John Flynn meets James Mackenzie: developing the discipline of rural and remote medicine in Australia.

This commentary is a reflection on the lives of two men, whose qualities seem to reflect those needed in the establishment of the academic discipline of rural and remote medicine in Australia. The two men displayed three characteristics which those involved in change require: they were there; they equipped themselves to make a difference; they were not afraid of where change might take them. If rural and remote Australasia is to receive appropriate health care, the main medical workforce has to be made up of contextually trained rural generalists. This rural doctor will be a general practitioner with the additional competencies of paediatrician, internist, obstetrician, anaesthetist, surgeon, emergency physician and so forth, depending on the needs of both rural hospital and community. Without training for this role, our ageing rural workforce will never be renewed. Our medical schools, postgraduate councils and colleges are currently failing to provide appropriate numbers of such Australian trained graduates to fulfil the needs of rural communities. That task needs to be carried out by an academic discipline of rural and remote medicine, working through all these bodies. The current tripartite structure of medical education (4-6 years medical school, 2-3 post-graduate years, 4 years vocational training) with metropolitan domination and frequent transfer of responsibility, is directly contributing to the crisis in rural medicine, where 'rural and remote' is seen as an occasional tourist destination, rather than the centre of the process. The Rural Clinical Schools model needs to be expanded to provide a platform for appropriate education and a training pathway not only for medical students, but also for prevocational, vocational and established rural generalists. Only in this way will we be able to convert the 'Tsunami of medical graduates' expected in 2010 to an adequate supply of rural and remote generalists into the future.