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ACRRM Registrar Dr Ricky James feels pretty lucky: he has found the long-term fit he knows he wants for his General Practice career in Warwick, 130 km south-west of Brisbane.

Ricky arrived in the regional hub, which services an extended population of 30,000, in early 2019 and was welcomed into the local GP fold by the team at Condamine Medical Centre.

He spent his first 12 months of training based at the practice building his primary care skills and this year he has transitioned to splitting his time between the practice and Warwick Hospital, where he provides emergency care and inpatient treatment.

Next year he will travel regularly to nearby Toowoomba to pursue Advanced Rural Skills Training in obstetrics, a skill-set he knows will be beneficial to bring back to the local community.

Life is good. Ricky and his wife Robyn, an Emergency Department nurse, have bought a house. They are even beginning to think of themselves as Warwick locals.

But, as is the case for many registrars, the path to here hasn’t exactly been a straight road. Ricky shares with us a few nuggets of rural registrar wisdom he has acquired while navigating his own twists and turns.


  1. Bad luck sometimes yields the best outcomes

A case of bad luck is ultimately what led Ricky to choose Rural Generalism.

He was in his fourth year of medicine at The University of Queensland and preparing to embark on his Advanced Hospitals Practice units when he found out he’d missed out on his first five preferences and was being sent north to Bundaberg Hospital.

“I was initially pretty disappointed,” Ricky says.

“I had been hoping to get a Brisbane hospital as I was planning to propose to my [then] girlfriend and she was working at the Royal Brisbane and Women’s Hospital, but getting Bundaberg ended up being a blessing in disguise.”

“There were only 14 people in my rural clinical school group—I’d been in a group of 100 in Brisbane the year before—and by the time I left the hospital I’d worked in every department,” he said.

“The medicine was interesting and it was hands on. I’d talk to my friends doing their placements in city hospitals and they’d tell me 80% of their time was taken up filling out paper work.”


  1. A foolproof test for choosing rural medicine

Without experiencing rural medicine it can be hard for junior doctors to know if their sensibilities will be aligned.

Having reached this juncture in his rural GP training, Ricky says now there is a basic test he recommends to junior doctors who are unsure about whether or not to give rural General Practice a try.

“These days I say to people: pick your specialty based on the five conditions you want to see every day for the rest of your career,” he explains.

“When you consider it this way there are really only two specialties—General Practice and Emergency Medicine—where the cases you treat are going to be consistently varied.

“So, if variety is what you are after, then General Practice—and rural General Practice in particular—is a pretty good bet.”


  1. If you’re ok with hard work, becoming a GP won’t disappoint

Having spent plenty of time now in both the General Practice and hospital settings, Ricky says he knows which one poses the greater challenge.

“In General Practice I believe you work harder,” he says.

“You are seeing between 30-40 patients a day and that requires so many skills alongside the medicine.

“You need to be an excellent communicator, a fast reactor, an expert at time management, and empathetic—which means really listening to the patient,” he explains.

“In the hospital setting you can usually find five minutes to take a mental break and just think about what’s up next, but in General Practice you rarely get that luxury.”

“So, yes, it isn’t easy but building all of those skills to be able to give patients what they need from you is very rewarding.”


  1. There’s more than one way to look at Advanced Rural Skills Training

Ricky says when he arrived in Warwick he was planning to pursue paediatrics for his Advanced Rural Skills Training.

However, as he became more familiar with the community and its needs and learned there was a paediatrician based in nearby Toowoomba he decided to change his selection to obstetrics.

“I realised I wanted my advanced skill to be something that really aligned with what the local community needed,” he explains.

“And it made me realise there a couple of ways to look at Advanced Rural Skills Training.

“You can either pick a skill that you love and that you want to have as a feature of your job, or you pick a community that you want to be a part of and you decide on an advanced skill based on what that community needs.”

The timing of Advanced Rural Skills Training can also have an impact on a registrar’s skill selection, Ricky says.

“Most people elect to do their advanced training first. I left mine until later and I am actually glad I did, because it has given me time to learn more about where I want to be as a rural GP and to weigh up all the options.”