Doctors for the bush

FOR those of us who live in the city, access to a doctor is not really an issue but for those who live in rural Australia, access to health care can prove to be a problem due to the doctor shortage in regional areas.

Australian Medical Association president Dr Steve Hambleton said there was a nationwide shortage of doctors, with rural areas shouldering a disproportionate workforce shortage burden.

“Rural Australia is highly reliant on international medical graduates to address these workforce shortages,” he said. “The contribution made by IMG doctors has been essential and greatly appreciated by the communities they serve, but this strategy is not sustainable in the long term.”

Hambleton said a broad practical plan that incorporates clever thinking and local solutions were needed to attract doctors to rural practice and keep them in local communities for the long term.

“We need to attract and retain Australian-trained doctors in rural areas. To do that, rural practice must be an attractive career and lifestyle choice for doctors.”

General practitioners are the backbone of rural health care and GPs in rural areas need strong procedural skills, he says.

“We need to expand the opportunities for GPs and GP trainees to access advanced skills training in areas such as surgery, obstetrics, gynaecology and anaesthetics, and we must ensure that incentives are in place to attract doctors with these skills to rural and remote areas.”

The AMA is urging the government to support its rural rescue package which was developed alongside the Rural Doctors Association of Australia. The package highlights the need for a rural isolation payment to be paid to all rural doctors, including GPs, specialists and registrars, to reflect the isolation associated with rural practice.

It also calls for a rural procedural and emergency/on-call loading to better support rural procedural doctors and specialists who provide obstetrics, surgical, anaesthetic or primary emergency on-call services in rural communities.

Attracting doctors to the bush is complex.

“It is not just about the money. It extends to professional development, existing health infrastructure, family needs, education and lifestyle,” he said.

“State governments have contributed to workforce shortages by closing down or downgrading public hospitals in many rural areas. This leads to an environment where rural doctors cannot practice vital skills or procedures...The AMA believes a public interest test should apply before local hospital services are closed or downgraded.”

The AMA also believes support needs to be provided for not just doctors but their families as well.

“More attention needs to be given to supporting spouses and family members across suitable employment and education opportunities when one member of the family moves to the bush.”

Other issues covered by the AMA submission:

Medicare Locals

GPs in rural areas are very concerned the introduction of Medicare Locals will result in a loss of knowledge about health care needs.

The AMA believes GPs must be a key part of Medicare Local decision-making structures to ensure services are tailored to the community’s needs. In many cases, Medicare Locals so far seem to have been implemented with insufficient regard for the input of the local GPs.

Bonded Medical Places (BMP) Scheme

The AMA is calling on the government to abolish the unfunded BMP scheme. Overseas evidence shows it will not deliver sustainable improvements to the rural medical workforce.

The AMA is calling instead for the enhancement and further expansion of incentive based programs such as the Medical Rural Bonded Scholarship Scheme and the HECS reimbursement scheme.

The Australian standard geographical classification – Remoteness Area Classification (ASGC-RA) scheme.

Over the past few years, the federal government has put extra money into the rural workforce incentive programs, but there are major concerns about the use of the ASGC-RA classification system to determine the level of incentives that apply to different rural areas.

The AMA submission highlights several anomalies that are making it much harder for some towns to recruit doctors, and puts forward recommended changes to the use of the scheme. These changes would improve the way incentives are targeted.