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Trainee GPs must be willing to consider rural practice

The phone rings. It’s 8.30pm and you are the on call GP for a rural area. Do you need to review a vomiting child at the community hospital? Are your skills required at a road accident? Can you offer suggestions for a terminally ill patient in need of better symptom control?

Rural practice demands a generalist approach. It’s not always busy, but the variety makes it exciting. The days of Dr Finlay are long gone, along with the tea, scones and elbow pads. Rural practice combines elements of good old-fashioned personal attention with evidence-based GMS. True generalism couldn’t be more apparent when you’re ‘it’ for a rural, remote or island community. Working and living in stunning scenery, with a close – and often highly supportive – community is a major attraction.

We’ve both been drawn to rural careers for similar reasons. General practice affords the chance to keep a real mix of knowledge and skills, and rural practice extends the spectrum even further. Mixing the old with the new becomes a fact of life, so if a helicopter isn’t available to whisk a STEMI heart attack patient off for primary percutaneous intervention, you’ll need to crack on with thrombolysis and manage that patient until transfer is available.

We think that many GPs haven’t considered rural practice, preferring to stick with the urban environment they trained in. Rural areas have always been challenged by recruitment and retention, and small changes in staffing can have a big effect on access.
A lack of trained healthcare professionals can be devastating for remote areas. The loss of staff may even make it difficult to provide locally based emergency services.

Do current GP trainees get adequate opportunities to think about rural practice? In undergraduate medicine few will have placements in locations that allow them to see the unique aspects of caring for patients in a rural setting. Rural healthcare isn’t limited to general practice – there are numerous useful opportunities for trainees of all ambitions. More than 30% of the UK population lives in a rural area, so in the true sense of holistic practice, it is important to consider challenges of the rural environment in non-GP specialties too.

Improving rural training

Rural practice requires GPs who can provide a dynamic range of medical care. Some cover community hospitals that provide services from rehabilitation and intermediate care to fracture clinics and ultrasound lists. Emergency medicine is an important part of the job too: we can be consulting a patient about their cardiovascular risk score one minute and managing a cardiac arrhythmia or major trauma the next.

Scotland is leading the way by offering a new ‘rural track’ to the GP training programme, where specialty training is delivered with a remote and rural emphasis while covering the core competencies for the MRCGP. Much has been learned from the existing GP rural fellowships, which remain a great way for recently qualified GPs to kick-start their career in rural practice.

We think the rural training options now available can help prepare GPs to overcome the drawbacks that are specific to rural practice: the goldfish-bowl effect of being a recognised face, the risk of professional isolation, regular out-of-hours duties and the extra distance to, well, everything. Advances in technology have made the world smaller too – broadband and applications such as Skype are becoming ubiquitous.

What is our advice to trainees interested in a rural career? Speak to current rural GPs. One such resource is, which also hosts an email network for trainees who are interested in rural practice. Once the opportunities become clear, rural practice becomes an attractive career choice.

This article has been published as part of the Pulse special report on employment, which will be published in the issue out on Wednesday 18 April.

Dr David Hogg (left) is a GP on the Isle of Arran and editor for Dr Chris Williams is a GP in the Highlands and medical education fellow at NHS Education for Scotland