A champion for rural plastic surgery

Dr Jaeme Zwart

A third of Australians live outside cities but many surgical specialties are still not wellrepresented in regional and rural areas. New surgeons train primarily in the cities, maybe visit for a rural experience, then most return to metropolitan surgical units to grow their careers. How do we change deeply ingrained attitudes about regional and rural surgery, support our hardworking rural surgeons, and move closer to achieving health equity for all Australians? Dr Jaeme Zwart, a plastic surgeon based in Cairns, Queensland, is an ardent champion for rural surgery. He’s been working in Cairns for 18 years and is committed to serving the local communities for the long haul. He says a few other plastic surgeons have worked in Cairns for extended periods of time, but for various reasons they have left. He’s a member of the RACS Rural Health Equity Advisory Group and the Australian Society of Plastic Surgeons (ASPS). Through his work, he’s determined to help drive change for rural surgeons and their communities. “One third of the Australian population live outside a metropolitan city. Just nine per cent of plastic surgeons work in a rural setting. So, a very small number of overworked plastic surgeons are servicing a third of the population,” Dr Zwart said. There’s no plastic surgery training outside Brisbane, and, to Dr Zwart’s knowledge, he’s the only long-standing Fellow in his specialty in far North Queensland. “At one point, I was the only public plastic surgeon for about 10 years, servicing a large area of about 250,000 people. Thankfully, I now have three other colleagues who are as passionate as I am about delivering rural plastic surgery.” What steps are being taken to change the future for plastic surgery outside the big cities? ASPS has a rural and regional committee that brings like-minded surgeons together as a voice to advocate for rural plastic surgery. It’s also a muchneeded support network to combat professional isolation. In a monumental step in the right direction, ASPS established the Darwin Workforce Strategy two years ago. Metropolitan plastic surgeons work in Darwin on rotation, volunteering their time to do surgery and help augment a sustainable service. This fly-in-fly out system has brought plastic surgery back to the Northern Territory. Unfortunately, it’s not a sustainable long-term solution to the dire shortage of plastic surgeons in regional and rural Australia. ASPS is a not-for-profit organisation. The Darwin Workforce Strategy relies on the goodwill of surgeons to disrupt their city lives and volunteer their time without pay. However, Dr Zwart hopes the value of this model of service will eventually be recognised by the government, attracting funding for paid surgical rotations, and be replicated sustainably in other regions. In another positive step, ASPS has recently undertaken quantitative analysis of the plastic surgery workforce to identify the most pressing problems. The results will be released soon and should help guide advocacy and progress for the rural workforce. ASPS is also developing a guide for plastic surgeons who will work in a rural setting. Among other useful information, the resource focuses on experiences and problems encountered by rural plastic surgeons and the steps they took to find solutions.

The next crucial step, Dr Zwart said, is to establish opportunities for plastic surgery Trainees in regional and rural hospitals. “They all move to the city to train, where they establish their lives and then feel drawn to stay. If new surgeons can train at home, they might be more likely to stay home to build their careers.”

RACS is working on adapting the surgical training program and training facility criteria so regional and rural Trainees can learn their specialties near home, without the need to move to the city. Dr Zwart was initially drawn to Cairns for family, the relaxed lifestyle, and the incredible mountain biking opportunities. Although it has been tough at times professionally, he’s committed to his local communities and is determined to be a voice for change for rural Australians and their surgeons. For the future, he has his sights set on an established plastic surgery team based in Cairns that accommodates Trainees, and better health equity for far North Queensland communities, with timely access to plastic surgery near home.