Incentives skewed, say rural doctors
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’’.