Locum agencies put the squeeze on small towns

A North Queensland GP clinic risks closure, but not for lack of love or money.

---

Practice manager Carmen Edmondson and registered nurse Julie McKay have been trying quite literally to give away their GP clinic for the better part of a year.  

Even at the rock bottom price of $0, the couple can’t find a buyer willing to take over Cardwell Family Practice.  

“If a doctor walked in and said, ‘I will take over your practice, but I’m not paying you’, we would literally give that to them to keep the doors open,” Ms McKay told The Medical Republic.  

Around two hours’ drive from Cairns, the coastal town of Cardwell – population 1500 – is famous for its naturally occurring spa pool and popular with grey nomads over the winter months.  

It’s deep in banana and cane-farming country, and residents tend to have several risk factors for chronic disease – they’re older and more socially disadvantaged and there’s a large Indigenous community in the town.  

There’s been no shortage of work for the practice since Ms Edmondson and Ms McKay took it over in 2015, but they’ve recently informed patients that the clinic will likely close down at the end of September. 

“We’re not stopping this because we hate our community,” Ms McKay said.  

“We’re not stopping it because we’re broke.  

“We’re stopping it because we just can’t go on with this Band-Aid approach anymore.” 

By Band-Aid approach she means relying on locum agencies in lieu of permanent doctors.  

In some ways, it’s the same story that’s playing out in smaller towns across regional and rural Australia, with doctors unable or unwilling to make a permanent commitment due to the lack of work or schooling options for their family.  

“Many reasons are given – we don’t have private schools, we don’t have a Woolworths … we don’t have the music lessons or dance lessons,” Ms McKay said.  

When she and her partner first took over the practice, attracting semi-permanent locum GPs hadn’t been too difficult.  

The first doctor who came for a six-week stint stayed in Cardwell for a year, and the next doctor stayed for three. But in the last eight months, Ms McKay estimates that nine or 10 doctors have cycled through the clinic. 

Without a permanent doctor, the clinic isn’t able to provide the supervision requirements for an internationally trained doctor or GP registrar to be able to come on board. 

She’s angry with the usual suspects – the federal government for altering the DPA system, the state government for not providing enough support – but locum agencies hold a special place for her ire.  

“It’s just got to the point now that the general practitioner locum agencies have just got a stranglehold on little places like Cardwell,” Ms McKay said.  

Privately run locum agencies, she said, had been able to take advantage of the rural workforce shortage to drive prices up and tack on what she feels are egregious demands.  

“They charge a phenomenal amount,” the registered nurse said.  

“We’ve got locums that we fly into Cairns and then we pop them on the local Greyhound bus – which is quite comfortable – down to Cardwell, where they pick up their car, their accommodation and everything else that they require. 

“Our locum that was supposed to start in three weeks’ time has just pulled out because we won’t drive to Cairns and pick her and her mother up.” 

Then there’s the added labour of onboarding a new staff member and getting people up to speed on the cultural nuances of caring for the local First Nations community.  

Ideally, Ms McKay said, state governments would take over locum distribution to try and bring order back to the sector.  

She’s not the only one to flag possible price gouging in locum agencies of late. NSW Health Minister Ryan Park has ordered a special inquiry into health spending which will look into the cost of locums at public hospitals.  

GP-turned-politician Dr Amanda Cohn, a NSW Greens MP, moved a motion in parliament in June that using for-profit recruitment agencies to fill roster gaps in hospitals was “inefficient and expensive”. 

She suggested a centralised register of casual doctors instead.

Even if those changes somehow came through nationally, it’s unlikely that Cardwell Family Practice will be around to reap the benefits.  

When the practice closes its doors in September, patients will likely be forced to drive the half-hour to the next town for GP appointments – but this won’t be easy for many of the townspeople, said Ms McKay.  

“Ninety-nine per cent of patients can travel out of Cardwell, but among the elderly population there’s a lot of people on mobility scooters, there’s lots of people who don’t drive and there’s lots of people who are restricted to only driving within the Cardwell township,” she said.