Providing specialist services in Australia across barriers of distance and culture.

Most of Australia's population live in urban environments and have ready access to high-quality specialist surgical services. The 1% of Australians (210,600 people) who live in the Northern Territory of Australia sparsely occupy more than one-sixth of Australia's land mass and have varied cultural backgrounds. The organization of surgical services in the Northern Territory provides a case study in providing specialist surgical services to disadvantaged, rural and remote populations in a developed country. Historical and current initiatives to overcome barriers of distance include a coordinated network of health clinics, regional hospitals, and specialist surgical facilities staffed by health care practitioners with broad training and a wide scope of practice. Aeromedical services that facilitate patient and medical team transport were among the first worldwide. Recent initiatives to overcome barriers posed by cultural differences include an Indigenous Languages Interpreter Service, dedicated Indigenous health educators, and specialist outreach visits. Specialist services in the Northern Territory are delivered locally by appropriately trained generalists in cooperation with and supported by specialists from larger centers. This cooperative model of delivery of specialist services maximizes population access to the whole range of surgical therapies and encourages the efficient use of both specialists and generalists. Adoption of the principles of this model may lead to increasingly efficient delivery of specialist services in more densely populated regions.