Advice to solve the maldistribution of ED Doctors in rural Australia
Updated May 2019
We spoke with one of Australia’s leading Emergency Physicians, Professor Paul Middleton, about the growing problem of FACEM maldistribution in rural and remote Australia. He also shares some of his most memorable ED career experiences and offers invaluable advice to new FACEMs looking for their first Consultant role.
How do you think we should tackle the growing problem of FACEM maldistribution in Australia?
I believe it’s important to think of Emergency healthcare as a system, and this means all Emergency Doctors should commit to spending time in non-urban areas either during their training or as part of the early years of their FACEM practice. We all know there are difficulties with this, for example, the displacement of families, but perhaps the earlier in a career the better.
I also think there is room for more twinning arrangements where large metro hospitals twin with rural hospitals and potentially undertake a rotational scheme with all their senior Doctors for short periods.
Strangely, the private sector has done this well for decades, as well as the public sector to some degree, with Surgeons and Physicians flying out to rural areas for clinics and operating lists. We need to systematise this for EDs as well.
What have you enjoyed most about working in rural and remote hospitals?
You get to work with a greatly differing population, often more unwell, with more advanced pathology. It’s also very rewarding to work in a small community, whether in the hospital or outside, and it’s easier to connect and make friends.
What improvements do you think still need to be made in Emergency Departments in Australia?
The fact is, patients get sick when they get sick not when it’s convenient for an Anaesthetist, Cardiologist, Surgeon or anyone else who is limited to their hospital practice.
Having highly trained prehospital services with helicopter-based medical staff, enough senior specialists providing front-line care in EDs – rather than just leading junior staff – and responsive hospital in-patient services including radiology is what we need to provide appropriate care to those who deserve it.
What’s been your favourite Emergency Department to work in and why?
I’ve enjoyed most of them to a large degree so it's often difficult to pick. I trained in London originally, so St Mary's Hospital in Paddington and the Royal London Hospital have a particularly important place in my heart, but I also love Liverpool in Sydney with a passion. It’s fantastically busy there and the population is often really sick. We admit almost twice as many people as an average ED.
I also loved smaller Australian EDs such as Mersey in Tasmania as you really feel you make a difference to the community, as well as feeling that the staff respect you and are keen to have you there.
You must have met some fascinating characters on your ED travels. Who particularly inspired you?
One of my earliest mentors was Dr Robin Touquet from St Mary's Hospital in the UK. He was an ex-Royal Marine Doctor and one of the original 'Casualty' doctors who was grandfathered into the profession in the 1980s. His skills and knowledge were vast in both surgery and medicine and he was a great Traumatologist. But he was also interested in things often not thought about at the time such as the impact of alcohol, devising the Paddington Alcohol Test and taking the time to talk to all his patients old and young, rich and poor. He was a true inspiration for a lot of people.
And finally, what advice would you give to new FACEMS looking for their first Consultant role?
Don't rush! People often advise you to rush through the training and get a job as soon as possible. But there’s no need because you’re going to spend a long time in one place once you secure a consultant role.
Get as much interesting stuff done before you take a permanent job. I spent a year as a Fellow in Paediatric Emergency Medicine, a year as an ICU Fellow and a year as a Prehospital and Retrieval Fellow having fun in helicopters before several years part-time doing the same thing.
Thanks so much for sharing your valuable insights with us Professor Middleton.
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