

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