More outback doctors needed for people and planet

Should you find yourself in a remote pub in Australia’s Northern Territory (NT), it’s unlikely you would hear anyone complaining about the overpopulation of doctors making their way into town. Unsurprisingly, the opposite is true, with many outback areas facing a shortage of local medical practitioners. 

It’s an issue Dr Simon Quilty from the College of Health and Medicine at The Australian National University (ANU) witnessed first-hand when he arrived at the Katherine Hospital in 2012.   

Despite the importance of localised and immediate medical treatment, Quilty discovered that almost 700 patients had been flown some 340km to a much larger Royal Darwin Hospital the previous year.  

Without enough doctors to treat complex medical issues, those living in these remote communities had little choice but to leave.  

“When I started asking people whether they were willing to go, I regularly found that they weren’t,” Quilty says.  

“It’s often the preference of people living in rural and remote towns to stay close to family when they are unwell.”  

Adding flames to the fire is the extreme heat of a place like the Northern Territory.  And with our planet on track to warm up, Quilty says medical issues connected with the summer season that may not necessarily require aerial transfers can increase pressure on retrieval services. 

“It is absolutely my lived experience that rates of cellulitis and soft tissue infections like boils and abscesses go up in summer,” Quilty says. 

Research by Quilty and his colleagues shows a clear association between hotter temperatures and increasing obstetric retrievals in the Northern Territory. But birthing facilities are few and far between. Obstetrics are considered an emergency from a retrieval point of view. 

For women in remote NT this means relocating to Darwin, Alice or Katherine for “sit-down” time before they go into labour and for a brief period after the baby is born.  

Separated from the support of family and friends during a vulnerable and stressful experience, the red-dusted roads that create this distance shape more lives than one. 

The decision to fly patients out has another unsustainable impact — helping to fuel this region’s carbon footprint, which is something Quilty wants to change. 

“Every single human being, particularly those with lots of wealth and resources, needs to be responsible for their carbon footprint. Every single profession and every single industry needs to take responsibility. And aeromedical retrievals have a huge carbon footprint for a single patient transfer,” Quilty says. 

While solutions to this problem are far from simple, Quilty says they do exist. Reflecting on his own experiences, he says it only takes slightly increasing the number of doctors to make a huge difference in remote towns. 

“If you put one single physician in a hospital like Katherine for five years, it more than halves the rates of retrievals from that hospital,” Quilty says.  

Quilty’s placement as a specialist in Katherine Hospital resulted in halving the number of aeromedical evacuations and improving the scope of services available to people in the region – things like cardiac services and an oncology satellite unit that were only possible as a result of his training and ongoing support of such expansions.  
 
But Quilty says change shouldn’t stop there.  

“It’s also time to consider building birthing facilities in places like Tennant Creek. I know there’s a very strong desire from the Warumunga People and surrounding First Nations to have services closer to home.” 

Quilty estimates the average cost of retrieval from Katherine to Darwin is around $12,000 (aircraft time and fuel, and medical and flight staff time), and then there is the cost of repatriating a mother and her new baby afterwards. He says we only need to reduce 20 obstetric retrievals per year to pay the salary of one obstetrician.  

Unfortunately, recruiting doctors to the outback remains a serious challenge.  

Climate change compounds this issue with the brutality and intensity of NT weather causing about one in three doctors to consider leaving. When recruiting for his replacement in Katherine, Quilty advertised for five years before filling the role.  

“The culture of medical practice in Australia doesn’t make recruitment to places like Katherine easy,” Quilty says.  

“Almost all a junior doctor’s training is shaped by safety and risk avoidance, as practiced in large city hospitals. But in rural and remote medicine such expectations can be nothing more than academic.”

Quilty says adequate rural and remote training plays another important role in his push for improved medical treatments in Australia’s backcountry.

This is something currently lacking from our healthcare systems and education providers. Such training would play a vital role in supporting doctors to move to the outback long term and provide care to communities where proximity to family during times of illness is a cultural necessity.   

“Learning to manage risk and provide the best possible care in resource limited settings are skills that can be developed but are not valued through most specialist medical education and training pathways,” Quilty says.  

A version of this article appeared at ANU College of Health and Medicine