We were due to shut our doors this month as we lost almost all our hard-won doctors, but a DPA ruling has changed everything.
Friday, 14 January was the day I dropped to my knees and cried in utter and overwhelming relief.
I had just heard the words: “Hervey Bay is now classified as DPA following an application to the Coalition government’s exceptional circumstances review.”
Visiting our medical centre, local federal MP and Resources Minister Keith Pitt said he had heard from medical professionals how hard it was to employ new GPs in our region and from constituents who have had difficulties getting in to see a GP.
“The decision to classify Hervey Bay as a Distribution Priority Area gives local GP practices a larger pool of doctors to recruit from, which should make it easier for clinics to secure more doctors,” he said.
“I’m sure Hervey Bay locals will welcome this announcement as it doesn’t matter whether you are young or old, your health is important and having timely access to a GP should be the same whether you live in regional Australia or in a capital city.”
To understand the impact of these words, you’ll need to appreciate the struggles and stresses we faced for so many years.
My husband and I moved to Hervey Bay in 2006 as he had signed up to do GP training and was placed in Maryborough, Queensland. This was far from ideal as I was a city girl and had an established career in the Brisbane CBD but at the end of the day we had little choice and made the move.
Within the first week I realised there was a doctor shortage problem when I tried to book in my six-month-old baby for her immunisations. I phoned the nearest GP practice to register us as patients and got rudely told “books closed”. I thought that was a bit strange, so I called the next practice and was told the same thing.
Eleven phone calls later and the same conversation was repeated to me at every single practice I called: “We are not taking new patients and our books are closed.”
In the end, and as a last resort, I joined as a patient at my husband’s GP training practice (despite it being a 70-minute return trip from where we lived at the time) but beggars can’t be choosers and I needed to get my baby her vaccinations. It did make me wonder about all the other people who were moving to the area and I couldn’t fathom what they would do about getting into a practice.
I found the entire situation rather shocking, given I had been living in Brisbane and could always get a GP appointment the day I needed one. This was indeed a whole new world.
What made us start our own practice in 2012? I couldn’t really tell you. We had bought a home in the Hervey Bay area, I had finally made some good friends, the cost of living was cheaper and given the GP Training program didn’t pay much and I had given up a high salary working in the corporate sector in Brisbane (meaning we were down to one income), we found that living and working in an area with a lower cost of living was worth considering on a longer-term basis. Given the difficulties while working on the GP training program, including being overworked, underpaid and poorly treated, the thought of working as a husband-and-wife team where we called the shots held some appeal – with the bonus being I could return to my career in a management role (albeit in a different field) .
Of course, my difficulty when trying to open our own practice was the same problem we had experienced when trying to get into a GP practice: a total and utter shortage of doctors wanting to join us.
In desperation, and after six months of advertising and not receiving a single application, I wrote my first letter to the Department of Health in 2012. Having not been able to recruit any other doctors with the exception of one skin doctor wanting to work only two days a week, I realised we were going to struggle. I received a letter back from the DOH saying “the area is over serviced with GPs and we will not be giving any DWS [now DPA] exemptions”. This was devastating news but for a decade I never gave up, repeatedly writing letters to the DOH, contacting the local and federal ministers’ offices, contacting TV stations and media outlets, begging Rural Health Queensland for help, writing desperate pleas published in this very publication and starting a patient petition signed by thousands of patients asking the government to help us hire extra doctors in our area.
After 10 years of stress and anxiety, I couldn’t honestly tell you what the single moment was that day in August 2021 that finally made me fall apart after being so strong for so long. The constant struggles managing a medical centre during a pandemic, with staff shortages and never enough doctors on site, or it could have been the sight of the huge pile of bills. It could have been the patient abusing one of the receptionists because we had “dared to try to charge a gap of $27” (of which he had been informed before the appointment over the phone and in two SMS reminders).
But if I have to pick just one thing, it was that the media crew and a journalist we had scheduled to come over to feature our story of doctor shortages and our repeated cry for DPA status was cancelled at the last minute as a “more topical story” came up. The desperate plea I had prepared would not get any air time, and I had been clinging to this as a last resort for saving our practice.
Hiring doctors in a non-DPA area four hours’ drive from Brisbane and with a very challenging patient base was effectively impossible. The only doctors we could hire were FRACGP GPs not under moratorium restrictions, but why would Fellowed specialist GPs want to work in a lower-socioeconomic region that is short of restaurants, facilities, jobs and shopping centres?.
We had the option to employ registrars on the GP Training Program; however, they are now almost non-existent because of shortages in doctors signing up for GP training.
That left us with our last and least-favourable resort: needing to sponsor international medical graduates using 19AB replacement provisions. This requires the principal doctor (supervisor) to be on the floor 100% of the time the IMG is working and to also be interrupted at the end of every consult that the IMG has with their patient to double check the management. Plus, the supervisor takes a 50% risk on their own medical registration should an error occur. Hardly an attractive proposition but when you are desperate you do what you need to do to survive.
It took us 18 months to make this work, most of it taken up by red tape and requiring thousands of dollars both in visa fees and in staff hours, as we needed to fill out overwhelming amounts of documentation for every single IMG application.
Once approved, these IMGs then had to spend four weeks observing, under AHPRA regulations, before being able to see their own patients. So they all arrived out of cash and in desperate of an income.
Our last IMG quit his job in India as he was due to fly out to begin his employment term with us in early 2020, but was stuck when covid closed the borders. He subsequently waited a year (four cancelled flights at the last minute) and ended up paying $10,000 EACH for a plane ticket for his wife and himself, plus 15 days in hotel quarantine before joining us to start his four weeks of unpaid observation, before finally being able to see two patients per hour!
Not a huge money spinner for the GP who had given up everything to be here OR the practice that had put in so much time and expense – yet we still congratulated ourselves at having secured extra doctors for our patients. We felt so truly grateful we had managed to save our practice from bankruptcy, and to keep our staff in jobs and our patients receiving medical care.
But on 15 July 2020, our world came crashing down with a statement released from RACGP that said: “The Australian Government is changing the rules for doctors who do not hold fellowship who want to work in Australia. From January 2022, non-VR doctors who do not hold a specialist qualification are required to complete an approved program to be eligible to sit the RACGP fellowship examinations.”
My heart started racing. I felt like I was going to vomit, and I called my husband out of his consult room to show him. To our horror, after putting in three years of training and taking the risk, expense and responsibility on my husband’s medical registration, we now found out that four of our six doctors needed to leave in January 2022 in order to be eligible to sit their FRACGP exams and needed to move to a Practice Experience Program practice, and these were located only in DPA areas. We were NOT in a DPA area and this meant the writing was on the wall – after all those years, dollars, risk and energy spent getting doctors to work at our practice, we would be back at square one, with a solo skin doctor and one GP to manage a six-doctor practice with 19,000 registered patients.
There was no other choice: we would need to close our doors in January 2022, losing the doctors we had fought so hard to get in the first place.
Having to tell our 10 loyal and hardworking staff who had shown up through tough pandemic conditions that they would all be without a job in this high-unemployment town was soul-destroying.
Facing this incredible sadness and having watched three medical centres in as many weeks fold in our region because of constant doctor shortages made my health suffer, my heart break and my hope fade. After 10 years of trying to hold our practice together and 10 years of trying to recruit through agencies, trying to secure registrars, trying to find doctors wanting to stay at our practice, we had secured four international doctors only to find out it was all for nothing.
At the end of my time as practice manager and while training my new PM to take over from me, the Regional Health Minister, Dr David Gillespie, suddenly and unexpectedly put out a press release that allowed practices the opportunity to put forward their case for “exceptional circumstances review” to be considered as an area to be awarded DPA exemption. My heart stopped. Could this save us?
In all honesty, I never thought we would pull it off. I had just spent the previous few months speaking to consolidation HR experts about the best ways to retrench staff, speaking to our accountants about how to dissolve our practice and speaking to our four IMGs about the best options available to them and about where they should relocate.
But Friday’s announcement changed everything. We had staff openly sobbing, our doctors hugging each other in joy and triumph, and within 24 hours I’d received messages from more than 170 patients about how happy they were and what a difference this decision would make in their lives.
In the 24 hours after the announcement, I was also approached by three doctors asking for positions with our practice, I’d been able to make two casual staff full-time permanent employees. We are now able to advertise for an extra admin member and an additional nurse, meaning not only that all our existing jobs are secure but also that we can hire more staff to deal with the extra intake of doctors and patients that will follow.
Sometimes persistence pays off – sometimes it helps to scream and shout and not just stay silent when you see a broken system.
It definitely helps to surround yourself with the right team and to my new practice manager, Alissa Mahoney, who literally picked me up off the floor on a day when stress and exhaustion made it hard for me to breathe, I say “thank you”. Alissa picked up the DPA fight with renewed energy and determination, and phoned Minister Keith Pitts office almost every single day to ask for updates.
For me, personally, we won the fight but I still made the right decision to step away as practice manager. Our practice is now strong again, we will grow, we will thrive and it is being tended to by the loving hands of the new PM who is just starting her journey in this role and who has the energy and vibrancy and passion that I lost a long time ago.
It’s been a very long 10 years, and would I do it all again? I honestly don’t know. I do know that Friday night felt like the first night I could sleep soundly in many years and this weekend my husband has been laughing and my kids were jumping up and down, feeling the weight lifted off their mum and dad’s shoulders, so for now this is good enough.
For those practices still struggling, I say stand strong, don’t give up, keep the fight going and know it may take 10 years but if we can do it then you can too.