Rural healthcare only getting worse, says AMA

The AMA wants medical schools to be obliged to raise their intake of students from rural backgrounds to a third of the cohort

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The AMA has urged the government to get serious about addressing the rural doctor shortage by adopting tougher selection rules for medical students and providing subsidies to pay rural doctors’ children’s school fees.

AMA President Michael Gannon said the plight of Australia’s seven million rural patients was worsening, even as the country was heading for an oversupply of medical graduates.

“(Rural patients) often have to travel long distances for care, and rural hospital closures and downgrades are seriously affecting the future delivery of health care in rural areas. For example, more than 50% of small rural maternity units have been closed in the past two decades,” he said.

“Australia does not need more medical schools or more medical school places. Workforce projections suggest that Australia is heading for an oversupply of doctors.

“Targeted initiatives to increase the size of the rural medical, nursing, and allied health workforce are what is required.”

Specifically, the AMA’s new plan to build up the rural medical workforce proposes obliging medical schools to raise their intake of students from rural backgrounds to 33%, up from the current guideline of 25%.

The same ratio of students should spend at least one year of clinical training in a rural area, and governments should step up investment in in rural generalist pathways, it said.

“Selecting a greater proportion of medical students with a rural background, and giving medical students and graduates an early taste of rural practice, can have a profound effect on medical workforce distribution,” Dr Gannon said.

He also called for encouraging more Indigenous people to train and work in healthcare, noting the proven link between the health of Indigenous people in rural areas and their access to culturally appropriate health services.

Fixing rural and remote medical workforce shortages needed also to take account of doctors’ family members, the AMA said.

Government and other stakeholders should support doctors in the bush by ensuring adequate facilities, professional support and education, flexible work arrangements including locum relief, and rural loadings.

Policy makers should also provide support for employment opportunities for doctors’ spouses and children’s education, as well as subsidies for housing and/or tax relief.

The AMA’s new position paper on rural health initiatives, released this week, draws together many suggestions that have been talked about by rural health leaders for some time, with input from a 2016 survey of 600 rural doctors.

However, it comes ahead of a greater focus on rural health in 2018, with the inaugural National Rural Health Commissioner, Professor Paul Worley, expected soon to start outlining priority steps for national rural generalist pathways and other key initiatives.   

“It’s certainly an opportunity to set an agenda,” CEO Peta Rutherford of the Rural Doctors Association of Australia said.

But she said there was no silver bullet for rural health.

“Things like tax or education incentives, or support for spouse employment, are all very welcome, because the family situation is often a key driver for people having to choose whether to stay or leave a community.

“Subsidising school fees would be welcome, but it’s not going to resolve the issue.”

The AMA put emphasis on policy to turn around the decline in GP proceduralists in rural areas – a key objective of the rural generalist program.

In 2012, about one quarter of the rural and remote GP workforce consisted of GP proceduralists, but that figure had fallen to 10% in 2014, it said.

Meanwhile, the mean average age of rural GPs was 50 in 2014, and more than a third were older than 55.

“As these doctors approach retirement the workforce shortage will become even more pronounced,” it said in a position paper in 2017.

 The AMA has also proposed establishing a community residency program for prevocational training in rural general practice and adopting a stronger rural emphasis in specialist training.

Rural doctors responding to the 2016 survey also said genuine improvement in healthcare access for rural patients would require high-speed broadband services and investment in hospital and practice facilities.

A benchmark survey of medical graduates, released last October, highlighted the concentration of city-based training that some say stack the odds against doctors taking up rural practice.

The Medical Schools Outcomes Database survey found more than 80% of new graduates were working in capital cities or major urban centres such as Cairns, Newcastle and Geelong.

Highlighting the need for family support, the ratio of new graduates who were already partnered has hovered around 48% since 2013.