Rural and remote physiotherapy: Its own discipline

Rural and remote health is a recognised academic discipline. The delivery of health services in rural and remote areas is always on the political agenda and well known to be a problem. Given this focus there is a growing history of different state and commonwealth initiatives and policy changes. A growing body of experience, research and knowledge has developed. Rural and remote physiotherapy too has emerged in its own right as a discipline. Formal recognition in the professional associations is seen with dedicated rural and remote groups, representation on national advisory councils and state boards. For those rural and remote physiotherapists seeking to be recognised as specialists formally within their own profession, a process of identification of key competencies is required to define this specialisation. Specialisation models are traditionally based on clinical mastery with a patient. The challenge for rural and remote physiotherapy specialisation is to translate a mode of practice that is predominately characterised by location and scope into a process largely designed to recognise clinical specialties. Identification and quantification of the clinical, administrative and professional competencies that are required for effective rural and remote physiotherapy practice provide benchmarks for attainment of advanced standing. These developed competencies will give direction and focus for those wishing to pursue specialisation as a rural and remote physiotherapist. The competencies must represent a continuum of professional development, rather than discrete stages, and acknowledge both formal and experiential learning pathways.1 The possible framework for achievement of specialisation as a rural and remote physiotherapist under discussion includes: Demonstration of a duration of practice in rural and remote areas Evidence of contribution to the particular rural and remote community that the physiotherapist services Leadership roles within the profession and health sector.1 This specialisation framework recognises the professional advantages that come from being a key influential figure in the health status of an entire community. By focusing on the leadership role and contribution to the community, the debate changes from the challenges of rural and remote practice to its rewards. For example, program development or coordination addressing a particular need within a community becomes part of the evidence of contribution to a community. Leadership can be demonstrated by advocacy on local health issues together with acting upon the identified social determinants of health. Rural and remote physiotherapy specialisation processes can change the focus to the positive opportunities rural and remote practice presents. In time, this could prove a useful recruitment and retention strategy. Essentially where other clinical specialisations require a person to display mastery of their individual assessment and intervention skills, rural and remote specialisation would require a clinician to demonstrate skills in a population- or community-based assessment and intervention. This approach defines rural and remote practice by what it is, rather than what it does not have. The skills working in a rural and remote community that a physiotherapist requires include: Determining population-based needs and facilitating community involvement Focusing on appropriate communication strategies to clients and communities, searching for other means and ways Devising responsive strategies to individual and community needs with new ideas about service models Learning new and changing professional identities A practical understanding across the range of health practice areas in order to identify appropriate referrals and networks Acting as researchers and evaluators of what they are doing and letting everyone know their success stories. Whilst many of these factors are true of physiotherapists not working in rural and remote areas, the emphasis can be different. The roles that physiotherapists have developed in primary health care, population health and health promotion all need to be implemented in a lower resource framework often associated with rural and remote areas. As rural and remote physiotherapists should know their community well, this gives an opportunity to develop discrete and integrated programs that aid the particular health needs of the community. The rural and remote physiotherapist becomes a leader in the community and profession. Concepts of community development and the utilisation of the expertise of local people have not been core components of physiotherapy training nor other health education.2 Changes are occurring. Rural health training is now an integral part of health professionals training. Programs that specialise in the rural and remote health professions are growing all the time. In preparation for the current and future workforce in rural and remote areas, the following capabilities are required: Responds to expectations of a new way of working, across organisational and professional boundaries in different teams; a changing face of the professions Participates in workforce planning based on the needs of patients, such as a focus on an integrated chronic diseases model rather than providing services within a defined role of a particular profession Welcomes new service providers who will emerge to achieve integrated community care such as therapy assistants or triage experts Develops important skills in community development, primary health care and assessing and responding to the social determinants of health To be savvy in technology to access and provide information To be able to evaluate the evidence of health care interventions in forming health care approaches. Pursuing population health approaches and networks of care requires development of clinical and other protocols for these networks. This work needs skills in evaluating the evidence but more so in population health and primary health care. As the health care disciplines’ training changes to prioritise this education, other rural- and remote-based university courses have adopted population health and primary health care as core curriculum. The challenge for the health professions is not to continue with profession centric, competitive practices with an individual client focus being disconnected from a bigger picture.3 Rural and remote health professionals with strengths in interdisciplinary care are well placed to embrace change and develop new modes of practice. Recognition of these skills as advanced standing in the profession forms part of the continuing debate.