As Dr Dan Wilson sees it, there’s an uncomfortable truth about healthcare in Australia: “Your postcode determines your health outcomes.”
“The further away you move from a capital city, the less time you spend in this world, and the quality of your life – measured objectively through quality adjusted life years – is less,” Wilson says.
“I think those communities that truly do suffer are those where there is no access to primary care. Communities where they previously had a general practice, nurse practitioner or nursing service, and that practitioner leaves, are a peak example of where [healthcare] will plummet very, very quickly.”
Wilson is a general practitioner in the town of Maryborough, Victoria, population 8,000. He’s also one of Maryborough’s rural generalists, a relatively new term for the specialist GPs who also provide emergency and other care in a rural town. In Wilson’s case, this includes working at Maryborough hospital, and providing birthing and gynaecological services.
Lake Victoria in the Central Victorian Gold Rush town of Maryborough
As someone who grew up in the New South Wales town of Kempsey, has previously worked in the Victorian country towns of Ballarat and Ararat, and serves as the president of the Rural Doctors Association of Victoria, Wilson has a front row seat to the healthcare challenges facing rural and regional Australia. It’s something he’s devoting his career to addressing.
But the 31-year-old took the long way around into medicine. Wilson says he “always knew” he wanted a career that would help others, but didn’t immediately connect that goal with being a doctor. After flirting with the idea of becoming a vet, he ended up undertaking a Bachelor of Biomedical Science at Griffith University.
Studying at Griffith was a deeply supportive experience that showed Wilson how much he loved the sciences, and became the platform that inspired him to pursue medicine as a vocation. “I now have six tertiary-level qualifications under my belt,” Wilson says. “And out of all those degrees, I truly look back at Griffith as one of the fondest in my tertiary education experience.”
The experiences Wilson had coming of age as a young gay man also spurred him to find a better way to deliver healthcare.
“I can remember several times as a man in my early 20s, maybe even late teens, seeking healthcare, and so many assumptions were made about my personal circumstances,” he says. “Inappropriate tests were ordered, and inappropriate referrals were put in place.
“Not only does that waste taxpayers’ money, but also it completely made me disengage with the healthcare system as a consumer. It doesn’t incentivise that person to look after their own health if the front face that they interact with does not feel inclusive or safe.”
Wilson wants to see Australia reach health equity: equal opportunity to seek or have access to good health and wellbeing.
“An example of that might be someone living where I live, near Creswick, Victoria. We’ve got a general practice down the road, I’ve got access to running water, I’ve got a home that I can return to, and I have a safe support network. I’ve got pretty easy access to what I would say is good health and wellbeing. However, some of those opportunities are not afforded to many other people in suburbs or even just streets away from me.”
As well as where we live, factors such as being a survivor of abuse, living without a home, or having a history of living in institutionalised care can be barriers to health equity. First Nations Australians also face lower healthcare outcomes and life expectancy.
And, as Wilson found first-hand as a young man, the health prospects of people from diverse backgrounds can suffer if they feel judged when seeking care. That’s why he strives to be a practitioner who creates a safe space for patients from all walks of life, whatever their sexual orientation, cultural background or other demographics.
Wilson thinks we are seeing some change in rural healthcare, though it’s “hard to know” whether this is for the better. Advances in digitally enabled healthcare – such as allowing patients in rural Australia to have video appointments with doctors – can help in some scenarios, though Wilson cautions they can’t always be a substitute for face-to-face care. And he’s concerned about what will happen to small communities when the GPs serving them retire, and there are no younger doctors ready to take their place.
He has big goals to make Australian healthcare better for everyone: firstly, to close the gap between rural and remote Australian health outcomes and those in cities. Wilson also wants Australia to move from a sick model of care, in which healthcare providers are focused on treating when illness strikes, to the more holistic preventative health model seen in countries such as Norway.
And he’d like to see formal recognition of rural generalist as a specialist term that reflects the real skills that doctors in rural communities have – something he says medical bodies have recently made steps towards.
On a more personal level, Wilson says he’ll never leave general practice, or stop working in rural areas – “that’s for sure”. But he feels he’s likely to move more toward health leadership roles in the future, something he credits Griffith with opening the door towards.
“My experience at Griffith University was … I barely have words for it, it was just simply easy,” he says. “It was enabling. It was rewarding. It was a massive stepping stone to launch a career in health advocacy, and health leadership.”
