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OPINION: Rural and remote communities need to lead rural and remote health

The rural and remote health system is broken. This is not the fault of rural and remote people or a result of where they live.

Rural and remote people have negligible control over their local health services and are routinely ignored or overlooked in policy decisions about future priorities and planning. They can’t be blamed for the failings of a system that was created for them, not by them.

It is too simplistic (and frankly it’s an excuse) to place sole responsibility for rural doctor shortages on the geographic isolation of rural and remote towns from major cities.

Over the last 50 years the geography of rural and remote Australia has not changed, yet we used to have GP/VMOs in rural and remote towns running the local health system alongside rural and remote people.

One thing that has changed however is that we have centralised decision making about rural and remote health in metropolitan and regional cities, placing decision making in the hands of people who do not have to deal with the consequences of the failure of rural and remote health care.

We created a deficit discourse that placed the responsibility for the failure of the system onto rural and remote people for their “lifestyle” choice to farm the land, feed our people, generate export wealth and care for country.

We went from a situation where rural and remote GPs were respected clinical leaders in their communities, and in which medical generalism was valued, to one where rural GP/VMOs all too often sit at the bottom of a fragmented acute and emergency care system.

We have funded a multi-million dollar “rural health” industry largely based in metropolitan and regional cities that has supplanted rural and remote people as the genuine voice of their own communities.

Is it any wonder that GPs eschew rural and remote practice leading to workforce shortages?

Around 7 million people—about 28% of the Australian population—live in rural and remote areas. They have appallingly poor levels of access to local health and medical care which contributes to higher rates of preventable illness, avoidable hospitalisation and death compared to metropolitan and regional cities.

This fact is no longer a call to action to redouble our efforts to invest in proven solutions, but a pitch that is used to attract more and more funding for "innovative new approaches" that too often look like nothing more than clever ways to replace local rural GPs rather than attract them.

Over the last 20 years we have invested billions in rural health and medical programs. Yet according to the NSW Rural Doctors Network we have gone from having 800 GP/VMOs in rural and remote NSW to 200 in just ten years.

Rural and remote people have embraced every one of these "innovative new approaches" in the desperate hope of an improvement in access to health and medical services. They trusted us when we said there would be a tsunami of GPs washing up on the shores of rural and remote Australia.

The feeling of disappointment and frustration over the failure of these programs and policies is palpable, made more evident during the current outbreak of COVID in our communities where questions now abound “if there is a mass COVID outbreak, what will happen to the people in our communities without adequate local health care?”.

Rural and remote communities tell me that they want root and branch reform of their local health system led by rural and remote people. They want their voice to be at the table when decisions about their lives and their health services are being made.

They want solutions based on what has been proven to work, of which there are numerous working examples, rather than some “innovative new approach" designed by people who don't live in rural and remote towns and therefore will never have to deal with the consequences when it fails.

It’s time for rural and remote people to be genuinely engaged and empowered to address their own health needs and to be given the resources to do so. We need to fund rural and remote communities to design local solutions delivered by local people for local people.

Mark Burdack is CEO of Rural and Remote Medical Services Ltd (RARMS) an Australian health charity established in 2001 to support rural and remote communities that were struggling to access local health and medical services. Today RARMS operates 8 charitable health services in rural and remote NSW, and serves a catchment of more than 300,000 rural and remote people. It is one of the largest providers of health care to Aboriginal people in NSW by active patient load. For more information email Mark Burdack on



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