In August the Senate decided to launch an inquiry into GPs in regional, rural and remote areas — yet another in a series of inquiries over the decades into the vexing issue of how to get more GPs working in small bush communities.
It is due to report by the end of March — which may or may not mean it is finished before the election — and has received more than 200 submissions.
For a government with an election to save, however, that timetable is useless. Rather than try to work out what actually might work, the Nationals’ Minister for Regional Health David Gillespie announced last week — though good luck finding the details anywhere — that the government would “eliminate the HELP debt of doctors and nurse practitioners who work in general practice in a rural, remote, or very remote location for a specified period”.
The media duly reported it as a new program. But it’s not new at all.
In 2015 this government cancelled the HECS Reimbursement Scheme which “reimburses standard HECS debts of medical students should they choose to train and work in rural and remote communities”. So the new program is just the reintroduction of a program the government had axed.
It did “replace” it with an “enhancement” of another scheme, the bonded medical program which also paid students’ tuition fees if they practised in rural and regional communities. As the Health Department admitted to the inquiry, the transition has been dogged by problems for years.
Why was the original reimbursement scheme, which has now been restored, axed? It had a long history of not working. It turns out money isn’t the big issue in attracting GPs to work in the bush, according to research. Factors like long hours and stress are also crucial, along with other financial factors like the ability to own one’s practice.
There’s also lack of collegial support, lack of professional development opportunities, and non-professional factors like the lack of employment opportunities for partners and separation from family and support networks.
It’s well known that GPs from rural areas are much more likely to want to work there, and successive governments have been trying to lift the level of country kids heading into — and staying in — medicine, along with establishing medical colleges in regional areas.
In short, it’s a long-term, complex problem that has resisted governments throwing money at it for a long time. But that hasn’t deterred Gillespie and the Nationals for reheating an old, questionable policy in the lead-up to the election.
Do you think it’s about the money, or other professional or lifestyle factors? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name if you would like to be considered for publication in Crikey’s Your Say column. We reserve the right to edit for length and clarity.
As a doctor in a regional area, who has previously practiced in a small rural town let me tell you, it’s about the lifestyle. It’s all about the lifestyle. Entirely about the lifestyle. If you want to make it about the money you will need quite literally truckloads of cash for it to work. And we are talking about great big truckloads, a truckload on a regular basis for each and every doctor.
Rural/remote practice is difficult for a huge number of reasons. First and foremost it’s professional isolation. If you are the sole doctor in a small town then you are on call 24/7. You are sorely lacking for a colleague to share difficult cases with. You can never go anywhere. You can’t take a holiday. You can’t even have a really good hard night out on the turps. Because you need to be there for the townspeople every single hour of every single day. Holidays are hard to come by, because it is nigh on impossible to get a locum. Similarly getting to conferences (which are now more or less mandatory to attend so you comply with your Continuing Medical Education requirements) as once again locums are like rocking horse poo. And it’s getting harder because the NSW and Queensland Government have a policy of “pay whatever it takes” to secure locums for government services, often paying 25, 30, even 50% over the going rate for a locum to ensure they get one. Against which the humble solo or small practice just simply cannot compete, the standard rate is pretty much at the break even point, try and increase it to compete with the deep pockets of the State treasury and you go backwards financially.
Then there is often the partner factor. Most doctors meet their partner at some time during their university years, or in their early post graduate training, which was exactly my experience, I met Mrs Harding number 1 at Uni, and Mrs now Dr Harding number 2 during postgrad training. The partner often has their own career which is already or getting established at the time the doctor is ready to start practicing in a remote area. Often one not designed for a small rural location. Try telling your partner who is well on their way to a partnership in a law firm, or headed for a chair at a university that you are heading bush. The answer is often “bye, and by the way I’m keeping the dog”. So the doctor stays in town. And it doesn’t matter on the gender mix here, male/female, female/male, male/male, female/female, the same principal applies. Professional people tend to have professional partners, both careers have to be considered.
Then come children. Education opportunities (despite what the Nationals would have us believe) are no where near as good. Unless you board them. And boarding does not suit every child (some revel in it for sure, others find it the most miserable experience of their lives). So once again the Big Smoke looks better.
And then finally there is lifestyle. Some really do enjoy life in the bush and it’s attendant lifestyle. Many rural practitioners come from the bush to begin with (I do). But I’m yet to see figures on just how many medical students from the bush stay in town, captivated by the bright lights, the restaurants, the theatre, and all the other attractions of city life (the possiblility of running into Guy Rundle perhaps, yet to enjoy that one). We know that students from the bush are more likley to stay there, but to what extent? This metric seems missing from these studies. My bet is most from the bush actually stay in town once educated, and while some return to their rustic origins, more actually stay in town, and it’s only a marginal increase in numbers who go bush compared to their city reared contemporaries.
So open the coffers boys. If you think money is the answer to this problem you are going to need lots and lots of it.
The government is not interested in SOLVING the problem of doctor shortage.
This whole exercise is for political consumption: “look at what we are doing to help”.
And LNP voters will lap it up!
Maybe the Nats could get serious about belting the Sydney Liberal party around the ears and promote the build up of regional towns and centres so that people from the cities would want to move there, doctors, industry, etc..
My guess is that the lack of employment prospects for partners and professional isolation are important deterrents. One way of tackling the latter could be to reconsider the way medicine is practiced. Specialists are flexible enough to work in more than one location. AFAIK, that is not the case for general practice. Larger medical practices with more than one branch would allow young doctors to work in rural areas for two or three years without feeling isolated, or stuck. Plenty of other doctors would enjoy and benefit from the experience from time to time. Working in rural Australia is not a punishment.
Regional areas would probably be attractive for those from regional areas wishing to remain in their broad community.
However, regions may not be so attractive and/or accessible for outsiders whether e.g. doctor or their partner looking for fulfilling employment or related roles; many are reliant on filling some positions upon new migrants or temporaries.
What is missed, is that the demography of regions in Australia is changing like elsewhere, i.e. lower fertility, ageing (esp. workforces), declining small towns/communities, consolidation of family farms, migration to cities and urbanisation for more regional youth.