Sustainability in a dispersed workplace

Dr Bridget Clancy

Sustainability in the dispersed workplace

Rural Surgery Section (RSS) Chair and Rural Health Equity Steering Committee (RHESC) Vice Chair, Dr Bridget Clancy, delivered the Australian and New Zealand Journal of Statistics (ANZJS) lecture in the plenary session: The dispersed workplace – Lessons from the extreme. The title was Excellence through Equity. Dr Clancy emphasised that the poorer health outcomes rural people experience are due to lack of access to care—not due to a poorer standard of care. There is ample evidence of rural excellence in surgical training, surgical innovation and surgical outcomes. Dr Clancy was awarded the ANZJS Lectureship in recognition of her research, strategy development and advocacy in rural health equity. Dr Clancy reported that rural medical school graduates earn higher academic scores than their urban counterparts. The AHPRA Medical Training Survey 2021 found SET Trainees are more satisfied with their rural training experience and more likely to recommend their current rural training post to their peers, compared to Trainees in urban posts. Dr Dinah Hippolyte-Blake and other researchers in a recent quantitative study of ‘… the incentives and barriers that influence preferences for rural placements during surgical training in Australia’ (ANZJS 2022) found that SET Trainees value rural training, provided their sociocultural needs are met, and they can prepare for their exams. Respondents cited more first-operator experience, direct consultant supervision and broader case mix compared to urban posts. The audits of surgical mortality show rural surgical outcomes are the same or better than urban outcomes—despite equal or greater patient complexity and more advanced disease at presentation. Dr Derek Mao presented a talk entitled A comparison of the causes of death between patients treated in metropolitan versus rural centres following emergency colorectal resection from the Queensland Audit of Surgical Mortality. He concluded patients who have emergency surgery in rural centres had a higher mortality rate due to advanced stage at presentation and lower mortality due to surgical complications or new medical complications. Several presenters confirmed equivalent oncological outcomes for breast cancer surgery in rural hospitals. Surgical volume for some procedures, regardless of location, is associated with improved patient outcomes. Pancreaticoduodenectomy is one such example, with high volume considered as being 20 or more procedures per year. This is as per research conducted by surgical PhD candidate Dr Joshua Kovoor—although the availability of specialised infrastructure may be equally as important as volume. Dr Kevin Tree, an unaccredited surgical registrar, reported similar outcomes and survival from emergency palliative open gastrojejunostomy in a regional setting compared to international benchmarks. He noted metropolitan centres are more likely to have facilities for endoscopic stenting. Dr Kishore Loganathan, an unaccredited surgical registrar, found comparable outcomes in operative time, length of stay and complications for adrenalectomy in a low volume regional