Training emergency medicine doctors for rural and regional Australia: can we learn from other countries?

Australia is a country with a relatively small rural population dispersed over an enormous area. Issues similar to how best to deliver health services and recruit health professionals to rural areas exist in other countries. For professional and lifestyle reasons, most specialist doctors (including emergency medicine specialists), choose to live and work in major metropolitan centres. Outside the major Australian cities, most presentations to emergency departments are dealt with by 'non-specialist' doctors, often with limited specialist back up. Recruitment of suitably trained medical staff is increasingly difficult. There is increasing reliance on overseas trained doctors from widely varying backgrounds. In Canada and New Zealand, family medicine trained emergency medicine doctors are a significant proportion of the workforce in rural and regional emergency departments. To undertake a detailed investigation of the non-specialist emergency medicine doctors in Australia, and examine strategies to secure a more highly trained emergency medicine workforce for rural and regional Australia. A survey was undertaken of 230 doctors working in 57 rural and regional Australian emergency departments. Consultations and interviews were held with 53 key clinicians, educators and administrators. There were no training or education standards for doctors working in smaller Australian emergency departments. There was considerable instability in the workforce with many planning to leave their current position or reduce their involvement in emergency medicine. The vast majority felt a need to undertake further emergency medicine training. There was little agreement among stakeholders as to how emergency medicine should be taught, or services delivered in rural and regional Australia. There is need in Australia to offer a specific postgraduate qualification in emergency medicine for doctors wishing to practise emergency medicine outside major city hospitals. Ideally, such a course would be largely taught in rural and regional hospitals and would contain additional elements relevant to rural practice. The Canadian and New Zealand emergency medicine qualifications may be useful models.