What have the Romans ever done for us?

Abstract

The only privilege of being the Editor in Chief of a journal is that I get the opportunity to write an editorial for every edition. I can say, within reason, what I like, without peer review, censor or editing by anyone else. This being my last editorial for the journal that is probably even more true. So, as I sat contemplating the blank screen to write this editorial, my tongue decided it was once again time to explore the tooth that was causing me some discomfort, where a chip had come off making it extremely sensitive. My experience of managing this dental problem brought my mind to the RHMT funding for rural health workforce training and that is when the title of this paper came to the front of my mind. Yes, for those of you from my generation, I am referencing the classic scene from Monty Python's, Life of Brian. As John Cleese, playing the part of Reg goes on to say “apart from sanitation, the medicine, education, wine, public order, irrigation, roads, a fresh water system and public health, what have the Romans ever done for us?” What has that got to with the Australian rural health care. Well at times I feel like I am Reg in the Life of Brian. I struggle to see what the Romans, in the form of the RHMT funded Rural Clinical Schools, University Departments of Rural Health and Dental Training Expanding Rural Placement Programs have done for us. If I go back to my tooth. I live in a regional city, Bendigo, with both a Rural Clinical School (Monash), a University Department of Rural Health (La Trobe University) and a Dental School, solely based in Bendigo. Yet, when I saw the dentist and it was determined that I need my tooth assessed for suitability of a crown (it might need root canal work), my options were to wait a long time for an appointment with the Endodontist who comes to Bendigo from Melbourne, or travel to Melbourne to see them at their practice. In the latter case, I could get an appointment within a week, in the former, more than a month wait with ongoing pain. So, despite all the RHMT funding and rural health workforce training here in Bendigo, if I wanted a reasonably quick resolution of my tooth pain, I needed to go to Melbourne. Fortunately, I have the advantage of a good income and flexible employment, which allowed me to do that, with no financial penalty. Unfortunately, the vast majority of our rural communities do not have that privilege. So, at an individual level, I feel like Reg. Apart from “on average, graduates who had the most rural clinical placement experience are now working more in regional, rural and remote Australia” (1 p213) and “the RHMT program, has a direct economic benefit to the communities and regions with economic analyses demonstrating a positive multiplier effect of around 2 i.e. for every spent under the RHMT program another dollar is generated in the local economy” (1 p 236), I wonder what has the RHMT programme done for us. Despite these assertions, we do not have any good quality evidence anywhere that the approach we are taking is actually addressing the problems of recruiting and retaining a rural and remote health workforce. Where are the data that the workforce shortage in a city or town is less after an RCS or UDRH was established than before, or that towns without RCS's and UDRHs have more workforce shortages and worse health outcomes than communities with them. In the most recent review, that I am aware of,2 identified that 34 papers focused on health workforce retention interventions for rural and remote areas. They conclude that most of the studies were of low quality, that about only one-third applied appropriate statistical analysis to the date, less than half adjusted for key potential confounders, and many had no comparator groups.2 In no other contexts of health care would that be considered a solid literature base to make any conclusions on, yet it does not deter the authors from asserting “Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.”2 So, my plea to the few people who read these editorials is can we please stop pretending that the RHMT programme has had a major impact on the health and health workforce of rural and remote Australia and spent the time and intellectual effort to actually determine if this approach is working because I am not seeing what the RHMT programme has done for my tooth.