23 May 2018

Was budget just a pea and thimble trick for GPs?

Government TheHill

In the wake of this month’s federal budget, doctors are struggling to understand how a putting a small dent in the medical migration program can fix Australia’s GP workforce issues.

The government says it can save $415.5 million by cutting 800 visas for overseas-trained GPs in the next four years – the largest single savings item in the 2018-19 budget.

The centrepiece of the health spend is the $550 million Stronger Rural Health strategy, which focuses on training and retention measures in regional Australia, including end-to-end training programs for medical students and other health professionals.

“The strategy will put 3000 more highly qualified doctors and more than 3000 nurses and hundreds more allied health professionals into the regions over the next 10 years,” Rural Health Minister Bridget McKenzie said on budget night.

Concrete steps include a four-fold increase in GP placements for junior doctors – from 240 rotations to more than 1000 per year – and an extra 100 training spots for rural generalist GPs from 2021, on top of the 300 already planned.

But the projected saving of more than $400 million, to pay for these promises, is a focus of concern. 

The $415.5 million savings figure is “based on not having to pay the cost of services that would arise if the growth in the supply of doctors was not slowed down”, a Department of Health spokeswoman told The Medical Republic. 

The calculation includes Medicare, PBS, and diagnostic, pathology and specialist referral costs, but it does not take account of replacement services. 

“On the very limited detail available, it is difficult to see how (the savings figure) is going to be realised,” Dr Bill Coote, a former GP and AMA secretary-general, said.

“It seems an heroic assumption that the number of services will drop, given the number of practices and GPs and demand for services. Let’s hope it’s not a pea and thimble trick.”  

Influential rural GP leader Dr Paul Mara said there were already too many doctors in the country, adding the strategy of importing doctors to solve rural workforce shortages had clearly been a failure.

“Most don’t have the qualifications and the experience. We are now discovering we have to put more resources into training them,” he said.

Dr Mara suggested a repayable bond scheme would prod practices to be more committed to training doctors to pass their fellowship exams.

ACRRM and the RACGP welcomed budget promises of more support for overseas trained doctors in rural practice to gain their GP fellowships, although detail is lacking.

In reality, it is clear that the immigration program has fuelled the urban-country medical workforce imbalance, with a flow of doctors to the cities.

Despite their smaller numbers, overseas-trained GPs in major cities already outweigh Australian and New Zealand-trained GPs in terms of Medicare billings.

Medicare figures for 2016-17 show 9789  OTDs in the cities accessed MBS items of $2.703 billion in 2016-17, compared with $2.699 billion by 14,683 locally trained GPs.

Large numbers of non-VR OTDs are also working in major cities – 3013 to be precise – presumably under area-of-need provisions, including after-hours services.

Alongside the planned visa cuts, the government is winding down the “other medical practitioner” programs that employ many non-VR OTDs, effectively setting a five-year deadline for them to achieve fellowship.

AMA President Dr Michael Gannon said the budget showed the government was taking “tiny steps” towards the goal of having a predominantly locally trained medical workforce.

“We applaud the government in at least starting to introduce some evidence-based measures … that are likely to increase the number of doctors who settle in rural areas,” Dr Gannon said.

“The reality is that the vast majority of doctors given visas under district of workforce shortage provisions end up working in our major cities. That’s not a workforce strategy.”