Dr Yvonne Williams has three young children and set up her own practice in Shannon, Co Clare, five years ago after returning to Ireland from Australia.

She decided to become a rural GP because she is a country girl at heart, she says.

“I’m from a long tradition of proud west Cork women and my mother always said that country people are the salt of the earth, so I applied for this job five years ago and was delighted and surprised to get it.”

She relished the prospect of setting up her own practice in a small community where she would get to know people very well, she says.

“I love the idea of looking after three generations of the same family because you get such a good sense of where people are coming from when you know the granny and the cousins.

“In a real sense, you’re a family doctor compared to when you work in an urban centre where there is often quite a turnover of patients and you wouldn’t know their families.”

Being a doctor is a very rewarding job, she believes.

“You’re privileged to be a trusted confidante of people who come to you with their biggest fears and worries and concerns and it’s wonderful to be able to help. Most doctors would have a very personal relationship with a lot of their patients, particularly if someone’s relative is dying and you’re looking after somebody at home maybe for six months and you’re in and out of their house. You get to know them and their families very well, so it’s a very rewarding job.”

CHALLENGES

However, cuts to rural practice allowances have affected rural GPs, she says.

“We’ve had a lot of cuts to rural practice in the last five years since I started. There were a series of emergency cuts to the funding for people with medical cards and a cut in doctors’ funding for distance codes. This is the fee that would have allowed GPs some extra money in acknowledgment of the fact that many of their patients lived quite a distance from the practice and were in need of house calls in order to be seen.

“Rural practice allowances (a subsidy towards running a practice) had also been cut but they are due to be restored in part.”

Finding a locum (a stand-in doctor) can be difficult in rural Ireland also.

“Many GPs can no longer take a holiday because of this. If they do, they have to rely on a colleague’s goodwill to take on the workload of two for a short space of time.

“Some doctors are simply not taking holidays and that’s very difficult if there’s stress or burnout. It’s the same if someone in your family is ill or there’s a funeral you need to go to or a concert you want to see. You often can’t.

“You also have the guilt from not being able to spend time with your family or take a break when you are tired from working very hard.”

Out-of-hours work can also be a burden for GPs.

“In rural areas we have to do our own out-of-hours cover which is quite different to urban areas. My classmates who have chosen to work in the city don’t have to do evening or night shifts, whereas many rural GPs have to work in the evening or perhaps overnight and then do a full day’s work afterwards.

“We’re with Shannondoc out-of-hours service here and, for example, last Sunday I worked from 9am until midnight and then came in for a full week’s work on Monday morning. I’m also covering for a colleague this week, so that’s doing the workload of two having worked a 15-hour shift on Sunday.

“It is difficult to do that at full capacity indefinitely, she says, and the stress of not knowing if you’ll be able to take a holiday in the next six or 12 months has a knock-on effect in all areas of your life.”

Delays in ambulances getting to rural areas is another challenging factor in rural Ireland.

“There can be quite a long delay waiting for an ambulance sometimes. As a GP, you can become a default paramedic sometimes or you become a first port of call for people who really should be going by ambulance to hospital. That’s because of their reluctance to travel a good distance to hospital. They don’t call an ambulance because they know they might be waiting longer than ideal in A&E. That’s no fault of the ambulance staff who are wonderful, but there simply aren’t enough of them or ambulances at the moment in the HSE.”

Nearby Ennis General only has a minor injuries unit, which is a 20-minute drive away and is only open for limited hours.

“That’s one of the challenges in a rural practice – people tend to come to the GP out-of-hours service where they traditionally would have gone to the local emergency department.”

The lack of direct public transport to University Hospital Limerick is also an issue in her area.

“There is a reluctance on the part of people to travel longer distances to a hospital and they mightn’t be well enough for the trip. Where I work, there is no public transport directly to Limerick hospital. You’d have to get a bus to the city and then a bus to the suburb it’s located in. For many people who are elderly, the cost of a taxi is prohibitive too.”

Mobile phone and Wi-Fi coverage can also be patchy in rural areas, she says.

“It would be haphazard in places. Wi-Fi is important for patients referred to CBT websites because they are suffering with depression or anxiety for example or for a person with asthma referred to a video about correct inhaler usage techniques, for example.”

House calls would be another huge issue. GPs are not paid for house calls to medical card patients.

“It’s something a lot of people aren’t aware of. There is no fee at all so you leave your practice and maybe a roomful of patients if you decide to go out on a house call.”

House calls are becoming less common because doctors are under such time pressure, she adds.

“There isn’t a gap in the day that might have been there 10 or 15 years ago. Most would have done it traditionally but with there being fewer GPs now, and with GPs being so busy because of an ageing population, you don’t always have time.”

DR WILLIAMS’ ADVICE TO FARMERS

Dr Williams has experience of treating many farmers. She sees them as individuals who work long hours, often don’t take holidays and often neglect their health.

“Most would come in only if they are sick but I’d love to say to them, if you’re over 30, spend 20 minutes a year having a check-up – have your blood pressure and cholesterol level checked and if you are over 50, you need a prostate check too. That 20 minutes could save your life.”

More needs to be done in terms of educating men and encouraging men to be more proactive about looking after their health, she believes.

“Simple things like wearing a factor 50 on their hands and face and wearing a hat or cap can prevent melanoma. A lot of farmers come in with sun damaged skin on their face and scalp and arms from being outdoors over the years. Also, things like heart disease and stroke, diet and stress … In a few minutes you can get your blood pressure and weight checked and get some advice about where you might be going wrong.”

WHAT GOVERNMENT CAN DO TO ENCOURAGE MORE DOCTORS TO WORK IN RURAL IRELAND

“At present, one third of GPs are over 55 and due to retire. Many work in rural areas. You may not get a young GP to move to that area and it may be difficult for their spouses to get jobs in a rural area, but if there was a salary with a contract it would take the pressure off a young GP. They wouldn’t have to buy or build a premises or find staff themselves. That would make it much easier for young graduates to take up practice in rural areas.”