Dr Fergus Gardiner1
1Royal Flying Doctor Service of Australia
As celebrations of our 90th year of operation wind down, it is pertinent that the Royal Flying Doctor Service (RFDS) continue to look to the future, to ensure that our services remain competitive and efficient, optimally targeted and designed to meet the needs of a changing population in remote and rural Australia. The Australian population is estimated to be 29.4 million by the year 2028 with a percentage growth of 1.4% from the previous year. Chronic diseases are estimated to increase from 11.8 to 13.8 million Australians living with at least one chronic disease between 2018 and 2028, with cancer, mental health, and cardiovascular disease prominent. Neurological disease Disability-Adjusted Life Year (DALY) increased by 3.7% per year from 2003 through to 2011, indicating that without further intervention this prevalence will continue to grow until 2028. Pathology, imaging, and pharmaceuticals is expected to reach 6.6, 1.3, 9.3 service episodes per-patient per-year, respectively in 2028. This equals 17.2 services accessed per patient per year in 2027-2028 as compared to 13.3 in 2007-2008. This increase is significant (p=<0.01), and is believed to reflect growing chronic disease rates. When comparing areas of low to the areas of high medical service supply there are a significant difference in provision, with the majority (p=<0.01) of the low supply being in rural and remote areas. Furthermore, the majority of clinical provision per 100,000 people are predicted to be located in metropolitan areas by the year 2028, with significant (p=<0.05) workforce shortages in rural and remote areas as reflective of recommended benchmarks. There are, and will continue to be, significantly lower services in rural and remote as compared to metropolitan areas, and that workforce provision is and will also continue to be significantly lower than metropolitan areas per 100,000 population. This is concerning as the rates of DALY per 1000 population related to cancer, cardiovascular disease, mental health, are expected to continue to be significantly higher in rural and remote as compared to metropolitan areas. Consequently, there will need to be: 1) health prevention to halt growth in cancer, mental health, cardiovascular disease; 2) extra primary treatment to respond to chronic disease growth; 3) extra health staff incentives for going to the bush. The RFDS will be in high demand throughout the next ten years, with expected growth of service provision in primary and retrieval medicine, and increased outreach program provision involving specialists, Allied Health, mental health, dental, and telehealth to rural and remote areas.
Fergus Gardiner has recently completed a PhD (medicine) specialising in chronic kidney disease management. Fergus has been the lead author on research projects, involving emergency and military medicine, rural and remote healthcare, pathology, and obstetrics and gynecology. Prior to commencing with the Flying Doctor, Fergus served in the Australian Defense Force before employment in large teaching hospitals and the Department of Health. Fergus is a visiting academic at the Australian National University Medical School, were he conducts epidemiology and clinical research. Furthermore, he is a consultant associated with applications to the Federal Government’s Medical Services Advisory Committee, in the field of chronic disease management.