Ruth Stewart has been given the task of fixing a problem that has stumped Australia for decades. How do you get doctors to the bush and keep them there?
"If it was simple it would have been solved," the new Rural Health Commissioner says.
She's well qualified to take on the challenge. The long-serving rural GP and obstetrician has spent most of her life avoiding places like Canberra.
She left the city to live and work in rural and remote areas as soon as she got the basic level training she needed to get out, working in tandem with her husband who is a general practitioner and anesthetist.
She now lives on Thursday Island, off the coast of Far North Queensland, a whopping 2800 kilometres away from where she now sits.
"I am a rural person.That's where I want to be, that's where my people are," she says.
When Dr Stewart thought she might have to uproot her family and move to the city so the children could have access to different schools, the children opted for boarding school instead.
"They went are you kidding me? We wouldn't ask you to move," she says.
Australia has been trying unsuccessfully to get more doctors to work in rural and remote areas for decades.
At James Cook University, where Dr Stewart has been the director of rural clinical training for eight years, around 67 per cent of their graduates work outside urban centres.
"That is a groundbreaking statistic. I've had academics from other universities tell me how proud they are that they have 25 per cent of their graduates working in rural and remote," she says.
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However the the shortfall of doctors in country areas has grown all the more urgent with the coronavirus pandemic.
For years, the gap has been plugged with medical professionals trained overseas.
With migration all but grinding to a halt with the COVID-19 border closures, there are fresh questions about how sustainable that model is.
"I think our long term problem is that Australia, which has the highest number of doctors per capita in the world, is still needing to import doctors because we haven't worked out how to ensure that the doctors we have will work in rural and remote Australia," Dr Stewart says.
Australia has placed restrictions on overseas-trained doctors to keep them practicing in certain areas for a set period of time.
Rural Health Minister Mark Coulton said around three-quarters of overseas-trained doctors ended up back in the city.
"Many of them left their families in the city and had one eye on the road all the way," Coulton says.
In his electorate of Parkes, which takes in the western NSW towns of Dubbo, Moree, Bourke and Broken Hill, there is a high reliance on overseas-trained medical workers.
"That pipeline has really been disrupted," Mr Coulton says.
The shortfall of locally-trained doctors in rural and remote areas is all the more perplexing as there are no shortage of doctors in Australia.
"We're graduating about 7000 a year, but we we do have a maldistribution of where they go," Mr Coulton says.
"I think we need to be much more reliant on training our own. Not to say that the overseas docs haven't done a great job. Many of them have come and established themselves and they're much loved and regarded in their local community, but the flow of people now right back to the students who were coming here to study medicines at universities has been disrupted."
There are many reasons why a young doctor may not want to go bush.
"One of the reasons junior doctors don't go to the country, it's not so much the job, it's more to do with their personal experience. It takes so long, generally by the time you get through uni and you do your residency, internship, and you're off to [start working] you might have met your life partner, if you're a women, you might be at the age where you might like to have kids," Mr Coulton says.
The federal and state governments are looking at new employment models for junior doctors at trial sites where there will be maternity leave, holiday pay and regular shifts.
But Dr Stewart also believes it comes back to the way we train doctors in Australia.
"We have placed a lot of emphasis on centres of excellence. Centres of excellence have been seen as being hyper-specialised and hyper-specialisation just can't work in small communities because if you've only got 2000 people, you can't have five different specialists serving their care," she says.
"Because Australia has been really focusing on specalisation we've failed our rural and remote communities."
It also means young doctors are missing out on learning advanced skills.
"If you train your students in major teaching hospitals where they have a specialist team all around them, where they have all the machines that go ping and they're never working on their own, that's what they feel safe doing," she says.
"It's a bit like if you're used to walking down a street with street lights and traffic lights and a police car at the end of the street, that's what you think safety looks like. If you find yourself walking down a country road in the dark, lit only by moonlight and you can't see any lights at all, you feel that you're unsafe."
Stewart says if you preferentially select students from rural and remote areas and train them outside a city, they are more likely to stay in regional Australia.
Providing city students with "early and repeated" experiences in rural and remote communities can also make them more likely to stay, so long as they are well supported, she says.
"My husband and I were GPs in private practice and in the hospital in southwest Victoria for 22 years and we were sitting there going,'We have the best job in the world, why is no one following us.
"Some of the changes we implemented were to get undergraduate medical students into our practice, to get interns into our practice.
"We found that getting a whole learning community in the practice so that registrars could see that if they came and worked here they'd be surrounded by other people, there'd be educational opportunities within the town.
"We suddenly went from being the last choice to being one of the highest choices in that training organisation."
She says there are pockets of this happening all across the country.
"If I can identify those and share that learning around Australia then I feel that I will have achieved something," Dr Stewart says.
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