Training and Sustaining Rural Anaesthetists: Insights from a 12-Month Audit of Paediatric General Anaesthetics in Wagga Wagga

Billy Poulden, Dr Judy Killen

Introduction: Access to high quality paediatric general anaesthesia (GA) is fundamental to the provision of surgical services in rural areas. Paediatric anaesthesia is a core competency for ANZCA trainees. Skill maintenance requires regular paediatric case exposure, collaborative practice, simulation-based training, and continuing professional development. Providing safe, sustainable paediatric anaesthesia depends on both workforce capability and service availability, posing a significant challenge to the rural workforce.

Aim:

To evaluate the volume of paediatric general anaesthetic cases in Wagga Wagga over a 12-month period and assess whether this caseload supports both the training of anaesthetic registrars and the ongoing maintenance of paediatric anaesthesia competency for rural anaesthetists.

Methods:

We audited all paediatric general anaesthetic cases performed from 1 July 2023 to 30 June 2024 across three centres in Wagga Wagga, NSW: Wagga Wagga Base Hospital (WWBH), Calvary Riverina Hospital (and Surgicentre), and Riverina Day Surgery (RDS). Cases were grouped by age (<12 months and 1–4 years).

Results:

A total of 462 GA cases were performed in children aged 0–4 years, with 48 under 12 months. Most were at WWBH (n=247), followed by Calvary (n=167) and RDS (n=46). This highlights a substantial paediatric caseload in a rural setting.

Discussion:

This volume supports ANZCA training and provides critical exposure for rural anaesthetists to maintain skills. However, services rely heavily on a small number of clinicians, particularly a single paediatric surgeon, raising sustainability concerns. Balancing high-quality care with local service provision is complex. While centralisation may benefit complex cases, studies show that with adequate support, rural surgical outcomes are often comparable to metropolitan centres. Investing in rural training is also key to workforce retention—specialists with significant rural exposure are nearly three times more likely to remain in rural practice.

Conclusion:

Wagga Wagga’s paediatric surgical activity presents a strong case for supporting local anaesthetists and trainees through sustainable, locally delivered services. Encouraging rural procedural practice, fostering collaborative training, and strengthening regional networks are essential to maintaining paediatric anaesthesia competency and supporting rural healthcare.