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

Graduate Case Study in Communication Louise Miller
Assignment Three 09042093M

Table of Contents
Table of Contents 1
Table of Plates 1
Abstract 2
Acknowledgements 2
Declaration of Conflict of Interest 2
Introduction 3
Research Questions 5
Literature Review 6
Methodology 8
Findings 8
In the Beginning…. 8
The Middle Years…. 12
Lately… 16
Discussion 17
Conclusion and Recommendations 22
References 24
Table of Plates

Plate 1: First Logo, circa mid-1990s 18
Plate 2: Second Logo, circa 2001 18
Plate 3: Third Logo, circa 2005 18
Abstract

Difficulties in the recruitment and retention of doctors for rural and remote medical

practices have long recognised the important role of the medical spouse in the decision

to move to a rural practice and to remain there. The many issues faced by medical

spouses 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 a

social network that self-organised to a funded and accountable organisation auspiced

under Rural Doctors Workforce Agency. The difficulties of targeting a group defined

purely by their relationship to others (the doctor-spouse) and with no other

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characteristics necessarily in common, geographically dispersed, and providing activities

or 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 organisation

has survived through three phases – from the minimal funding phase, through a period

of good funding and now back to minimal funding, undergoing generational change and

a move to accountability at the same time.

Acknowledgements

Particular thanks to Rural Doctors Workforce Agency for allowing me access to RMFN

files dating back to the early 1990s and to the CEO Leigh Carpenter for his time and

thoughts. Thanks also to the participants, current and previous RMFN coordinators at

RDWA, and previous Committee members.

Declaration of Conflict of Interest

The author declares a conflict of interest. I am a rural medical spouse and have been

involved in the RMFN SA, attending networking weekends and received a $1000

education grant in 2001. I worked as the Workforce Officer at Murray Mallee Division of

General Practice from 2001-2004, a role that included being the Division RMFN Co-

ordinator.

Introduction

Recruitment and retention of General Practitioners (GPs) in rural and remote Australia is

become increasingly difficult (Strasser et al, 2000, 222-226). This has significant impact

on the equity of health provision in these areas and has increasingly become a focus of

policy, research and funding. (Veitch, 2003, 2) A number of issues have been raised as

impacting recruitment and retention (Joyce, Veitch, Crossland, 2003, 7-14) and one

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major area identified relates to the doctors’ spouse and/or children, referred to as

medical 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 and

families of GPs and specialists (primarily GPs) who live and practice in rural SA. Rural

Medical Family Networks have existed in Australia since the early 1990’s and more

formally since approximately 2000. Despite this there is little published literature on the

networks themselves or their functionality, although they are often included as part of GP

support (Joyce et al, 2003, 7; Humphrey et al, 2001, 91-102) and the role of the spouse

as 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 Conference

recommended Commonwealth funding to develop or grow spouse support networks at a

state and national level (National Rural Health Alliance, 1991) and by 1996 some of the

support aspects that had been implemented were included in a paper on the General

Practice Rural Incentives Program. (Holub, Williams, 1996, 120) Small amounts of

funding ($15,000 annually) were made available in South Australia throughout the

1990’s, and in 1999 the Commonwealth Government committed $125,000 over three

years as part of the GP Rural Incentives Program (GPRIP), a program aimed at

supporting 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 of

the mode of funding the Rural Medical Family Networks as projects through Rural

Workforce Agencies and Divisions of General Practice, although again the focus is

mostly on need and activities, not on the networks themselves. Research on the needs

of medical families has been conducted in Australia and internationally, although some

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of the issues faced by Australian medical families regarding extreme remoteness are not

relevant in some other settings. Similar scale funded networks seem not to have been

implemented 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 the

spouse 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 the

GP’s time commitments, impact on family life, impact on spouse’s careers (Nichols

1991), 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) as

well as the general difficulties associated with living in an isolated community often far

from 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 is

worth noting that many positives related to being the spouse of a general practitioner

and 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 medical

spouse is through the lens of how it impacts the doctor spouse and the decision to

remain or leave rural general practice.

Research Questions

My research questions relate to the evolution of RMFN SA, a support network set up by

and for rural medical spouses. Specifically:

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How have the purpose, values, structure and activities of the Rural Medical Family

Network in SA changed in the three phases of its existence: pre-funding, funding and

post-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 Review

The RMFN is an interesting organisation on a number of counts. Of particular interest

from a feminist perspective is the fact that qualification for membership is by the

occupation of the spouse / partner, not by any characteristic, achievement or interest of

the member themselves. (The majority of members are female spouses of male doctors,

although some male spouses and some same sex partners (male and female) are

members – membership does not require any active nomination, just being the spouse

in a rural area.) Therefore although the membership is mostly female and the purpose

of the organisation is support of the members, the main criteria for membership is not

centred 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 area

reinforces this lack of centrality of the female members.

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RMFN is a volunteer run and organised group, whose sole aim is to provide support to

members. Justification for its funding is under the banner of the recruitment and

retention 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 interaction

with the funding bodies, it is the medical spouse who is most important. In this manner it

is difficult to think of an equivalent organisation.

Schein contends that culture will form around any relatively stable unit with shared

stresses and challenges. (Schein, 1993, p47-49) RMFN consists of those spouses who

choose to be members. There are no financial barriers to membership. Therefore it

could be assumed that those spouses who choose to be active members share goals

and understandings. Smircich says that a strong culture can be used to legitimate

activity (Smircich, 1983, 344-345), and in this sense some of the social activities that

seem difficult to justify on an accountability framework perhaps made sense to

members.

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 they

exist, the subcultures (particularly around the founding members and the committee) do

provide a level of identity and relationship definition, but the majority of members would

be external to the subcultures. (Pepper,1995, p31; Schein 1993, p47-49)

This research will examine the culture of the RMFN (SA) from the viewpoints of

participants in a number of roles and hence the qualitative framework is more

appropriate. (Morgan, Smircich, 1980, p492) This approach recognises the centrality of

each member to their experience of RMFN, and the validity of each individual’s

experience. The organisation has remained relatively small over the decade and a half

since its inception in SA (in part due to the small number of medical positions in rural

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SA), and members come from a wide variety of backgrounds and find themselves in

different situations in rural SA. These participants are at a local level responsible for

creating the reality of the RMFN, because they are part of the organisation and because

they 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 of

volunteers (Omoto, Snyder, Martino, 2000, for example), and much of this is for personal

reasons, most organisations examined also have an external purpose – to serve a

disadvantaged group, fundraising, emergency services. The RMFN is different in that

the volunteers are providing services for themselves, there is no external purpose.

Methodology

The data for this study was sourced through interviews with the CEO of Rural Doctors

Workforce Agency, interviews with four Project Officers and three previous RMFN

Committee members. (Some of these interviews were conducted via email or telephone

due to issues of distance.) Document reviews were conducted using previous

newsletters, the RMFN website, previous annual reports and other documents such as

brochures and meeting minutes, funding agreements and papers relating to Committee

business. Particular thanks to Rural Doctors Workforce Agency CEO Leigh Carpenter

for allowing access to documents.

Findings

In the beginning….

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The RMFN began in the early 1990s when spouses of Rural Doctors Association SA

(RDASA) and particularly the RDASA Board, found themselves meeting regularly when

their husband’s attended conferences. They discovered that they had similar issues

relating 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 rural

practice to be involved in the RDASA Board – the original RMFN members could be

viewed 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 they

were from different areas of SA they were for the most part from larger towns or near to

regional centres (ie: not remote areas). They had many similarities socially and similar

interests, which was the basis of their friendship. Having discovered that the issues they

faced were the same as each other, they reasoned that these issues may affect other

spouses. An article was published in the RDASA magazine, and presentations were

given 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 the

organisation, continued to meet the social needs of the central group. A small amount of

funding was made available through (initially) RDASA, then by 1995 through SA Rural

Divisions Co-ordinating Unit (SARDCU) to the amount of $15,000 per year. This funding

paid for committee members travel costs to monthly meetings in Adelaide and to

interstate conferences where they gave presentations, and was used to develop a

newsletter.

Newsletter articles at this stage focussed issues relevant to rural doctors that also

affected their spouses, such as allowances, availability of locum doctors, amusing

anecdotes about rural practice, book reviews, and recipes.

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In 1995 a project manager was allocated to the RMFN through SARDCU, funded

through core SARDCU funding. This brought a higher level of accountability to the

RMFN Committee which was sometimes treated with suspicion. The Project Manager

facilitated the development of local branches of the RMFN based geographically (linked

to local Divisions of General Practice), developed a database of rural spouses, tried to

bring literature and evidence to the attention of the committee and focussed on strategic

planning. The Project Manager organised a survey of medical spouses (65% response

rate) to identify issues and build an evidence base to back the Committee’s aims and

funding proposals, and developed position papers, such as one on working with

Divisions 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 of

a national network funded primarily through the Commonwealth Government

Department of Health and Ageing). Another major development at this stage was the

development of standards for housing provided as part of the package for doctors in

rural areas. This paper was based on the standards of housing provided for bank staff

and 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 nomination

and election, the meetings still fulfilled the social needs of the members and were largely

the same core group. Individual personalities on the Committee had considerable

influence 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 a

difficulty the core group had in transitioning from a social group of friends to a more

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formal structure. As more rural spouses volunteered to join the committee, a formal

decision 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 the

country, with the idea that a positive rural experience might encourage the trainee to go

back when they were qualified (again a doctor-centric aim rather than an aim specific to

the needs of the spouse). The spouses of GP trainees tended to be significantly

younger than the Committee (although when Flinders University started postgraduate

medicine courses, trainees and their spouses started to be older as well). Some effort to

get trainee spouses on the committee tended to be less successful – sometimes the

spouses stayed in the city developing their own careers (trainees generally move every

six 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 they

were often focussed on their careers. This affected whether they identified themselves

as “medical spouse” or through their work, and hence whether the RMFN seemed

relevant. 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 are

contained in the records.

Orientation packs for new spouses to rural SA were developed with information such as

local facilities and services, how to settle in to a rural community, where to seek

additional support (Bush Crisis Lines), and personal visits from the local RMFN

representative. In latter years once workforce became an issue taken up by rural

Divisions of General Practice, the Division Project Officer would also visit. A web site

was started, attached to SARRMSA, and a families program was organised concurrently

to the RDASA conference.

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In 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 “they

wanted to have one person they could call on to attend meetings in Canberra and

represent spouse viewpoints”. The network now had three levels, local, state and

national, and had visibility with the Commonwealth Government.

Some small level lobbying for funding had occurred in the past, both from the state

RMFN level and from other organisations such as RDASA and RACGP Rural Faculty.

Some local RMFN branches lobbied and received funding from their local Division of

General Practice (Eyre Peninsula RMFN received $4000, Barossa RMFN $2000). In

1999, as part of the GP Rural Incentives Program, support for rural families was funded

for $125,000. The overall aim of the funding was to support the recruitment and more

specifically, the retention of GPs in rural areas and the funding was allocated through the

rural 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 moved

to another organisation. A new Project Officer was employed with part of her time for

RMFN and part for other support projects such as Dr Doc, which focussed on the health

of rural GPs and their families. Rural Divisions of General Practice were funded $5000

to include RMFN activities in their workforce support program.

As with the previous Project Officer, this person also felt that the push for more

accountability brought by both the funding and by the existence of a Project officer was

not always welcome, particularly where it represented priorities that conflicted with the

social needs of the group. At about this time some of the original committee members

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began to back away from the organisation, feeling they had ‘done their bit’ or to ‘let

others have a turn’. (Several Committee nominations included notes to the effect of “if

anyone else nominates please withdraw my nomination”.) Both of these Project Officers

felt part of their role was to ensure the meetings dealt with broader spouse / family

issues than the specific ones affecting committee members, while acknowledging that

the committee were still volunteers, reimbursed for travel costs but receiving no other

payments. They both report that a portion of the meeting was taken up with ‘moaning’ or

complaining – the sorts of activities that might be appropriate in a social network of close

friends. Having said this, the Committee members were also aware that in their

communities they were very privileged and were seen as such, and that funding for ‘rich

doctors wives’ did not play well publicly. However, they still felt that it was important to

publicise the issues affecting doctors families as part of the retention process – many of

the issues such as alienation in the community and the way rural communities treat the

doctors 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 (wives

more 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 a

support network where membership eligibility is by virtue of this same identity rather than

any characteristic of the spouse themselves.

At this stage the membership and involvement at meetings and annual planning days

was still (and remains) overwhelmingly female heterosexual. While the majority of the

population of medical spouses is female, the level of diversity represented in the active

membership seems less than reflected in the wide population of medical spouses. Few

male spouses have attended or been involved but often their issues are quite different

and the ‘doctor’s spouse’ tag does not seem to apply as strongly to them, and they often

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have 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) Few

same-sex spouses have been involved (the one I am aware of was female). While some

effort 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 Medical

Graduates (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 origin

and were starting again. They often had considerable cultural barriers in the SA home

town and were very visible by virtue of their skin colour. The spouse had often had a

city-based career which did not translate well to rural SA, such as one female spouse

who had been very senior on one of the ‘big five’ accounting firms in Africa but could

only find accounting work ding tax returns in the SA town her husband worked in. Others

found their overseas qualifications did not transfer easily to Australia.

One (white South African) IMG spouse joined the Committee. Orientation packs started

to include where to source Halal meat, spices and grains, and religious facilities for

various faiths. The RMFN potentially provided considerable social support to the

spouses of IMGs who were required by contract to remain in rural areas for 5 or 10

years, and anecdotally posed interesting issues such as spouses from different social

casts in the country of origin socialising together in Australia.

Activities from the state RMFN continued to include the newsletter, monthly meetings

and an annual planning day, the latter being was open to RMFN members, regional

representatives and Division Project officers. A series of fact sheets on settling in to rural

SA including topics such as schooling and childcare most relevant to IMG families, were

produced and are still available on the RMFN website. Education grants of up to $1000

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were made available to spouses by application (maximum ten per year) for re-education

so that they could find local work. An annual weekend retreat in the Barossa Valley

proved very popular and provided both social networking and through a variety of

speakers, messages about self-care, caring for the health of the family (particularly

stress 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 of

spouses across SA that it ever was. However, it was not central to the average

member’s life. The newsletter, a glossy full colour A4 production of approximately 8

pages produced twice a year, in fact had little content (much of the content was

advertisement-style information about various support services available). The annual

retreat was very popular and attracted spouses from across SA including one or two

male spouses, one same-sex female spouse, one rural specialist spouse and several

IMG spouses, but was only one weekend per year. The web-page had a chat room

attached which was rarely if ever accessed (current online records indicate the only

messages are from the moderator).

The internal culture of the RMFN committee was strong, but to the lives of most

members it was a service provided rather than an organisation to which one felt a sense

of identity and belonging. In part this may be because of the distances involved between

where 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 to

build relationships in the local town. Qualification for membership remained by virtue of

the relationship to the doctor-spouse and did not have a component requiring

acceptance or commitment by the member spouse. Although the organisation aimed to

meet the needs of the spouse, the very basis of membership was their role as

spouse/partner, and funding was provided on the basis of the hoped-for effect on the

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doctor-spouse (that they would stay rural). The importance of the spouse’s happiness

was only relevant if this translated to the GP staying in the rural area and was not an end

in itself.

Local activities were largely social based. Most local RMFN groups reported having

Christmas parties, often with Father Christmas visiting (not relevant for those not of

Christian faith background, or those without children). Other activities included morning

teas and lunches, golf mornings – not relevant for those who worked. Some concurrent

sessions with the doctor-spouse Continuing Medical Education events occurred in most

Divisions, often relating to managing stress or IT / business type education. Centrally,

RMFN continued to organise family programs to run concurrently with RDASA

conferences – including children’s and spouses programs.

There was push from both the membership and the Project Officer to make the

committee more representative of the membership. Ideally the Committee should have

included spouses from each region in SA and an OTD spouse (which it did), a trainee

spouse, a male spouse, a same-sex spouse and a specialist spouse (although once the

funding went to Divisions of General Practice specialists were not core business as they

had been when it was based on RDASA membership). Other difficult issues such as

what to do when the spouse of a Committee member retired or died (making them no

longer a medical spouse) challenged the Committee.

Lately…..

The large scale funding for RMFN finished in about 2003. RDWA has continued funding

part-time project officer time and some of the activities of RMFN remain, specifically the

newsletter (twice a year), and the website. The Committee structure remains with one

representative from each region although meetings do not currently occur. The current

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President 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 and

Division project officers (several of whom are also rural medical spouses). Activities

remain largely social and family-oriented. Some Divisions produce local RMFN

newsletters including family news (births, marriages, graduations, etc) which are

available through the RMFN web page, linked to RDWA website. The last RMFN

conference and AGM was held in conjunction with the RDASA / RDWA conference and

included a family program. Largely, it would seem that while the funding was a great

opportunity for the organisation to fulfil its plans and ideas, the overall activities have

returned to much the same as pre-funding. Some changes have occurred – the RMFN

cause is on the national agenda, and the needs and influence of medical spouses on the

decisions of rural doctors to remain or leave rural medical practice is widely

acknowledged. This has been reflected in the activities of rural Divisions of General

Practice, who continue to support local RMFNs and continue activities such as visits to

new families and the orientation packs. The Committee, inactive as it currently is, has

had a generational change and almost none of the Committee members from the 1990s

are still on the Committee. That it is now relatively inactive perhaps reflects the

commitment of the 1990s members who continued to progress the cause with little or no

funding, albeit largely meeting their own needs.

Discussion

The RMFN in SA grew out of an essentially social group who, like many groups of

friends, had a lot in common and were not representative of the wider membership. The

decision to use this group as the basis for the funded representative organisation has

brought both positives and negatives. The positives were that a group of committed

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volunteers was available, who already had taken up this issue at a state and national

level. This core group were key drivers of the RMFN agenda through times of minimal

funding and minimal reward and gave their time and efforts without remuneration. The

negatives were that the group had a strong sense of ownership which interfered with

efforts to make RMFN Committee more representative. As a group they were quite

homogenous and moved as one to resist potential threats, including the imposition of

accountability by the project officers. It is a credit to the Project Officers that were able

to 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 of

personalities and ‘one-person’ issues. While the influence of the strong personalities

was not always on-target with the needs of the wider membership and the Committee

was quite internally focussed, when others joined the Committee the strength of purpose

and motivation was dissipated. Members interested in becoming Committee members

or forwarding a different agenda reported not wanting to upset the Committee members

who were ‘nice ladies’ with a strong sense of ownership of the agenda. Raising

alternative viewpoints was perceived (rightly or wrongly) as being received as criticism

by Committee members.

An alternative model was used in Queensland where a new organisation was set up with

the funding parallel to the social group that had been driving the agenda (and through a

different auspicing organisation). This has led to two functional medical spouse

representative organisations and (anecdotally) considerable politics and bickering

between them.

Content analysis of some of the public documentation of the RMFN including

newsletters, website, planning day reports and brochures reveals a strong commitment

to family values as represented by the families of the original Committees. The first two

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logos (chronologically) represent a ‘nuclear family’ (father and mother and two children

male and female). (Plates 1 and 2) This could be construed as excluding families without

children or same-sex couples. This logo was replaced in 2005 by a logo representing

three 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 2005

mid-1990’s (source: 2001-2005 (source: to current. (source:

proposed design for a newsletter Dec-May 2005) newsletter Oct 2005 – Jan

fridge magnet) 2006)

In mid-1990s pink coloured paper and envelopes were used for invitations. In November

1996 the Committee discussed how relevant this was to male spouses but decided to

use the pink paper anyhow. One reason for the coloured paper was to make sure the

surgery would see it was personal and would forward the envelope to the doctor’s

homes – cursive writing on the envelopes was used for the same reason (there was also

discussion on how various colours looked when printed).

Some effort was put into attracting male spouses, including a mailout in early 2001

which 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

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female spouses who are often in a tradition ‘housewife’ role, and that spouses find

employment in rural areas easier to access and hence they have a community role not

related 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, book

reviews, parenting tips, support lines and articles and activities for children. Some

articles on rural experiences, particularly written by IMG children, are included. The

RMFN in the early stages largely represented the lives, views, experiences and

preferences of the founding Committee members.

While RMFN met some of the needs of the rural spouses on the Committee and

attending events, even in its era of good funding it did not address some of the

underlying causes of unhappiness with rural life that caused GPs to decide to leave rural

practice. It did not change the way the rural communities treated the medical family – as

privileged outsiders, or the fact that they were and are outsiders or newcomers to the

communities that often have seen few newcomers for generations. (Many spouses

report being told ‘you have to live here 40 years / four generations before you are

considered a local’ or a similar message. True or not, this is not a welcoming

statement.) There is considerable resistance to the focus on the needs of medical

families because they are seen as privileged “ladies who lunch”, and the RMFN focus on

social activities did not change this image. There is seemingly little awareness in the

rural communities of both the shortage of doctors willing to work in rural and remote

locations or of how the rural community can build commitment to stay in the doctor and

his/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 the

way that the Committee had envisaged. Most of the programs put in place with the

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funding were not sustainable and while the education grants were welcomed, they were

probably not significant enough to make a real impact, and as their doctor-spouses are

relatively well paid the money probably did not make a large difference. (Current

strategies have increased this to $3000 upon resettlement in rural areas, which may help

OTD spouses particularly.) (SA Dept of Health, 2005, p12-13) The weekend retreats

were very welcome and a good way of providing spouses with ‘time out’ from their roles

in their family and in their local communities, however this has not been sustainable

without funding. The current arrangement with the retreat as part of the RDASA / RDWA

conference does not provide the time off from the family role and the presence of

medical spouses is somewhat constraining (medical spouses enjoyed ‘cutting lose’ from

their 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 the

requirement for the organisation to become more accountable and strategic. The

funding 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 membership

and more responsive to the broader needs of medical spouses. In some ways the

achievement of funding and the recognition this represented fulfilled some of the aims of

the original Committee members. It also both provided a legitimate method of

communicating with the Commonwealth Government (through funding reports) and

inhibited other forms of communication (such as external lobbying, articles and

conference presentations that might be critical of the Government. Funding an

organisation is a good way of quietening criticism and controlling the agenda. (Hocking

2006)

20 of 26


The funding did develop the organisation membership but the barriers of distance and

the infrequency of events prevented a strong statewide culture from developing in the

membership. Ironically, rather than supporting the existing Committee culture, the

funding was the impetus for Committee members to leave. As the original Committee

culture was based on personal friendships and preferences, the funding weakened this.

The introduction of other issues and agendas by other spouses under the cover of

needing to be responsive to needs of the membership was not always welcomed an

sometimes 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 in

part 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 of

friendship or similarities. As the Committee is currently inactive, it remains to be seen

whether what has replaced the original Committee culture is functional, strong or

relevant. Whereas the original Committee was very much sway to personalities, it could

be hoped that as the current Committee is at least notionally elected (although there is

frequently only one nomination per position) and has the stated task of representing

local members, that the influence of individuals is less significant and the course of the

RMFN SA is relevant to the majority of members. Structures for the representatives to

gather the opinions of other local members are weak and informal at best, non-existent

at worst.

Conclusions

Despite some significant gains such as getting the RMFN cause on Division and

Commonwealth agenda and the acceptance of housing standards, the issues the RMFN

was formed to address remain the same, in part because of the ongoing nature of the

issues. The focus of many of the issues are rural community attitudes and beliefs about

21 of 26


medical families and medical spouses. While spouse support does potentially address

the impact of the issues (unhappy medical families wanting to leave), it doesn’t address

the causes – the juxtaposition of medical families from ‘other places’ (and often cities) in

rural communities that are foreign to them, and the community attitudes to and about the

medical families. (Veitch Grant, 2004, 1-7)

The funding was a mixed blessing for the organisation and certainly for the original

Committee members, most of whom have now left the Committee. The original

Committee members who stayed together through the lean times, albeit largely for their

own social reasons, had a drive and commitment to forward the agenda and progress

RMFN as an organisation for South Australian spouses. It remains to be seen whether

RMFN SA is able to use the accountable processes and representative structure that it

now has to build the momentum and cohesiveness it had in the past. However, given

that the strategies RMFN employs to address the issues of medical spouses in rural

areas, low level funding and local support may be more appropriate, and the answers to

the issues may lie more with community development approaches addressing the root

causes of the issues.

22 of 26


References

Bond N, 2003, “Looking for the Hollow Log” Experiences and Perceptions of Queensland

Rural Medical Spouses. May 2003. Queensland rural Medical Support Agency

Cheney H, Wilson E, 2003, Meeting the family support needs of rural GPs via a rural

community development approach. Paper presented at the 7th National Rural Health

Conference

Cunningham W, Dovey S, 1999, Being the spouse of a general practitioner, New

Zealand Family Physician, December 1999, http://www.rnzcgp.org.nz/news/nzfp/Dec99/

cunningham.htm

Fine, M, 1993, ‘New Voices in Organizational Communication: A feminist Commentary

and Critique’ in Bowen S, Wyatt N (editors), Transforming Visions: Feminist Critiques in

Communication Studies. Hampton Press, New Jersey pp125-166

Hays RB, Veitch PC, Cheers B, Crossland L, 1997, Why Doctors leave rural practice,

Australian Journal of Rural Health (1997) 5, 198-203

Hocking B, 2006, (CEOof SANE), Keynote presentation at the SA Divisions of General

Practice 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, February

1996, Volume 4, No 2, 117-127.

Hoyal F, 1995, Retention of rural doctors, Australian Journal of Rural Health, 3, pp2-9

23 of 26


Humphreys J, Jones J, Jones M, Hugo G, Bamford E, Taylor D, 2001, A critical review of

rural medical workforce retention in Australia. Australian Health Review, 24: 4, pp91-102

Joyce C, Veitch C, Crossland N, 2003, Professional and Social Support Networks of

Rural General Practitioners, Australian Journal of Rural Health, 11; 7-14.

Kamien M (Chair) 1987, Report of the Ministerial Inquiry into the Recruitment and

retention 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 at

the 1st National Rural Health Conference, Toowomba.

Morgan G, Smirich L, The Case for Qualitative Research. The Academy of Management

review; Oct 1980; 5; pp491-500

National Rural Health Alliance, 1991, Spouse Issues: Recommendations, 1st National

Rural Health Conference, Toowoomba.

Nichols A, 1997, The Spouses of Rural Doctors – A Significant Influence Professional

Life 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 1st

National Rural Health Conference, Toowoomba

Omoto A, Snyder M, Martino S, 2000, “Volunteerism and he Life Course: Investigating

Age-related Agendas for Action”, Basic and Applied Social Psychology, 22:3 pp181-197

Ozolins IZ, Greenwood G, Beilby J, 2004, Keeping women doctors in the country. Rural

and Remote Health 4 (online), No 268.

24 of 26


Pepper, GL 1995, Communicating in Organizations: A Cultural Approach. McGraw-Hill

Inc, New York.

Prochazka T, 2006, personal communication

Roach S, 2002, Report of a Needs Analysis prepared for the Rural Medical Family

Network (WA) and the Western Australian Centre for Remote and Rural Medicine. The

RACGP 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;33:90-94

SA Dept of Health, 2005, Recognising the past – rewriting the future. A new partnership

with rural doctors (2005-2009). Government of SA

Sexton R, 2003, Maintaining the Well-being of rural GPs, British Medical Journal Career

Focus, 2003; 326

Schein, EH, 1993, On Dialogue, Culture and Organizational Learning. Organizational

Dynamics; Autumn; Vol 22, No 2, pp40-51.

Smircich, L 1983 Concepts of Culture and Organizational Analysis. Administrative

Science Quarterly, Vol 28 No 3, pp339-358.

Sotile WM, Sotile MO, Physicians’ wives evaluate their marriages, their husbands, and

their life in medicine: results of the AMA-Alliance Medical Marriage Survey. Bulletin of

the Meninger Clinic; Winter 2004; 68, 1 Health and Medical Complete, pp39-39

25 of 26


Strasser RP, Hays RB, Kamien M, Carson D, 2000, Is Australian Rural Practice

Changing? Findings from the National Rural General Practice Study, Australian Journal

of Rural Heath, 2000; 8: 222-226

Veitch, C, 2003, Elements of rural practitioner retention: a synthesis of four related

research projects. Paper presented at the 7th National Rural Health Conference, Hobart.

Veitch C, Crossland LJ, 2005, Medical family support needs and experiences in rural

Queensland. The International electronic Journal of Rural and Remote Health

Research, Education, Practice and Policy, Nov 2005.

Veitch C, Grant M, 2004, Community Involvement in Medical Practitioner Recruitment

and Retention: Reflections on Experience. The International Electronic Journal of Rural

and Remote Health research, Education, Practice and Policy. June 2004.

Warren, C (former RMFN Program Officer) personal communication 2006

Wise A, Nichols A, Chater A, Craig M, 1996, Rural Doctors’ Spouses: Married to the

Practice?, April 1996, Queensland Medical Education Centre

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