Time ripe to ad­dress rural cri­sis

The Weekend Australian - Travel - - Health -

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.’’

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