6 November 2019
Commissioner slams inaction on rural reform
Towns across Australia crying out for water are facing a tragic, but not unexpected, problem, says Rural Health Commissioner Emeritus Professor Paul Worley.
And just as drought is often seen through a binary lens of either having water or not having water, so is the shortage of general practitioners in the bush.
But Professor Worley, addressing delegates at the Rural Medicine Australia conference on the Gold Coast in Queensland, said ensuring GP services did not dry up should be a constant priority, not just when the shortage hits rural towns.
“We are working and working and working to solve the problem and to create a generation of doctors who see general and rural practice as the privilege that we know it is,” he said.
Professor Worley’s experience as the first Rural Health Commissioner appointed since 2017 has given him the opportunity to listen to the problems faced at all levels of the primary health care system.
Most stakeholders agreed, he said, that forcing GPs into rural and remote locations because of bonded placements or geographically restricted provider numbers were only Band-aid solutions.
“We find out many years later that these solutions work for the crisis, but the problems still persist,” Professor Worley said.
Professor Worley said three main areas needed drastic attention to sustain equity in primary care.
For many years, ACRRM and the RDAA have said that where doctors are trained greatly affects where they choose to practise.
Despite this advocacy, the majority of medical training continues to be concentrated in the major cities, with rural and remote medicine being seen as a trickle-out approach.
“We need to train students and junior doctors where they are going to work, which means end-to-end medical school training followed continuously with junior doctor and registrar programs based in the bush,” Professor Worley said.
A leading example of this is the rural-focused medical school program operating out of James Cook University in Queensland.
But Professor Worley said for a real difference to be seen, the paradigm of medical education needed to shift from students leaving city-based programs to experience rural programs for short periods of time.
Instead, rural-based medical students could be the ones going into the city to experience metropolitan medicine.
But Professor Worley said that country training would not be enough to retain GPs, especially if the job itself was not attractive to the next generation of students.
“One of the key messages I’ve heard over the last two years is that the jobs [in general practice] have to be designed for people who are going to be working part-time, and have a family,” he said.
Reflecting on his career, Professor Worley said he entered a job designed for a man with a partner who could act as the caregiver to any children who might be at home.
“General practice is no longer family-friendly in the eyes of the next generation. The job of being a GP trainee has been taken over by the other specialty colleges in terms of it being attractive,” he said.
General practice has failed to provide part-time training, maternity leave and annual leave, which has made it a less attractive training pathway.
FINANCING FOR THE FUTURE
The final problem Professor Worley identified was among rural generalists already working in the profession.
Due to funding models, GPs in rural and remote areas are more likely to upskill in emergency, obstetrics, and anaesthetics because they are able to bill a specialist fee.
This is increasingly problematic as the demand for GPs skilled in aged care, palliative care, mental health and metabolic disease is on the rise. But why would a GP bother to upskill in an area where they can only bill a Medicare item number 44?
“We have to get the financing systems supporting a new generation of rural generalists and look at the areas we need specialist level care in our rural and remote communities,” Professor Worley said.