Time ripe to address rural crisis
on improving the financial rewards for rural doctors, in order to maximise the incentives to practise there. These include pumping another $80 million over four years into the existing program of rural retention grants, which already pay rural doctors up to $25,000 per year for staying in country areas, and increasing the number of scholarships and scrapping of HECS debts for medical graduates.
Peter Rischbieth is the president of the Rural Doctors Association of Australia and has been a GP practising obstetrics and anaesthetics in Murray Bridge, South Australia, for the past 20 years.
Despite being just an easy hour’s drive from Adelaide’s CBD, even this town cannot find enough doctors. Rischbieth says five maternity units in the region have closed in the past 10 years, and there are vacancies for two GP obstetricians and a doctor able to perform caesarean sections.
‘‘ We know there’s a huge Medicare underspend in rural areas,’’ Rischbieth says. ‘‘ We need more services to get junior doctors to come out and joing us.’’
At the moment it seems few are. Figures presented at this week’s summit by the RDAA showed that as at March this year, only two of the 280 Queensland graduates in 2005 were working in rural and remote locations, a drop from 11 out of 225 the previous year.
Ten years ago the RDAA began arguing for specific Medicare ‘‘ items’, or rebates, to be created only for rural doctors, that pay more money than standard rebates and would thus increase the income of bulkbilling rural doctors.
Until now other medical groups, including the AMA, have resisted this proposal, but the RDAA hopes that in the current political climate its time may be nigh.
But the association also says the solutions go beyond money.
Rischbieth points out that when the UK Government in 2004 allowed GPs to opt out of after-hours care if they wished — at the cost of a 6000-pound cut in their salary — 90 per cent dropped out, creating a huge extra cost to source the services through other channels. ‘‘ Money is not the only thing,’’ he says. The association’s chief executive Steve Sant says that the RDAA wants a rural health obligation to be introduced, similar to the requirements that apply to Telstra, ‘‘ so if you have a heart attack you can receive appropriate care’’.
‘‘ Health services in the bush are on the brink, they really are,’’ Sant says. ‘‘ We have a number of initiatives in place but they are not making a difference. We need to do something substantial, and something right now, because a lot of the doctors out there now are in their late 50s and they are not going to be replaced by the students coming through in time.
‘‘ We need 1000 doctors tomorrow to get back to a basic level of service in the bush.’’
Financial incentives are part of it — 20 years ago there was just a 20 per cent earnings differential between a rural GP and a city specialist, but now the gap is 200 or 250 per cent.
Some other groups stress the need for other measures than simply paying doctors more.
John Wakerman, chairman of the National Rural Health Alliance, which represents not just doctors but a broad array of nurses and other allied health workers in rural areas, says there are ‘‘ serious medical workforce problems that don’t seem to be improving’’.
While the problems are complex and there is no magic bullet, he says we ‘‘ need to take a deep breath, step back and look at the national situation,’’ he says.
The Alliance says the roles of commonwealth and state Governments need to be clarified, through a proper rural and national health plan.
Concern about the sustainability of some rural communities also needs to be addressed — concerns that will not have been lessened by recent news that the hoped-for breaking of the drought and the La Nina weather pattern seems to be weaker than previously predicted.
And the alliance also emphasises the need for improved infrastructure to attract health workers — not just doctors, but others such as dentists — and to look where necessary at other models, such as existing arrangements where the business of a practice is owned and operated by a town council or other body, so the incoming GP does not have to worry about being unable to later sell the practice.
‘‘ We need a proper workforce around them, so we are not just putting all the pressure on GPs, and they have nurses and an allied health team and a practice manager looking after that side of things,’’ Wakerman says. ‘‘ This is a very important time for us and we think there’s a window of opportunity.’’