13 February 2019

The big business of healthcare for the bush

ACRRM Rural TheHill

Budget night is about winners and losers, about fixing moods, rewarding friends and discouraging off-message investments. Protagonists will have been going door to door telling their story, broadcasting their expectations to disinterested parties and media hoping that, inspired or fraught, their message gets traction.

Two years ago, I joined the parliamentary media conga line winding through the corridors of the house to eventually front the waiting cameras with my “response” to the fortunes or misfortunes bestowed upon my cadre of believers.

I was then president of the Rural Doctors Association of Australia and we were pleased with a new national rural health commissioner and the promise of a national rural generalist program.

Two years later we have a report sitting before a minister waiting on a promise of money to make the vision become reality. Once again, I will soon join the lottery lock up, as President of the Australian College of Rural and Remote Medicine, praying that the post-budget procession to the media scrum won’t be a forlorn one.

It seems crazy that this is how we do business in health by creating competition, competing narratives, telling stories of triumph over others to attract kudos and funding to our cause.

The Australian health system has an envious reputation for being accessible, affordable and for most providing good outcomes.

Our scorecard isn’t so great the more west and north you drive, and not for our first nations’ people.

Regardless, an American patient of mine faces the prospect of returning to their country unable to afford life-sustaining treatment cheaply available here. According to the OECD we are in the sweet spot when it comes to the costs of health in this country. We’re doing OK where it counts, but we need to do better.

Australia has more registered (AHPRA recognised) disciplines in medicine than any country in the world, bar the United States.

We are graduating more medical students from more medical schools than we ever did in our history, 83% of whom see themselves as a subspecialist in a tertiary institution. Hence, we continue to rely extensively on international colleagues to support medical services the further we travel from the central business district of your favourite city.

One regional health service alone has nearly 100 clinicians on limited visas or registration. It seems that we Aussies just aren’t comfortable with exploring our great brown land.

This year will mark my 30th in my rural community where I still look after mothers and babies, do palliative care, general practice and respond to emergencies. I am a GP supervisor working for multiple universities, teaching students and GP registrars in addition to my ACRRM role.

Ten years ago, I was described as a “dinosaur” by a well-meaning specialist colleague who saw no future for procedural practice in a rural area. The solution, at that time, was to find a faster aircraft for those rural punters felt to be retrievable. There had to be a different answer and that answer was the voice of a community unwilling to accept that the only good care available was 1000 kilometres away.

Fast forward to our current circumstance. We live in a great country, training excellent clinicians, yet focused on the wants of our craft groups and the desires of our youth, rather than the needs of our people, especially those most in need.

Is it reasonable that recipients of taxpayers’ money should be able to determine where that money is spent? Budget night will be a time for an accounting of the priorities of this government, but also a time to reflect on the accountability of the health system and its many parts, to those we serve.

A national rural generalist program is an opportunity to select young people, give them great training and support them into a recognised career in rural and regional areas.

Ten years ago, my community demanded local care, to birth near where they lived, to receive their cancer treatment with their family, or to die well in their own home. Today my community has that option through the work of many to see the re-discovery of the country GP, the rural generalist.

It is past time that the nation invested in its rural communities and returned to them control of their health care through investment in excellent rural clinicians.

Dr Ewen McPhee is Practice Principal, Medical Educator, Rural GP Obstetrician and President
of ACRRM.

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