Not having spent any time in Australia, I would defer to those who have.
Even better would be comments of those spending time in both locations.

After directing a faculty development program for rural medical educators
for 3 years, I did have specific training as a rural medical educator. Even
so it took me 4 years to understand all of the various education, health,
and other factors involved with Nebraska's rural health efforts.

Attempting to comprehend the various health areas, and then layer in
education, economics, sociology, and distributions in another nation would
take significant time as well.

From those of us that seem to be falling further behind in our own nations,
it certainly is possible that Australia looks better for a number of
reasons, but still could be slipping down the incline at a slower rate.

The contrasts at the Rural Wonca meeting were staggering. There was little
participation from the hosting nation, with few attendees despite an
excellent venue, a Seattle location, good timing, and widespread sharing of
the effort and speakers. The Australian folks that attended were well
supported, had numerous contributions, and had clearly caught and passed
the US some years back in new models, understanding the models, replicating
them, adapting them, and thinking through the various support mechanisms.

I do not think that there are any training models to match the specific GP
frontier training in Australia although we did not do bad with an
accelerated rural FP training program or a 3-3-1 effort ending with a rural
and procedural fellowship. However our accelerated models were terminated,
despite the best evaluations and the best distributions of any model in our
workforce history. Our distributional medical education models such as
Duluth have been forced to merge with the U of MN. Mercer was a finely
tuned medical school for rural, underserved, and FP and it has been
completely compromised for this effort. Oral Roberts also had top
distribution and was closed. Advances that increase Black and Hispanic
admissions to all medical schools have collapsed down to fewer and more
dependence on a handful of medical schools. Rural born admissions are
declining and many of these are children of professionals and those from
higher income rural areas, not as likely to distribute, but better at it
than other admissions.

The nation destroyed the physician assistant and nurse practitioner models
which were designed to be 100% primary care, 25% rural, and 15%
underserved. this was billions in investments over decades. Now PAs and NPS
are less than 40% primary care, less than 15% rural, and 10% underserved at
best and likely less. FP remains 88% primary care for 30 years of a career,
24% rural, and 12% underserved, with 20 or 30% levels in those of
underserved origins. Projections demonstrate that by 2015 family medicine
with only 3000 graduates a year will be 40 - 60% of primary care, rural
primary care, and underserved primary care even though NPs graduate 5000 a
year, PAs graduate 5000 a year, and IM and Peds graduate about 5000 a year.
This is 15000 a year compared to 3000 in FP. A nation that wastes this
level of primary care capacity and basic health care access is going to
look bad compared to other nations.

Primary Care Remaining in the US in 2015
378660 total
31288 PA
27972 NP
95000 IM
68400 Peds
156000 FM

It is difficult to assess the collapsing rural economies of the world with
challenges in agriculture, mining, water quality, losses in manufacturing,
and being left behind in information technology and access. It is difficult
not to be pessimistic in such a situation. Holding actions may not appear
to be much help, but they do give time for adaptations and especially for
governments to gain awareness of what they are doing to all most socially
and geographically distant.

Only one US policy has managed to make much of a difference. Somehow the
rural hospitals of the nation managed to get Critical Access Hospitals
passed that shifted a few percent of all major medical center dollars to
rural hospitals. It is a drop in the bucket for the major medical centers
but took the hospitals from red to black ink. With declining education,
distributions of education, physicians, and distributions of health
funding, even this policy will not likely matter. Downward spirals in a
number of areas are clearly in evidence as well as the social, health, and
other associated difficulties.

We have about 3 states in the top 20 economies in the world that also have
the top 3 federal support levels and they have many of the brightest people
from all over the world. Despite this, they fail to provide even a minimum
level of infrastructure and take resources from every other state and
nation on the planet.

Robert C. Bowman, M.D.
[log in to unmask]
www.ruralmedicaleducation.org

search google on Physician Workforce Studies for supporting documentation

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