"Annie", who works in a small rural hospital, writes:
"Stop blaming doctors for the health system" (4 December, item 14).

"Dr Graham", don't make assumptions about rural doctors. And don't make assumptions about rural health services. I work in a small rural hospital with the most dedicated and hard working doctors that Melbourne hospitals would die for. They deliver babies with competent midwives as a team effort, and only send off those high risk mothers to Melbourne or large regional hospitals. They do emergency L.U.S.C. when required and safe to do so. The can intubate patients needing to fly out, they can fix hernias, remove fish hooks, will travel to Melbourne in choppers on a Sunday with unstable patients to be told when they arrive and deliver their precious cargo that they have to make their own way home, in a pair of shorts and shirt and no wallet, because they hadn't thought past saving the persons life. In fact last Sunday our on-call GP did just that and caught the V-Line train home (and didn't whinge about it).

We have many students and junior registrars on placement. They love it. They learn a great deal. Some of them we hope will return to the country later to practice. They will be able to have a good life and will be well supported by their communities.

The two nurse practitioner candidates in our service are encouraged, supported and thoroughly mentored by the senior doctors. The only way rural doctors can keep practicing is to have nurses who will be nurse practitioners and senior nurses supporting their on call roster. These well trained nurses are generalists, with amazing capacity to deliver a baby, hold the hand of a dying elder, remove a plaster cast from a four year old and recover the total hysterectomy.

Of the 312 patients seen in October in our out of hour's clinic or non funded emergency department 225 of them were not seen by a doctor. This is not a new phenomenon, and not peculiar to us. In fact most of what happens here happens in other small rural centres. Often the needs are easily dealt with, but none the less are the same issues that send people to doctors' clinics in suburban Melbourne. The practice nurses also have a huge role. It takes a group effort and we have a great group. We are gearing up for the summer where we will have to deal with large volumes of tourists. And we do, and they say, I would give anything for a service like this in Melbourne, Sydney, New York wherever they come from.

The reason we don't have enough proceduralist GP's and nurse practitioners in Australia, has nothing to do with overseas. GPs and nurses have families that live in these towns; their kids go to the same school, play soccer and basketball on the same teams. The real truth is that the nurse practitioners have barriers around this ill informed rhetoric that come from people including the AMA and others who have no real understanding of what the issues are.

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