Four months ago I took my first foray into running a single-handed practice. I’m based in Coachford, a rural village in mid-Cork with a large and far reaching catchment area. To date it has been one of the most frustrating, tiring, complicated, bewildering, exhilarating and exciting things I have ever done. Admittedly there were nights I drove home wondering if I should just keep on driving until I hit France, especially during the woeful floods that badly hit rural Cork this winter. 

A tree even blocked my road to work once and I wondered if it was a sign from God. I’m beginning to believe, however, that God knows I’m well able for trees, rural practices and anything else that can be thrown at me... and I would need to be – running a rural practice single-handed in 2016 is no walk in the park.

Cork now and forever

Just to give a bit of background, I’m 28 years old and a qualified GP since 2014. I trained in Cork at both undergraduate and graduate level – you’ll have to drag me from the county kicking and screaming (unless there’s a promise of shopping involved). After graduating from the GP scheme, like many of my colleagues, I was set adrift in the seas of locuming and covering maternity posts. However this drifting lifestyle doesn’t really suit my type A personality. 

I wanted certainty and control in my working life. Most patients don’t engage with a locum GP the way they would with an established one, one they know they’ll attend for years to come. That can be quite frustrating on a professional level. Hence, when the GMS list in Coachford became available, I jumped at the opportunity.

I never dreamed I would succeed. I had a very positive experience locuming in the practice there. I’d already formed a good relationship with the staff, who encouraged me to apply. I assumed my age and lack of years as a fully fledged GP would work against me, but I got the job all the same. They say experience is the best teacher, and I’m certainly learning the truth of that, doing a lot of learning on my feet since I began here.

Setting up in Coachford

I gave myself six weeks to set myself up in Coachford, including redecorating and outfitting, all while working full time. What can I say – I’m ambitious! Not to mention slightly impatient… my family and friends practically lived in Coachford for those weeks in the evenings and weekends. I’m probably lucky they didn’t kill me in my sleep. 

I was also especially fortunate to have had invaluable professional support from the GPs I was working with at the time, namely Drs Mary Favier, Ciaran Donovan, Suzanne Kelly and Joe Hartnett. Despite it all, and against the challenge of a few major and many minor hiccups, I opened the door to my patients on November 23 last. 

Bureaucratic ducking and weaving

The most significant challenge of these first six months has been dealing with the HSE’s bureaucratic ducking and weaving, regarding the rural practice allowance, which was unceremoniously removed from the post on its re-advertisement. Despite recent media reports highlighting the need to attract GPs to rural practice and lauding the recent restoration of the rural practice allowance, in the real world this is an ongoing battle. 

There is smoke but no fire. This is but one of the many issues I deal with on my lunch breaks, given that I rarely have five minutes during my working day to make patient-related phone calls, let alone ‘personal’ ones. However, there are also plenty of challenges that crop up during my working day as well. 

While I am based in Coachford, historically the Coachford GP covered clinics in Donoughmore and Rylane. If Coachford is rural, then these small townlands need another descriptor altogether. For me, they’re a 20-minute drive away, which can be time consuming in a busy single GP practice and a source of lost productivity. I have floated the idea to my patient cohort to make their move to the big smoke, but many have roots to rival an oak tree! It is difficult to provide quality care in these outreach clinics that are ill-equipped for anything more complex than a blood pressure check and repeat prescription requests. But the patient’s convenience trumps my agenda of good quality care. 

Positive patient response

My patient cohort in this area is vastly different from the young and walking well I mainly dealt with as a locum in the city. In Coachford and environs, most patients are older. Not few of them are bachelor farmers who probably stockpile apples in hopes of keeping me away. I am quite conscious of my image as the young blonde female GP rocking into town. Overall the response to my installment has been a positive one, in no small part due to the fear the community had of being left without a GP, like many rural areas around the country. Yet I am acutely aware of how I contrast with patient expectations of an older male GP and how it works against me in this case.

The isolation is also something I never truly encountered until I started this job. We all start out working in hospitals, part of a small speciality team and a wider hospital environment, where there is always someone else to bounce things off – even at three in the morning. Prior to this, I worked in practices composed of at least two GPs. It was a shock to the system to be ‘it’. I am ‘it’ for the patients but I’m also ‘it’ for the practice as well. If someone arrests, I have to abandon my post to attend to them while the scheduled visits pile up. Equally, if the printer breaks, I need to figure out why and how to fix it and who will fix it if I fail. There are no chats over coffee about difficult cases – there isn’t even anyone to have coffee with. And that’s even before I mention the South Doc commitment, which could be described as ‘onerous’ at best in a rural area.

Instilling my own ethos

Ultimately, however, the experience is a deeply rewarding one. It’s still what I aspired to from day one (yes, I’m one of ‘those’ doctors who knew they wanted to be a GP in first year of med school, and by gum I stuck to it). It speaks to my quasi-OCD soul that I am my own boss. I can run things exactly as I like, decorate to my own taste, choose my own systems, and instill my own ethos about how a practice should be run. I don’t have to defer or kowtow to anyone else, which is immensely satisfying on a personal level. 

I walked into a busy, vibrant practice. From the first hour the phones were ringing – I had no need to chase down business or build up the practice. Despite the challenges mentioned about working in a rural area, it also brings its own benefits. 

The patients are old-school and appreciative. They were both curious about and welcoming to the new GP, and everyone wanted to get a glimpse of me – my first and only taste of Z-list celebrity! There was a most intense interest in determining whether I was protestant or catholic (I’m keeping quiet to fan the fires of gossip). Overall I’m simply more engaged. This is my practice, these are my patients, and as such I won’t be handing off the problems or rewards to anyone else. This ownership is a form of belonging and it’s what I’ve searched for since starting medicine. Clichéd as it sounds, I really think I can do some good here – and I’ve only just begun.