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Be Careful what you wish for: the impact of funding on a small member-based organisation


Case study of a support group (Rural Medical Family network) that exists to support the families of general practitioners working in remote Australia. Many of these families come from overseas and/or …

Case study of a support group (Rural Medical Family network) that exists to support the families of general practitioners working in remote Australia. Many of these families come from overseas and/or cities, and the culture shift can be enormous

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  • 1. Graduate Case Study in Communication Louise MillerAssignment Three 09042093M Table of ContentsTable of Contents 1Table of Plates 1Abstract 2Acknowledgements 2Declaration of Conflict of Interest 2Introduction 3Research Questions 5Literature Review 6Methodology 8Findings 8In the Beginning…. 8The Middle Years…. 12Lately… 16Discussion 17Conclusion and Recommendations 22References 24 Table of PlatesPlate 1: First Logo, circa mid-1990s 18Plate 2: Second Logo, circa 2001 18Plate 3: Third Logo, circa 2005 18AbstractDifficulties in the recruitment and retention of doctors for rural and remote medicalpractices have long recognised the important role of the medical spouse in the decisionto move to a rural practice and to remain there. The many issues faced by medicalspouses have been addressed in a number of ways at a Commonwealth and State level,including the development of support networks. In SA this network has evolved from asocial network that self-organised to a funded and accountable organisation auspicedunder Rural Doctors Workforce Agency. The difficulties of targeting a group definedpurely by their relationship to others (the doctor-spouse) and with no other 1 of 26
  • 2. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mcharacteristics necessarily in common, geographically dispersed, and providing activitiesor functions that are meaningful both to the targeted membership and to the doctor-spouse (the true aim of the funding) has proved difficult. Nevertheless the organisationhas survived through three phases – from the minimal funding phase, through a periodof good funding and now back to minimal funding, undergoing generational change anda move to accountability at the same time.AcknowledgementsParticular thanks to Rural Doctors Workforce Agency for allowing me access to RMFNfiles dating back to the early 1990s and to the CEO Leigh Carpenter for his time andthoughts. Thanks also to the participants, current and previous RMFN coordinators atRDWA, and previous Committee members.Declaration of Conflict of InterestThe author declares a conflict of interest. I am a rural medical spouse and have beeninvolved in the RMFN SA, attending networking weekends and received a $1000education grant in 2001. I worked as the Workforce Officer at Murray Mallee Division ofGeneral Practice from 2001-2004, a role that included being the Division RMFN Co-ordinator.IntroductionRecruitment and retention of General Practitioners (GPs) in rural and remote Australia isbecome increasingly difficult (Strasser et al, 2000, 222-226). This has significant impacton the equity of health provision in these areas and has increasingly become a focus ofpolicy, research and funding. (Veitch, 2003, 2) A number of issues have been raised asimpacting recruitment and retention (Joyce, Veitch, Crossland, 2003, 7-14) and one 2 of 26
  • 3. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mmajor area identified relates to the doctors’ spouse and/or children, referred to asmedical families. (Veitch, 2003, 2; Nichols, 1997; Hays, Veitch, Cheers, Crossland,1997, 198-203; Humphreys, Jones, Jones, Hugo, Bamford, Taylor, 2001, 94,95,98)The Rural Medical Family Network is a network that exists to support the spouses andfamilies of GPs and specialists (primarily GPs) who live and practice in rural SA. RuralMedical Family Networks have existed in Australia since the early 1990’s and moreformally since approximately 2000. Despite this there is little published literature on thenetworks themselves or their functionality, although they are often included as part of GPsupport (Joyce et al, 2003, 7; Humphrey et al, 2001, 91-102) and the role of the spouseas a support for the GP is recognised. (Lippert, 1991, 237-238, Sotile, Sotile 2004,39-59). A 1991 paper presented at the 1st National Rural Health Conferencerecommended Commonwealth funding to develop or grow spouse support networks at astate and national level (National Rural Health Alliance, 1991) and by 1996 some of thesupport aspects that had been implemented were included in a paper on the GeneralPractice Rural Incentives Program. (Holub, Williams, 1996, 120) Small amounts offunding ($15,000 annually) were made available in South Australia throughout the1990’s, and in 1999 the Commonwealth Government committed $125,000 over threeyears as part of the GP Rural Incentives Program (GPRIP), a program aimed atsupporting general practice in rural areas. (Carpenter, 2006; Warren, 2006; Garrard,2006; Holub et al 1996)A significant amount of grey literature exists in Australia on RMFN, largely because ofthe mode of funding the Rural Medical Family Networks as projects through RuralWorkforce Agencies and Divisions of General Practice, although again the focus ismostly on need and activities, not on the networks themselves. Research on the needsof medical families has been conducted in Australia and internationally, although some 3 of 26
  • 4. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mof the issues faced by Australian medical families regarding extreme remoteness are notrelevant in some other settings. Similar scale funded networks seem not to have beenimplemented overseas.The issues of being the spouse of a general practitioner (not specified as rural or urban)are recognised in international literature. Issues identified as relevant include being thespouse of someone who is likely to be “perfectionistic, self-sacrificing and self-critical”(Sexton, 2003, 326; Rucinski et al, 1985, 90-94), lack of parenting support due to theGP’s time commitments, impact on family life, impact on spouse’s careers (Nichols1991), effects of community expectations (Cunningham, Dovey, 1999; Roach, 2002, 24,Hays et al, 1997, 200; Ozolins, Greenwood, Beilby, 2004, p2; Kamien, 1987, 47-52;Bond, 2006, 6; Wise et al, 1996, 62-63), general stress levels (Rout,1996, 157-160) aswell as the general difficulties associated with living in an isolated community often farfrom family and friends. (Roach, 2002, 24; Veitch, Crossland, 2005, 1-11; Cheney,Wilson, 2003, Humphreys et al, 2001, 9-95; Hoyal et al, 1995, 2-9; Lippert 1991) It isworth noting that many positives related to being the spouse of a general practitionerand living in rural areas were also identified. (Roach, 2002, 24, Hays et al, 1997,199-200).The overwhelming approach to examining the issues of the medical family or medicalspouse is through the lens of how it impacts the doctor spouse and the decision toremain or leave rural general practice.Research QuestionsMy research questions relate to the evolution of RMFN SA, a support network set up byand for rural medical spouses. Specifically: 4 of 26
  • 5. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MHow have the purpose, values, structure and activities of the Rural Medical FamilyNetwork in SA changed in the three phases of its existence: pre-funding, funding andpost-funding? Subsidiary Questions How have the various participants understood what has happened? Was the funding an enabler or a barrier for achieving the original purpose of the organisation? How has the organisation changed as a result of the funding in terms of structure, purpose and image? What is the RMFN’s current values and purpose and are they in tune with what its members want?Literature ReviewThe RMFN is an interesting organisation on a number of counts. Of particular interestfrom a feminist perspective is the fact that qualification for membership is by theoccupation of the spouse / partner, not by any characteristic, achievement or interest ofthe member themselves. (The majority of members are female spouses of male doctors,although some male spouses and some same sex partners (male and female) aremembers – membership does not require any active nomination, just being the spousein a rural area.) Therefore although the membership is mostly female and the purposeof the organisation is support of the members, the main criteria for membership is notcentred on the member themselves, a lack of centrality on the female perspective. (Fine,1993, 128) That the funding centres on supporting the GP to remain in a rural areareinforces this lack of centrality of the female members. 5 of 26
  • 6. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MRMFN is a volunteer run and organised group, whose sole aim is to provide support tomembers. Justification for its funding is under the banner of the recruitment andretention of the medical practitioner spouse (Kamien, 1987, xi, 47-52; Wise et al, 1996,63-64; National Rural Health Alliance 1991)), so at all times when there is an interactionwith the funding bodies, it is the medical spouse who is most important. In this manner itis difficult to think of an equivalent organisation.Schein contends that culture will form around any relatively stable unit with sharedstresses and challenges. (Schein, 1993, p47-49) RMFN consists of those spouses whochoose to be members. There are no financial barriers to membership. Therefore itcould be assumed that those spouses who choose to be active members share goalsand understandings. Smircich says that a strong culture can be used to legitimateactivity (Smircich, 1983, 344-345), and in this sense some of the social activities thatseem difficult to justify on an accountability framework perhaps made sense tomembers.Some small amount of subculture development is visible in the RMFN (SA)organisations, although to a large extent it is fairly incohesive. To the extent that theyexist, the subcultures (particularly around the founding members and the committee) doprovide a level of identity and relationship definition, but the majority of members wouldbe external to the subcultures. (Pepper,1995, p31; Schein 1993, p47-49)This research will examine the culture of the RMFN (SA) from the viewpoints ofparticipants in a number of roles and hence the qualitative framework is moreappropriate. (Morgan, Smircich, 1980, p492) This approach recognises the centrality ofeach member to their experience of RMFN, and the validity of each individual’sexperience. The organisation has remained relatively small over the decade and a halfsince its inception in SA (in part due to the small number of medical positions in rural 6 of 26
  • 7. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MSA), and members come from a wide variety of backgrounds and find themselves indifferent situations in rural SA. These participants are at a local level responsible forcreating the reality of the RMFN, because they are part of the organisation and becausethey are responsible for local decision making and direction. (Morgan et al, 1980,491-500)While a lot of literature exists around motivations for volunteering, characteristics ofvolunteers (Omoto, Snyder, Martino, 2000, for example), and much of this is for personalreasons, most organisations examined also have an external purpose – to serve adisadvantaged group, fundraising, emergency services. The RMFN is different in thatthe volunteers are providing services for themselves, there is no external purpose.MethodologyThe data for this study was sourced through interviews with the CEO of Rural DoctorsWorkforce Agency, interviews with four Project Officers and three previous RMFNCommittee members. (Some of these interviews were conducted via email or telephonedue to issues of distance.) Document reviews were conducted using previousnewsletters, the RMFN website, previous annual reports and other documents such asbrochures and meeting minutes, funding agreements and papers relating to Committeebusiness. Particular thanks to Rural Doctors Workforce Agency CEO Leigh Carpenterfor allowing access to documents.FindingsIn the beginning…. 7 of 26
  • 8. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MThe RMFN began in the early 1990s when spouses of Rural Doctors Association SA(RDASA) and particularly the RDASA Board, found themselves meeting regularly whentheir husband’s attended conferences. They discovered that they had similar issuesrelating to their role in their rural towns, being the spouse of a doctor who was on call,and issues relating to living in a rural area.By the nature of who their husbands were – doctors sufficiently established in ruralpractice to be involved in the RDASA Board – the original RMFN members could beviewed as relatively homogenous. They were all female, mostly of similar age (40 to 60)with children in the teens or older, of a similar socio-economic status and although theywere from different areas of SA they were for the most part from larger towns or near toregional centres (ie: not remote areas). They had many similarities socially and similarinterests, which was the basis of their friendship. Having discovered that the issues theyfaced were the same as each other, they reasoned that these issues may affect otherspouses. An article was published in the RDASA magazine, and presentations weregiven at the first National Rural Health Conference in 1991.The RMFN grew out of this social network and while there was a larger purpose to theorganisation, continued to meet the social needs of the central group. A small amount offunding was made available through (initially) RDASA, then by 1995 through SA RuralDivisions Co-ordinating Unit (SARDCU) to the amount of $15,000 per year. This fundingpaid for committee members travel costs to monthly meetings in Adelaide and tointerstate conferences where they gave presentations, and was used to develop anewsletter.Newsletter articles at this stage focussed issues relevant to rural doctors that alsoaffected their spouses, such as allowances, availability of locum doctors, amusinganecdotes about rural practice, book reviews, and recipes. 8 of 26
  • 9. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MIn 1995 a project manager was allocated to the RMFN through SARDCU, fundedthrough core SARDCU funding. This brought a higher level of accountability to theRMFN Committee which was sometimes treated with suspicion. The Project Managerfacilitated the development of local branches of the RMFN based geographically (linkedto local Divisions of General Practice), developed a database of rural spouses, tried tobring literature and evidence to the attention of the committee and focussed on strategicplanning. The Project Manager organised a survey of medical spouses (65% responserate) to identify issues and build an evidence base to back the Committee’s aims andfunding proposals, and developed position papers, such as one on working withDivisions of General Practice, a way of developing local support for the RMFN.(Divisions of General Practice were set up in SA between 1993 an 1997 and are part ofa national network funded primarily through the Commonwealth GovernmentDepartment of Health and Ageing). Another major development at this stage was thedevelopment of standards for housing provided as part of the package for doctors inrural areas. This paper was based on the standards of housing provided for bank staffand teaching staff in rural areas. These standards were adopted and remain in place,particularly used for locum doctors in rural areas.While meetings had agendas and structures and positions were decided by nominationand election, the meetings still fulfilled the social needs of the members and were largelythe same core group. Individual personalities on the Committee had considerableinfluence on the direction and activities of the RMFN. With the advent of the local RMFN,the Committee was restructured to have one regional representative from each area,although initially there were two representatives from some areas, reflecting perhaps adifficulty the core group had in transitioning from a social group of friends to a more 9 of 26
  • 10. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mformal structure. As more rural spouses volunteered to join the committee, a formaldecision was made on how the central committee would be comprised.There was also a push to include the spouses of GP trainees on placement in thecountry, with the idea that a positive rural experience might encourage the trainee to goback when they were qualified (again a doctor-centric aim rather than an aim specific tothe needs of the spouse). The spouses of GP trainees tended to be significantlyyounger than the Committee (although when Flinders University started postgraduatemedicine courses, trainees and their spouses started to be older as well). Some effort toget trainee spouses on the committee tended to be less successful – sometimes thespouses stayed in the city developing their own careers (trainees generally move everysix months which causes difficulties for the spouse to seek work local to the doctor-spouse’s placement), many young trainees did not have a spouse or if they did theywere often focussed on their careers. This affected whether they identified themselvesas “medical spouse” or through their work, and hence whether the RMFN seemedrelevant. Work opportunities in rural areas for spouses began to take a higher focus,and examples of the group mediating on the part of individual spouses seeking work arecontained in the records.Orientation packs for new spouses to rural SA were developed with information such aslocal facilities and services, how to settle in to a rural community, where to seekadditional support (Bush Crisis Lines), and personal visits from the local RMFNrepresentative. In latter years once workforce became an issue taken up by ruralDivisions of General Practice, the Division Project Officer would also visit. A web sitewas started, attached to SARRMSA, and a families program was organised concurrentlyto the RDASA conference. 10 of 26
  • 11. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MIn the late 1990s the Commonwealth Department of Heath and Aged Care (DHAC)facilitated the set-up of a national RMFN, according to one project officer because “theywanted to have one person they could call on to attend meetings in Canberra andrepresent spouse viewpoints”. The network now had three levels, local, state andnational, and had visibility with the Commonwealth Government.Some small level lobbying for funding had occurred in the past, both from the stateRMFN level and from other organisations such as RDASA and RACGP Rural Faculty.Some local RMFN branches lobbied and received funding from their local Division ofGeneral Practice (Eyre Peninsula RMFN received $4000, Barossa RMFN $2000). In1999, as part of the GP Rural Incentives Program, support for rural families was fundedfor $125,000. The overall aim of the funding was to support the recruitment and morespecifically, the retention of GPs in rural areas and the funding was allocated through therural workforce agencies. In SA this was SA Rural and Remote Medical Support Agency(SARRMSA), since renamed Rural Doctor’s Workforce Agency (RDWA).The Middle Years……At approximately the same time as the funding began, the former Project Officer movedto another organisation. A new Project Officer was employed with part of her time forRMFN and part for other support projects such as Dr Doc, which focussed on the healthof rural GPs and their families. Rural Divisions of General Practice were funded $5000to include RMFN activities in their workforce support program.As with the previous Project Officer, this person also felt that the push for moreaccountability brought by both the funding and by the existence of a Project officer wasnot always welcome, particularly where it represented priorities that conflicted with thesocial needs of the group. At about this time some of the original committee members 11 of 26
  • 12. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mbegan to back away from the organisation, feeling they had ‘done their bit’ or to ‘letothers have a turn’. (Several Committee nominations included notes to the effect of “ifanyone else nominates please withdraw my nomination”.) Both of these Project Officersfelt part of their role was to ensure the meetings dealt with broader spouse / familyissues than the specific ones affecting committee members, while acknowledging thatthe committee were still volunteers, reimbursed for travel costs but receiving no otherpayments. They both report that a portion of the meeting was taken up with ‘moaning’ orcomplaining – the sorts of activities that might be appropriate in a social network of closefriends. Having said this, the Committee members were also aware that in theircommunities they were very privileged and were seen as such, and that funding for ‘richdoctors wives’ did not play well publicly. However, they still felt that it was important topublicise the issues affecting doctors families as part of the retention process – many ofthe issues such as alienation in the community and the way rural communities treat thedoctors family are reasons why doctors leave rural practices. (Veitch, Grant, 2004, 3-7)One of the major issues affecting the lives of medical spouses in rural towns (wivesmore than husbands or same sex partners) is that they are known as the ‘doctor’s wife’and have no independent life or identity of their own. The irony is that the RMFN was asupport network where membership eligibility is by virtue of this same identity rather thanany characteristic of the spouse themselves.At this stage the membership and involvement at meetings and annual planning dayswas still (and remains) overwhelmingly female heterosexual. While the majority of thepopulation of medical spouses is female, the level of diversity represented in the activemembership seems less than reflected in the wide population of medical spouses. Fewmale spouses have attended or been involved but often their issues are quite differentand the ‘doctor’s spouse’ tag does not seem to apply as strongly to them, and they often 12 of 26
  • 13. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mhave more identity through work than women who often don’t work out of the home.(Bond, 2003, 77-80; Wise et al, 2006, 37-45; Ozolins, 2004; Roach, 2002, 20) Fewsame-sex spouses have been involved (the one I am aware of was female). While someeffort has been made to be more inclusive, it has largely not been successful.Another major change occurring at the same time was the influx of International MedicalGraduates (IMGs) and their families (formerly called Overseas Trained Doctors – OTDs).IMG families had often come from big cities in Africa or Asia to remote SA towns.Frequently they had left most of their possessions and money in their country of originand were starting again. They often had considerable cultural barriers in the SA hometown and were very visible by virtue of their skin colour. The spouse had often had acity-based career which did not translate well to rural SA, such as one female spousewho had been very senior on one of the ‘big five’ accounting firms in Africa but couldonly find accounting work ding tax returns in the SA town her husband worked in. Othersfound their overseas qualifications did not transfer easily to Australia.One (white South African) IMG spouse joined the Committee. Orientation packs startedto include where to source Halal meat, spices and grains, and religious facilities forvarious faiths. The RMFN potentially provided considerable social support to thespouses of IMGs who were required by contract to remain in rural areas for 5 or 10years, and anecdotally posed interesting issues such as spouses from different socialcasts in the country of origin socialising together in Australia.Activities from the state RMFN continued to include the newsletter, monthly meetingsand an annual planning day, the latter being was open to RMFN members, regionalrepresentatives and Division Project officers. A series of fact sheets on settling in to ruralSA including topics such as schooling and childcare most relevant to IMG families, wereproduced and are still available on the RMFN website. Education grants of up to $1000 13 of 26
  • 14. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mwere made available to spouses by application (maximum ten per year) for re-educationso that they could find local work. An annual weekend retreat in the Barossa Valleyproved very popular and provided both social networking and through a variety ofspeakers, messages about self-care, caring for the health of the family (particularlystress in the GP spouse), how to start your own business, and IT skills.At this stage, RMFN was probably the most active and relevant to the largest number ofspouses across SA that it ever was. However, it was not central to the averagemember’s life. The newsletter, a glossy full colour A4 production of approximately 8pages produced twice a year, in fact had little content (much of the content wasadvertisement-style information about various support services available). The annualretreat was very popular and attracted spouses from across SA including one or twomale spouses, one same-sex female spouse, one rural specialist spouse and severalIMG spouses, but was only one weekend per year. The web-page had a chat roomattached which was rarely if ever accessed (current online records indicate the onlymessages are from the moderator).The internal culture of the RMFN committee was strong, but to the lives of mostmembers it was a service provided rather than an organisation to which one felt a senseof identity and belonging. In part this may be because of the distances involved betweenwhere members lived. They were also by definition often taken up with their family roles,bringing up children and dealing with the issues of their doctor-spouse, and trying tobuild relationships in the local town. Qualification for membership remained by virtue ofthe relationship to the doctor-spouse and did not have a component requiringacceptance or commitment by the member spouse. Although the organisation aimed tomeet the needs of the spouse, the very basis of membership was their role asspouse/partner, and funding was provided on the basis of the hoped-for effect on the 14 of 26
  • 15. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mdoctor-spouse (that they would stay rural). The importance of the spouse’s happinesswas only relevant if this translated to the GP staying in the rural area and was not an endin itself.Local activities were largely social based. Most local RMFN groups reported havingChristmas parties, often with Father Christmas visiting (not relevant for those not ofChristian faith background, or those without children). Other activities included morningteas and lunches, golf mornings – not relevant for those who worked. Some concurrentsessions with the doctor-spouse Continuing Medical Education events occurred in mostDivisions, often relating to managing stress or IT / business type education. Centrally,RMFN continued to organise family programs to run concurrently with RDASAconferences – including children’s and spouses programs.There was push from both the membership and the Project Officer to make thecommittee more representative of the membership. Ideally the Committee should haveincluded spouses from each region in SA and an OTD spouse (which it did), a traineespouse, a male spouse, a same-sex spouse and a specialist spouse (although once thefunding went to Divisions of General Practice specialists were not core business as theyhad been when it was based on RDASA membership). Other difficult issues such aswhat to do when the spouse of a Committee member retired or died (making them nolonger a medical spouse) challenged the Committee.Lately…..The large scale funding for RMFN finished in about 2003. RDWA has continued fundingpart-time project officer time and some of the activities of RMFN remain, specifically thenewsletter (twice a year), and the website. The Committee structure remains with onerepresentative from each region although meetings do not currently occur. The current 15 of 26
  • 16. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MPresident is occasionally asked to represent spouse issues at conferences or meetings,or at the national RMFN meetings and her travel costs are reimbursed by RDWA.Local Division level activities still occur driven largely by local RMFN representatives andDivision project officers (several of whom are also rural medical spouses). Activitiesremain largely social and family-oriented. Some Divisions produce local RMFNnewsletters including family news (births, marriages, graduations, etc) which areavailable through the RMFN web page, linked to RDWA website. The last RMFNconference and AGM was held in conjunction with the RDASA / RDWA conference andincluded a family program. Largely, it would seem that while the funding was a greatopportunity for the organisation to fulfil its plans and ideas, the overall activities havereturned to much the same as pre-funding. Some changes have occurred – the RMFNcause is on the national agenda, and the needs and influence of medical spouses on thedecisions of rural doctors to remain or leave rural medical practice is widelyacknowledged. This has been reflected in the activities of rural Divisions of GeneralPractice, who continue to support local RMFNs and continue activities such as visits tonew families and the orientation packs. The Committee, inactive as it currently is, hashad a generational change and almost none of the Committee members from the 1990sare still on the Committee. That it is now relatively inactive perhaps reflects thecommitment of the 1990s members who continued to progress the cause with little or nofunding, albeit largely meeting their own needs.DiscussionThe RMFN in SA grew out of an essentially social group who, like many groups offriends, had a lot in common and were not representative of the wider membership. Thedecision to use this group as the basis for the funded representative organisation hasbrought both positives and negatives. The positives were that a group of committed 16 of 26
  • 17. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mvolunteers was available, who already had taken up this issue at a state and nationallevel. This core group were key drivers of the RMFN agenda through times of minimalfunding and minimal reward and gave their time and efforts without remuneration. Thenegatives were that the group had a strong sense of ownership which interfered withefforts to make RMFN Committee more representative. As a group they were quitehomogenous and moved as one to resist potential threats, including the imposition ofaccountability by the project officers. It is a credit to the Project Officers that were ableto work with the Committee to introduce accountability and strategic planning in stages.As a strong and cohesive group, the original Committee was sway to the pull ofpersonalities and ‘one-person’ issues. While the influence of the strong personalitieswas not always on-target with the needs of the wider membership and the Committeewas quite internally focussed, when others joined the Committee the strength of purposeand motivation was dissipated. Members interested in becoming Committee membersor forwarding a different agenda reported not wanting to upset the Committee memberswho were ‘nice ladies’ with a strong sense of ownership of the agenda. Raisingalternative viewpoints was perceived (rightly or wrongly) as being received as criticismby Committee members.An alternative model was used in Queensland where a new organisation was set up withthe funding parallel to the social group that had been driving the agenda (and through adifferent auspicing organisation). This has led to two functional medical spouserepresentative organisations and (anecdotally) considerable politics and bickeringbetween them.Content analysis of some of the public documentation of the RMFN includingnewsletters, website, planning day reports and brochures reveals a strong commitmentto family values as represented by the families of the original Committees. The first two 17 of 26
  • 18. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mlogos (chronologically) represent a ‘nuclear family’ (father and mother and two childrenmale and female). (Plates 1 and 2) This could be construed as excluding families withoutchildren or same-sex couples. This logo was replaced in 2005 by a logo representingthree hands of various sizes which is less traditional family in appearance. (Plate 3)Plate 1, logo circa Plate 2, logo circa Plate 3, logo circa late 2005mid-1990’s (source: 2001-2005 (source: to current. (source:proposed design for a newsletter Dec-May 2005) newsletter Oct 2005 – Janfridge magnet) 2006)In mid-1990s pink coloured paper and envelopes were used for invitations. In November1996 the Committee discussed how relevant this was to male spouses but decided touse the pink paper anyhow. One reason for the coloured paper was to make sure thesurgery would see it was personal and would forward the envelope to the doctor’shomes – cursive writing on the envelopes was used for the same reason (there was alsodiscussion on how various colours looked when printed).Some effort was put into attracting male spouses, including a mailout in early 2001which garnered only one response (there were male 19 spouses on the mailing list).This reflects the literature which indicates that male spouses have different issues to the 18 of 26
  • 19. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mfemale spouses who are often in a tradition ‘housewife’ role, and that spouses findemployment in rural areas easier to access and hence they have a community role notrelated to their doctor-spouse. (Bond, 2003, 77-80; Wise et al, 2006, 37-45; Ozolins,2004; Roach, 2002, 20)Newsletter articles however focus largely on the female spouse audience: recipes, bookreviews, parenting tips, support lines and articles and activities for children. Somearticles on rural experiences, particularly written by IMG children, are included. TheRMFN in the early stages largely represented the lives, views, experiences andpreferences of the founding Committee members.While RMFN met some of the needs of the rural spouses on the Committee andattending events, even in its era of good funding it did not address some of theunderlying causes of unhappiness with rural life that caused GPs to decide to leave ruralpractice. It did not change the way the rural communities treated the medical family – asprivileged outsiders, or the fact that they were and are outsiders or newcomers to thecommunities that often have seen few newcomers for generations. (Many spousesreport being told ‘you have to live here 40 years / four generations before you areconsidered a local’ or a similar message. True or not, this is not a welcomingstatement.) There is considerable resistance to the focus on the needs of medicalfamilies because they are seen as privileged “ladies who lunch”, and the RMFN focus onsocial activities did not change this image. There is seemingly little awareness in therural communities of both the shortage of doctors willing to work in rural and remotelocations or of how the rural community can build commitment to stay in the doctor andhis/her family. (Veitch, Grant, 2004, 1-7; Cheney H, Wilson, 2003)The funding was a significant change agent for the RMFN in SA, but probably not in theway that the Committee had envisaged. Most of the programs put in place with the 19 of 26
  • 20. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mfunding were not sustainable and while the education grants were welcomed, they wereprobably not significant enough to make a real impact, and as their doctor-spouses arerelatively well paid the money probably did not make a large difference. (Currentstrategies have increased this to $3000 upon resettlement in rural areas, which may helpOTD spouses particularly.) (SA Dept of Health, 2005, p12-13) The weekend retreatswere very welcome and a good way of providing spouses with ‘time out’ from their rolesin their family and in their local communities, however this has not been sustainablewithout funding. The current arrangement with the retreat as part of the RDASA / RDWAconference does not provide the time off from the family role and the presence ofmedical spouses is somewhat constraining (medical spouses enjoyed ‘cutting lose’ fromtheir more formal social roles at previous retreats).What the funding did provide was the impetus for generational change in the Committee,legitimacy in terms of the Commonwealth agenda and the local Divisions, and therequirement for the organisation to become more accountable and strategic. Thefunding brought the RMFN under the structure of RDWA and provided a Project Officer,which in turn required the organisation to become more representative of its membershipand more responsive to the broader needs of medical spouses. In some ways theachievement of funding and the recognition this represented fulfilled some of the aims ofthe original Committee members. It also both provided a legitimate method ofcommunicating with the Commonwealth Government (through funding reports) andinhibited other forms of communication (such as external lobbying, articles andconference presentations that might be critical of the Government. Funding anorganisation is a good way of quietening criticism and controlling the agenda. (Hocking2006) 20 of 26
  • 21. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MThe funding did develop the organisation membership but the barriers of distance andthe infrequency of events prevented a strong statewide culture from developing in themembership. Ironically, rather than supporting the existing Committee culture, thefunding was the impetus for Committee members to leave. As the original Committeeculture was based on personal friendships and preferences, the funding weakened this.The introduction of other issues and agendas by other spouses under the cover ofneeding to be responsive to needs of the membership was not always welcomed ansometimes appeared as a threat or oppositional to the issues the Committee held dear.The commitment that the original Committee had during times of low funding, driven inpart by their social needs, does not seem to have translated to the current Committee,brought together by a representative election process and without the strong bonds offriendship or similarities. As the Committee is currently inactive, it remains to be seenwhether what has replaced the original Committee culture is functional, strong orrelevant. Whereas the original Committee was very much sway to personalities, it couldbe hoped that as the current Committee is at least notionally elected (although there isfrequently only one nomination per position) and has the stated task of representinglocal members, that the influence of individuals is less significant and the course of theRMFN SA is relevant to the majority of members. Structures for the representatives togather the opinions of other local members are weak and informal at best, non-existentat worst.ConclusionsDespite some significant gains such as getting the RMFN cause on Division andCommonwealth agenda and the acceptance of housing standards, the issues the RMFNwas formed to address remain the same, in part because of the ongoing nature of theissues. The focus of many of the issues are rural community attitudes and beliefs about 21 of 26
  • 22. Graduate Case Study in Communication Louise MillerAssignment Three 09042093Mmedical families and medical spouses. While spouse support does potentially addressthe impact of the issues (unhappy medical families wanting to leave), it doesn’t addressthe causes – the juxtaposition of medical families from ‘other places’ (and often cities) inrural communities that are foreign to them, and the community attitudes to and about themedical families. (Veitch Grant, 2004, 1-7)The funding was a mixed blessing for the organisation and certainly for the originalCommittee members, most of whom have now left the Committee. The originalCommittee members who stayed together through the lean times, albeit largely for theirown social reasons, had a drive and commitment to forward the agenda and progressRMFN as an organisation for South Australian spouses. It remains to be seen whetherRMFN SA is able to use the accountable processes and representative structure that itnow has to build the momentum and cohesiveness it had in the past. However, giventhat the strategies RMFN employs to address the issues of medical spouses in ruralareas, low level funding and local support may be more appropriate, and the answers tothe issues may lie more with community development approaches addressing the rootcauses of the issues. 22 of 26
  • 23. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MReferencesBond N, 2003, “Looking for the Hollow Log” Experiences and Perceptions of QueenslandRural Medical Spouses. May 2003. Queensland rural Medical Support AgencyCheney H, Wilson E, 2003, Meeting the family support needs of rural GPs via a ruralcommunity development approach. Paper presented at the 7th National Rural HealthConferenceCunningham W, Dovey S, 1999, Being the spouse of a general practitioner, NewZealand Family Physician, December 1999, http://www.rnzcgp.org.nz/news/nzfp/Dec99/cunningham.htmFine, M, 1993, ‘New Voices in Organizational Communication: A feminist Commentaryand Critique’ in Bowen S, Wyatt N (editors), Transforming Visions: Feminist Critiques inCommunication Studies. Hampton Press, New Jersey pp125-166Hays RB, Veitch PC, Cheers B, Crossland L, 1997, Why Doctors leave rural practice,Australian Journal of Rural Health (1997) 5, 198-203Hocking B, 2006, (CEOof SANE), Keynote presentation at the SA Divisions of GeneralPractice Mental Health Conference.Holub L, Williams B, 1996, The general practice rural incentives program, development,and implementation: Progress to date. The Australian Journal of Rural Health, February1996, Volume 4, No 2, 117-127.Hoyal F, 1995, Retention of rural doctors, Australian Journal of Rural Health, 3, pp2-9 23 of 26
  • 24. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MHumphreys J, Jones J, Jones M, Hugo G, Bamford E, Taylor D, 2001, A critical review ofrural medical workforce retention in Australia. Australian Health Review, 24: 4, pp91-102Joyce C, Veitch C, Crossland N, 2003, Professional and Social Support Networks ofRural General Practitioners, Australian Journal of Rural Health, 11; 7-14.Kamien M (Chair) 1987, Report of the Ministerial Inquiry into the Recruitment andretention of Country Doctors in Western Australia, Dec 1987, WA Government Printer.Lippert N, 1991, The Spouses: A Major Support for the Rural Doctor, Paper presented atthe 1st National Rural Health Conference, Toowomba.Morgan G, Smirich L, The Case for Qualitative Research. The Academy of Managementreview; Oct 1980; 5; pp491-500National Rural Health Alliance, 1991, Spouse Issues: Recommendations, 1st NationalRural Health Conference, Toowoomba.Nichols A, 1997, The Spouses of Rural Doctors – A Significant Influence ProfessionalLife in the Bush. Paper presented at the 4th National Rural Health Conference, Perth.Nichols A, 1991, Spouse Issues: The Research Contribution. Paper presented at the 1stNational Rural Health Conference, ToowoombaOmoto A, Snyder M, Martino S, 2000, “Volunteerism and he Life Course: InvestigatingAge-related Agendas for Action”, Basic and Applied Social Psychology, 22:3 pp181-197Ozolins IZ, Greenwood G, Beilby J, 2004, Keeping women doctors in the country. Ruraland Remote Health 4 (online), No 268. 24 of 26
  • 25. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MPepper, GL 1995, Communicating in Organizations: A Cultural Approach. McGraw-HillInc, New York.Prochazka T, 2006, personal communicationRoach S, 2002, Report of a Needs Analysis prepared for the Rural Medical FamilyNetwork (WA) and the Western Australian Centre for Remote and Rural Medicine. TheRACGP Research Unit, Western Australia.Rout U, 1996, Stress among general practitioners and their spouses: a qualitative study.British Journal of General Practice, Mar 1996, pp157-160.Rucinski J, Cybulska E, Mentally Ill Doctors, British Journal of Hospital Medicine,1985;33:90-94SA Dept of Health, 2005, Recognising the past – rewriting the future. A new partnershipwith rural doctors (2005-2009). Government of SASexton R, 2003, Maintaining the Well-being of rural GPs, British Medical Journal CareerFocus, 2003; 326Schein, EH, 1993, On Dialogue, Culture and Organizational Learning. OrganizationalDynamics; Autumn; Vol 22, No 2, pp40-51.Smircich, L 1983 Concepts of Culture and Organizational Analysis. AdministrativeScience Quarterly, Vol 28 No 3, pp339-358.Sotile WM, Sotile MO, Physicians’ wives evaluate their marriages, their husbands, andtheir life in medicine: results of the AMA-Alliance Medical Marriage Survey. Bulletin ofthe Meninger Clinic; Winter 2004; 68, 1 Health and Medical Complete, pp39-39 25 of 26
  • 26. Graduate Case Study in Communication Louise MillerAssignment Three 09042093MStrasser RP, Hays RB, Kamien M, Carson D, 2000, Is Australian Rural PracticeChanging? Findings from the National Rural General Practice Study, Australian Journalof Rural Heath, 2000; 8: 222-226Veitch, C, 2003, Elements of rural practitioner retention: a synthesis of four relatedresearch projects. Paper presented at the 7th National Rural Health Conference, Hobart.Veitch C, Crossland LJ, 2005, Medical family support needs and experiences in ruralQueensland. The International electronic Journal of Rural and Remote HealthResearch, Education, Practice and Policy, Nov 2005.Veitch C, Grant M, 2004, Community Involvement in Medical Practitioner Recruitmentand Retention: Reflections on Experience. The International Electronic Journal of Ruraland Remote Health research, Education, Practice and Policy. June 2004.Warren, C (former RMFN Program Officer) personal communication 2006Wise A, Nichols A, Chater A, Craig M, 1996, Rural Doctors’ Spouses: Married to thePractice?, April 1996, Queensland Medical Education Centre 26 of 26