In­cen­tives skewed, say rural doc­tors

The Weekend Australian - Travel - - Health - Adam Cress­well Health ed­i­tor

THE $500,000 re­cruit­ment car­rot be­ing dan­gled by a coun­try NSW surgery has kin­dled sym­pa­thy for the plight of iso­lated coun­try towns, but rural doc­tors say some of the fed­eral Gov­ern­ment’s own poli­cies have wors­ened the work­force short­ages af­flict­ing most of coun­try Aus­tralia.

The half-mil­lion-dol­lar ‘‘ golden hello’’ is be­ing of­fered by the man­age­ment com­pany that runs the Vic­to­ria Street Surgery in Temora, which faces clo­sure un­less a pro­ce­dural GP qual­i­fied in anaes­thet­ics and ob­stet­rics can be found to re­place two doc­tors due to leave next week.

As re­ported by The Aus­tralian on Thurs­day, the $500,000 sign-on fee will be paid af­ter com­ple­tion of a three-month trial pe­riod, and will be on top of a sub­stan­tial earn­ings pack­age ex­pected to be well in ex­cess of $200,000 a year.

How­ever, the body rep­re­sent­ing rural doc­tors says far from be­ing an iso­lated case, rural work­force short­ages na­tion­wide are get­ting worse and state and fed­eral Gov­ern­ment ne­glect of the is­sue is largely to blame.

Rural Doc­tors As­so­ci­a­tion of Aus­tralia pres­i­dent Peter Ris­ch­bi­eth — a GP ob­ste­tri­cian and anaes­thetist who has prac­tised in the South Aus­tralian town of Murray Bridge for the past 20 years, said while short­ages of rural ob­ste­tri­cians were now well pub­li­cised, what was less well un­der­stood was that num­bers of rural GPs with anaes­thetic skills were also dwin­dling fast.

In NSW alone, the num­ber of qual­i­fied anaes­thetists had fallen from a high of 131 in 1996 to 89 in 2005.

This was sig­nif­i­cant, be­cause when a town loses its anaes­thetist — as is hap­pen­ing now in Temora — this of­ten has a knock-on ef­fect on other spe­cial­ists, some of whom can­not prac­tise with­out anaes­thetic sup­port.

In Temora’s case, it will mean that un­less a doc­tor ap­plies for the $500,000 there will be no-one in the town able to anaes­thetise emer­gency cases such as road crash vic­tims, or ad­min­is­ter an epidu­ral to a preg­nant wo­man, let alone al­low a cae­sarean de­liv­ery. In NSW, de­liv­er­ies of new ba­bies in rural ar­eas has fallen from 7818 in 1994 to just 4308 in 2005.

Paul Mara, the Gunda­gai GP who heads the man­age­ment com­pany of­fer­ing the money, said the fed­eral Gov­ern­ment’s own 2003 Fairer Medi­care re­forms (later repack­aged as Strength­en­ing Medi­care) had wors­ened the prob­lems of coun­try towns be­cause the re­forms had ‘‘ made it vi­able to run a city prac­tice’’.

‘‘ Fairer Medi­care in­creased the in­come of GPs in the cities by 40 per cent to 60 per cent in some cases, with­out any ex­tra work,’’ Mara said. ‘‘ Five to 10 years ago, a rural GP would use their hospi­tal work to sub­sidise their private prac­tice. But when Fairer Medi­care came along, doc­tors could sit in their surgery all day.‘‘While the Gov­ern­ment has im­proved the sit­u­a­tion (for GPs) dra­mat­i­cally, it’s taken away a lot of that in­cen­tive to get out and do the other stuff.’’

Ris­ch­bi­eth says rural health has dropped off the radar of both fed­eral and state tiers of gov­ern­ment and called for the Aus­tralian Health Care Agree­ments — the next round of which are now be­ing ne­go­ti­ated — to im­pose a ‘‘ rural ser­vice obli­ga­tion’’ on state and fed­eral Gov­ern­ments, sim­i­lar to that faced by Tel­stra.

A spokes­woman for fed­eral health min­is­ter Tony Ab­bott said rural GPs ‘‘ do a great job and they should be val­ued by all in the com­mu­nity’’.

‘‘ The Howard Gov­ern­ment has in­tro­duced a num­ber of mea­sures to make rural prac­tice at­trac­tive, such as higher Medi­care re­bates and other in­cen­tives,’’ she said. ‘‘ We will con­tinue to work with the sec­tor to look at rea­son­able and ef­fec­tive ways to get GPs to move and stay in the bush.’’

She added the $8 rural bulk-billing in­cen­tive in­tro­duced as part of the $4 bil­lion Strength­en­ing Medi­care pack­age had ‘‘ led to an all time high bulk-billing rate in coun­try Aus­tralia of 72.6 per cent in the March 2007 quar­ter’’.

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