Chance, choice and hard work

11 September 2020

I was delighted when Laurence gave me the opportunity to write this week’s blog. This week, I want to talk about opportunities.

My journey to General Practice

Many years ago, I fell in love with a handsome, 'rural-dwelling' farmer, who I met when I was touring Donegal as a third-year medical student.

Being from Amsterdam, dreaming of an academic career in global medicine while living alongside the canals of my free-spirited city, my friends and family declared me mad when I announced a few years later that I was moving to the most rural part of Northern Ireland to follow my heart.

Understandably, they strongly advised me against it, mainly due to the fact that we had grown up with images of conflict and social unrest. We viewed Belfast on a par with Beirut, and Northern Ireland as a place where peace was unimaginable.  

In August 1998 I was working as a Senior House Officer in the Tyrone County Hospital when the Omagh bomb went off. In that moment, my worst fears had come true.

I considered immediately packing my bags and returning home - but I didn’t. Looking back, I think it was mainly the people that kept me here. Everybody had been so welcoming, and I was still ‘discovering’ the 'rural way of life'.

I was also enjoying my work and was excited about my change in career choice to general practice. I was hopeful and felt there were opportunities in the air with the Good Friday Agreement signed. In later years, once rural living was a true part of me, we got involved in Social Farming.

For those who don’t know, Social Farming is an alternative way of providing social care and recovery for people with various life challenges. It’s a real rural-asset-based way of creating social inclusion and I love being a part of it.

Chance, choice, luck and hard work

Some parts of my life happened by chance, but many were by choice.

I feel fortunate that these were choices that I was able to make:

  • I was given the opportunity to consider and achieve a university degree due to a government bursary (an opportunity my mother never had)
  • I could contemplate becoming a doctor from a young age
  • I was able to live and work in another European country without restrictions; and I chose to live the 'country life' while still having a challenging and fulfilling career.

There is undeniably always a bit of luck at play. I was fortunate to become a partner in a progressive, outward-looking practice in Lisnaskea. I got involved in undergraduate and postgraduate education and was able to remotely (due to a good broadband connection) keep studying and obtain various postgraduate master's degrees. And there is the 'handsome famer' bit... 

Rural generalism

But unfortunately, 'luck' or 'chance' are often still the overarching determinant. It is such a shame that medicine, general practice, and particularly rural generalism, are inconceivable or unachievable to so many people.

This is a key driver behind my passion for 'widening participation' in medicine. Rural generalism can be 'hidden', with minimal or no exposure to rural general practice, or portrayed as 'undesirable'.

When asking a group of students about the pros of working as a rural GP I was shocked when they struggled to get beyond 'green fields' and 'fresh air'.

Yes, we have that, but what about 'professionally and academically challenging'? A good work/life balance? Working in an extended, collaborating primary care team serving your local population based on the principles of population-based medicine?

It is all of the latter that continues to stimulate me with a focus on opportunities instead of obstacles.

Educating the next generation of GPs

With remote working now a reality, rural generalism could be even more attractive to our young students and trainees.

Academia and education must absolutely be a possible part of the rural portfolio. It links in with the previous blogs from Dr Nicola Topping (RCGPNI’s First5 representative) and Laurence on portfolio careers, education and research.

With the Ulster University welcoming their first postgraduate medical students in 2021 and Queen’s University Belfast extending their clinical attachment time in general practice, it is time to showcase what we have to offer in rural practice. 

The South-West GP Federation was fortunate, together with the North Belfast Federation, to get involved in the sub-deanery pilot. This pilot aims to increase the availability of GP clinical placements and develop different ways of experience-based learning to facilitate our students (from various professions) to build up knowledge, skills and professionalism.

It emphasises working collaboratively across extended primary care teams, focusing on delivering real person-centred care. These are exciting times.

Get involved

Time to link in with like-minded. RCGP has a very active and outspoken Rural Forum. In addition, there are other organisations promoting and celebrating rural generalism, including the European Rural and Isolated Practitioners Association and the WONCA Working Party of Rural Practice

Engaging in and enjoying undergraduate education as a teaching practice or local educator is incredibly rewarding. I couldn’t recommend it more. And it also brings with it the added benefit that 'exposure’' to rural general practice positively influences future career choices.

If you haven’t already, I urge you to familiarise yourself with the main issues highlighted by Professor Val Wass in By Choice - Not By Chance (0.98 MB PDF)

Finally, I would just like to say that I am thrilled to be part of the generation of GPs that has created 'real choice' for our young people by widening participation to medicine and exposing our students to high quality undergraduate education.

I’m proud to help showcase all aspects of our fascinating, local profession - from Belleek to Bangor and Lisnaskea to Limavady - and I encourage you all to get involved.

Post written by

Dr Miriam Dolan, RCGP Rurual Forum NI Representative

Dr Miriam Dolan has been a GP partner in Maple Practice, Lisnaskea, since 2002. She was born and raised in Amsterdam, and currently lives with her husband in Fermanagh. Miriam is a GP trainer and undergraduate mentor. She is the clinical lead for Sub-deanery Pilot in South-West Federation and is actively involved in RCGPNI, her Local Medical Council and local Integrated Care Partnership.

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