LAUSR

O’Brien et al. in the March edition of the Journal are to be congratulated on their comprehensive, incisive, and relevant analysis of the inequity of access, process, and outcomes for Australia’s First Nations people with surgical conditions. The subsequent three step ‘call to action’ is equally thoughtful, practical and actionable. A notable exception is the lack of emphasis on strengthening surgical services in regional, rural and remote areas. It is acknowledged that most First Nations people live in metropolitan centres, geographically close to major surgical facilities but still do have significant barriers to accessing surgery for multiple reasons. Although less in absolute numbers, in the north and centre of the continent the proportion of the population that is of Aboriginal and Torres Straight Island descent increases markedly, peaking at 30% (estimated 75 456 in 2016) of the population in the Northern Territory and comprising over 50% of hospital separations. Similar proportions are reflected in the northern and central reaches of other States. It is well established that the health needs of people in rural and remote areas, particularly of Aboriginal and Torres Strait Islander, people exceed that of the wider Australian population. Despite this obvious need, the public surgical facilities serving these regions have major problems in attracting and retaining Australasian trained surgeons in most specialties. In recent times the Northern Territory has been unable to attract locally trained surgeons to fill desperate service delivery gaps in General surgery, Orthopaedic, Vascular, Urology, Plastic and Reconstructive, Neuro and Thoracic surgery. The reasons for this discrepancy are multifactorial but as a selfgoverning surgical profession we cannot escape some responsibility for failing to train, encourage and support high quality, appropriately culturally orientated surgeons who are willing and committed to living in and serving these communities. RACS current major strategy to tackle rural equity is relevant to this mismatch but a major cultural shift within our profession that prioritizes matching the distribution of surgeons to the needs of our population is necessary if we are to successfully ‘close the gap’.