Pros and cons of working outside major cities

4 minute read

For a young rheumatologist with a sense of adventure, it’s a wonderful opportunity to provide a service to an area of need.

This is the first instalment in an ongoing series on life in a regional rheumatology practice.


Orange Rheumatology was established in the 1980s by Dr Jan Carter. She worked as a solo practitioner servicing Central West NSW until in 1999 she was joined by Dr Susan Read. In 2002 Dr Carter moved to Newcastle. Dr Read continued working in Orange, mostly uninterrupted, for the next two decades until she retired in 2017. 

Dr Haesung Bak subsequently joined the practice, focusing particularly on applications for biologics. Professor Mark Arnold joined in 2014. 

They were ably assisted by rheumatology practice manager Glenda Bissett over this entire period. Glenda’s dedication and knowledge of the area, the patients and rheumatology practices helped ensure the continuity of Orange Rheumatology.

Orange’s patient mix is broad and differs from Sydney’s


There are currently five visiting consultant rheumatologists – Professor Mark Arnold, Dr Ann Leslie, Dr Ross Penglase, Dr Ian Gotis Graham and Professor Les Schrieber – who provide an outreach service, mostly monthly in two- or three-day visits. The practice is now located at Central West Specialist rooms in Orange. It provides rheumatology clinics for a large geographical area, including Bathurst and towns as far as three hours’ drive from Orange.

The patient mix is broad and different from Sydney private practice. Though most patients live in the large towns of the Central West, many are farmers – and there are more professionals than might be expected. 

There are a number of Indigenous patients. There is rarely need for an interpreter service, since regardless of ethnicity, English is typically our patients’ primary language. A substantial number of patients are Medicare only, and there are no public clinics in Orange to refer them to.

Orange Rheumatology has survived a number of challenges, including three changes in consulting venue over the past three years. REX Airlines – which had a monopoly – stopped its regular service to Orange between April and July 2020 because of COVID-19. This resulted in Telehealth being the only viable method of consultation for the non-resident rheumatologists. The break in service contributed to a blowout in the new patient waiting list to six months.

 In recent years it has proved possible to provide supervision for a rheumatology advanced trainee to work in this clinic. This has resulted in one of the trainees joining the practice as a consultant.


It provides a service to an area of need and saves patients a four-hour drive to Sydney to see a consultant rheumatologist.

Patients are almost invariably friendly and grateful, appreciating that it takes time and effort to conduct outreach services.

Consultants are busy from their first day of practice, seeing a broad range of clinical problems.

 There is the potential for financial support from various programs, including the federal government and Australian Rheumatology Association. This covers the costs of flights, accommodation and meals.

Orange is a lovely, safe town with excellent restaurants and nearby vineyards.


It is obviously more convenient to drive 20 to 30 minutes to a workplace in Sydney than to fly or drive to Orange.

REX Airlines has not always provided a reliable service. However, this has improved since COVID-19 and the arrival of Qantas as a competitor.

There is inadequate government support for infrastructure to enable dedicated secretarial support.

There has been limited opportunity to provide educational services for local general practitioners.


Orange is a great place to practice rheumatology. For a young rheumatologist with a sense of adventure, it’s a wonderful opportunity to provide a service to an area of need and be busy from day one in a lovely town.

Professor Les Schrieber is writing on behalf of Orange Rheumatology

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