The provision of general surgery in rural Australia: a narrative review.
General surgery
Rural health services
Journal
The Medical journal of Australia
ISSN: 1326-5377
Titre abrégé: Med J Aust
Pays: Australia
ID NLM: 0400714
Informations de publication
Date de publication:
18 Mar 2024
18 Mar 2024
Historique:
received:
24
08
2023
accepted:
24
01
2024
medline:
18
3
2024
pubmed:
15
2
2024
entrez:
15
2
2024
Statut:
ppublish
Résumé
Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia. The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes. Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes. To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural-facing generalist curriculum. Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres. Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery.
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
258-263Informations de copyright
© 2024 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.
Références
General Surgeons Australia. About us. Melbourne: GSA, 2022. https://www.generalsurgeons.com.au/about-us (viewed Feb 2024).
Royal Australasian College of Surgeons. Train for Rural: Rural Health Equity Strategy. Melbourne: RACS, 2021. https://www.surgeons.org/-/media/Project/RACS/surgeons-org/files/interest-groups-sections/Rural-Surgery/2-Train-for-Rural.pdf?rev=2e53ad7ecb3e4864be9dcc69e0556bb1&hash=6EF8D4FD8F5C13332C8C625D920E42C6 (viewed May 2023).
Royal Australasian College of Surgeons. Activities report 2021. Melbourne: RACS, 2022. https://www.surgeons.org/-/media/Project/RACS/surgeons-org/files/reports-guidelines-publications/workforce-activities-census-reports/2021-12-31_RACS_ActivitiesReport_2021_V4_Final.pdf?rev=7dced14774fa449e8a74b1023013998e&hash=528EC8EDAD1B41E0B2757EEECEAC97DF (viewed May 2023).
Clancy B. Royal Australasian College of Surgeons Rural Health Equity Strategic Action Plan: excellence through equity. ANZ J Surg 2022; 92: 1990-1994.
Chong A, Kiroff G. Preparing surgeons for rural Australia: the RACS Rural Surgical Training Program. ANZ J Surg 2015; 85: 108-112.
Department of Health and Aged Care. Australian Statistical Geography Standard - Remoteness Area [website]. Canberra: Commonwealth of Australia, 2021. https://www.health.gov.au/topics/rural-health-workforce/classifications/asgs-ra (viewed May 2023).
Department of Health and Aged Care. Health Workforce Dataset: Data Tool. Canberra: Commonwealth of Australia, 2020. https://hwd.health.gov.au/datatool/ (viewed May 2023).
O'Sullivan B, McGrail M, Russell D. Rural specialists: the nature of their work and professional satisfaction by geographical location of work. Aust J Rural Health 2017; 25: 338-346.
Nelson PG. General surgical manpower, Victoria, Australia. Aust N Z J Surg 1991; 61: 576-588.
Choi MS, van der Mark MA, Hung K. The distribution and composition of colonoscopy providers in Australia. Cureus 2022; 14: e22104.
Shanmugakumar S, Playford D, Burkitt T, et al. Is Western Australia's rural surgical workforce going to sustain the future? A quantitative and qualitative analysis. Aust Health Rev 2017; 41: 75-81.
Paynter JA, O'Sullivan B, Qin KR, et al. Characterizing the female general surgery workforce in rural and regional Australia. ANZ J Surg 2023; 93: 2283-2284.
Bruening MH, Maddern GJ. The provision of general surgical services in rural South Australia: a new model for rural surgery. ANZ J Surg 1998; 68: 764-768.
Chittleborough TJ, Lourensz K, Elliott M, et al. Outreach surgical consulting services in North East Victoria. Aust J Rural Health 2013; 21: 325-328.
Gruen RL, Bailie RS, Wang Z, et al. Specialist outreach to isolated and disadvantaged communities: a population-based study. Lancet 2006; 368: 130-138.
Hughes-Anderson W, Rankin SL, House J, et al. Open access endoscopy in rural and remote Western Australia: does it work? ANZ J Surg 2002; 72: 699-703.
Maurice AP, Punnasseril JEJ, King SE, Dodd BJ. Improving access to bariatric surgery for rural and remote patients: experiences from a state-wide bariatric telehealth service in Australia. Obes Surg 2020; 30: 4401-4410.
Hussain R, Maple M, Hunter S, et al. The fly-in fly-out and drive-in drive-out model of health care service provision for rural and remote Australia: benefits and disadvantages. Rural Remote Health 2015; 15: 3068.
Echuca Regional Health. About us. Echuca: Echuca Regional Health, 2021. https://erh.org.au/about/ (viewed May 2023).
Venchiarutti RL, Tracy M, Clark JR, et al. Geographic variation in referral practices for patients with suspected head and neck cancer: A survey of general practitioners using a clinical vignette. Aust J Rural Health 2022; 30: 501-511.
Oh D, Wright C, Young CJ. Management of obstetric anal sphincter injury: Colorectal surgeons’ perspectives in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2021; 61: 16-21.
Yeh J, Palamuthusingam P, Cameron D, Avramovic J. Impact of establishing a specialized hepatobiliary unit on liver resections in a non-specialized tertiary centre in regional Australia. ANZ J Surg 2022; 92: 769-773.
Bishop CV, Drummond KJ. Rural neurotrauma in Australia: implications for surgical training. ANZ J Surg 2006; 76: 53-59.
Brims FJH, Kumarasamy C, Nash J, et al. Hospital-based multidisciplinary lung cancer care in Australia: a survey of the landscape in 2021. BMJ Open Respir Res 2022; 9: e001157.
Underhill C, Bartel R, Goldstein D, et al. Mapping oncology services in regional and rural Australia. Aust J Rural Health 2009; 17: 321-329.
Youl P, Philpot S, Moore J, Theile DE. Population-based picture of breast reconstruction in Queensland, Australia. ANZ J Surg 2021; 91: 695-700.
Flitcroft K, Brennan M, Costa D, Spillane A. Documenting patterns of breast reconstruction in Australia: the national picture. Breast 2016; 30: 47-53.
Hall SE, Holman CDJ. Inequalities in breast cancer reconstructive surgery according to social and locational status in Western Australia. Eur J Surg Oncol 2003; 29: 519-525.
Flitcroft K, Brennan M, Spillane A. Principles of patient-centred care and barriers to their implementation: a case study of breast reconstruction in Australia. Support Care Cancer 2020; 28: 1963-1981.
Collins IM, Lum C, Versace VL. Influence of socioeconomic factors and distance to radiotherapy on breast-conserving surgery rates for early breast cancer in regional Australia; implications of change. Asia Pac J Clin Oncol 2018; 14: e224-e230.
Australian Society of Plastic Surgeons. ASPS Darwin Workforce Project impact report: 2022 - the second year. Sydney: ASPS, 2022. https://plasticsurgery.org.au/wp-content/uploads/2023/05/Darwin-second-year-impact-report_FINAL.pdf (viewed May 2023).
Bryant K, Dean N. Innovation in rural workforce strategies by a national surgical society: the ASPS experience. Australas J Plast Surg 2021; 4: 3-5.
General Surgeons Australia. Curriculum. Melbourne: GSA, 2022. https://www.generalsurgeons.com.au/education-and-training/curriculum (viewed May 2023).
Bruening MH, Anthony AA, Maddern GJ. Surgical rotations in provincial South Australia: the trainees’ perspective. ANZ J Surg 2003; 73: 65-68.
Miller FJ, Miller CA, Fox AM, et al. Influence of training on the family. ANZ J Surg 2006; 76: 907-911.
Hippolyte-Blake D, Dreschler A, Rose A, et al. A qualitative study of the incentives and barriers that influence preferences for rural placements during surgical training in Australia. ANZ J Surg 2022; 92: 341-345.
Chan LS, Scholes NJW, Jones M. Skin excisions: not so simple for the regionally based general surgical trainee. Aust J Rural Health 2011; 19: 205-210.
Wong K, Birks D. Operative experience in the Victorian general surgical training programme. ANZ J Surg 2003; 73: 1036-1040.
O'Grady G, Loveday B, Harper S, et al. Working hours and roster structures of surgical trainees in Australia and New Zealand. ANZ J Surg 2010; 80: 890-895.
Eley DS, Synnott R, Baker PG, Chater AB. A decade of Australian Rural Clinical School graduates - where are they and why? Rural Remote Health 2012; 12: 1937.
General Surgeons Australia. Training Committee. Melbourne: GSA, 2023. https://www.generalsurgeons.com.au/training-committees (viewed May 2023).
Monash University. About the hubs. Melbourne: Monash University, 2022. https://www.monash.edu/medicine/rural-health/hubs/about-us#:~:text=The%20regional%20training%20hub%20concept,phase%20of%20regional%20medical%20education (viewed May 2023).
McGrail MR, Doyle Z, Fuller L, et al. The pathway to more rural doctors: the role of universities. Med J Aust 2023; 219 (Suppl): S8-S13. https://www.mja.com.au/journal/2023/219/3/pathway-more-rural-doctors-role-universities
Bappayya S, Chen F, Alderuccio M, Schwalb H. Caseload distribution of general surgeons in regional Australia: is there a role for a rural surgery sub-specialization? ANZ J Surg 2019; 89: 672-676.
Campbell NA, Kitchen G, Campbell IA. Operative experience of general surgeons in a rural hospital. ANZ J Surg 2011; 81: 601-603.
Campbell NA, Franzi S, Thomas P. Caseload of general surgeons working in a rural hospital with outreach practice. ANZ J Surg 2013; 83: 508-511.
Liu J, Lei C, Reid J, et al. Extended scope of practice needed for Australian rural general surgeons: a review of South Australia's rural general surgical caseload and case mix. ANZ J Surg 2022; 93: 522-527.
Paynter JA, Qin KR, O'Brien A, et al. Rural general surgeon confidence with managing vascular emergencies: a national survey. Aust J Rural Health 2023; 31: 897-905.
Luck T, Treacy PJ, Mathieson M, et al. Emergency neurosurgery in Darwin: still the generalist surgeons’ responsibility. ANZ J Surg 2015; 85: 610-614.
Gilligan J, Reilly P, Pearce A, Taylor D. Management of acute traumatic intracranial haematoma in rural and remote areas of Australia. ANZ J Surg 2017; 87: 80-85.
Udovicich C, Page D, Huq M, Clifforth S. Neck of femur fracture management by general surgeons at a rural hospital. Australas Med J 2015; 8: 154-160.
General Surgeons Australia. PFET Program in Rural Surgery. Melbourne: GSA, 2023. https://www.generalsurgeons.com.au/post-fellowship-education-training/rural-program (viewed May 2023).
Stewart GD, Long G, Tulloh BR. Surgical service centralisation in Australia versus choice and quality of life for rural patients. Med J Aust 2006; 185: 162-163. https://www.mja.com.au/journal/2006/185/3/surgical-service-centralisation-australia-versus-choice-and-quality-life-rural
Liu J, Ting YY, Trochsler M, et al. Analysis of surgical mortality in rural South Australia: a review of four major rural hospital in South Australia. ANZ J Surg 2022; 92: 1681-1691.
Tocaciu S, Thiagarajan J, Maddern GJ, Wichmann MW. Mortality after emergency abdominal surgery in a non-metropolitan Australian centre. Aust J Rural Health 2018; 26: 408-415.
Swift K, Thompson F, Roeder L, et al. Appendicitis in Far North Queensland: a new take on an old story. ANZ J Surg 2022; 92: 114-120.
Quinn L, Read D. Paediatric surgical services in remote northern Australia: an integrated model of care. ANZ J Surg 2017; 87: 784-788.
Davis SS, Babidge WJ, Kiermeier A, Maddern GJ. Regional versus metropolitan pancreaticoduodenectomy mortality in Australia. ANZ J Surg 2019; 89: 1582-1586.
Davis SS, Noll D, Patel P, et al. Gastrectomy mortality in Australia. ANZ J Surg 2022; 92: 2109-2114.
Gray AD, Petrou G, Rastogi P, et al. Elective hepatic resection is feasible and safe in a regional centre. ANZ J Surg 2018; 88: E147-E151.
van Leeuwen MT, Falster MO, Vajdic CM, et al. Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data. BMJ Open 2018; 8: e020858.
Hall S, Holman CDA, Sheiner H, Hendrie D. The influence of socio-economic and locational disadvantage on survival after a diagnosis of lung or breast cancer in Western Australia. J Health Serv Res Policy 2004; 9 (Suppl): 10-16.
Fox PN, Chatfield MD, Beith JM, et al. Factors delaying chemotherapy for breast cancer in four urban and rural oncology units. ANZ J Surg 2013; 83: 533-538.
Marsh C, Wang J, Kollias J, et al. Disparities in access to breast care nurses for breast surgeons: a National Breast Cancer Audit survey. Breast 2010; 19: 142-146.
Marsh CJ, Boult M, Wang JX, et al. National Breast Cancer Audit: the use of multidisciplinary care teams by breast surgeons in Australia and New Zealand. Med J Aust 2008; 188: 385-386. https://www.mja.com.au/journal/2008/188/7/national-breast-cancer-audit-use-multidisciplinary-care-teams-breast-surgeons
Bergin RJ, Thomas RJS, Whitfield K, White V. Concordance between Optimal Care Pathways and colorectal cancer care: identifying opportunities to improve quality and reduce disparities. J Eval Clin Pract 2020; 26: 918-926.
Watson MM, South Australian Rural Surgical Research Group, Watson DC, et al. Quality of rural colonoscopy outperforms key performance indicators in a multi-centre prospective clinical study. ANZ J Surg 2022; 93: 528-533
Hoskins W, Taylor P, Jacob A, et al. Colectomies performed at a rural Australian hospital: a 7-year analysis. Aust J Rural Health 2013; 21: 279-284.
Wichmann MW, McCullough TK, Beukes E, et al. Outcomes of laparoscopic colorectal cancer surgery in a non-metropolitan Australian hospital: audit of 120 patients with long-term follow-up results. ANZ J Surg 2022; 92: 3214-3218.
Wichmann MW, McCullough TK, Beukes E, et al. Colorectal cancer surgery in rural Australia can match outcomes in metropolitan hospitals: a 14-year study. Med J Aust 2021; 214: 186-187. https://www.mja.com.au/journal/2021/214/4/colorectal-cancer-surgery-rural-australia-can-match-outcomes-metropolitan
Udayasiri DK, MacCallum C, Da Silva N, et al. Impact of hospital geographic remoteness on overall survival after colorectal cancer resection using state-wide administrative data. ANZ J Surg 2020; 90: 1321-1327.
O'Sullivan BG, Worley P. Setting priorities for rural allied health in Australia: a scoping review. Rural Remote Health 2020; 20: 5719.
Mannix K. The future of Australia's nursing workforce: COVID-19 and burnout among nurses. Melbourne: University of Melbourne, 2021. https://www.unimelb.edu.au/__data/assets/pdf_file/0004/4085194/katelyn_mannix_report.pdf (viewed May 2023).
Parlier AB, Galvin SL, Thach S, et al. The road to rural primary care: a narrative review of factors that help develop, recruit, and retain rural primary care physicians. Acad Med 2018; 93: 130-140.
Ostini R, McGrail MR, Kondalsamy-Chennakesavan S, et al. Building a sustainable rural physician workforce. Med J Aust 2021; 215 (Suppl): S1-S33. https://www.mja.com.au/journal/2021/215/1/building-sustainable-rural-physician-workforce