Rural workforce change is coming, but some say it’s already years too late.
Despite winning RACGP Supervisor of the Year in 2016, and RACGP General Practice of the Year and RDAA Rural Doctor of the Year in 2019, Ararat GP Dr Michael Connellan has not successfully hired an Australian-trained GP in a quarter-century.
Since 1996, the Ararat Medical Centre has only been able to recruit overseas-trained doctors – and while they are grateful for the staff, the required oversight can be an administrative burden.
One year, the practice had three doctors on level one supervision.
“We’ve got a number of international doctors in our practice at the moment and they’re on four different programs, all of which have different requirements,” Dr Connellan told The Medical Republic.
“One is on the remote vocational training scheme, we’ve got doctors on the PEP program, we’ve had doctors on the MDRAP program, we have one who went and became a registrar under the AGPT and we’ve got one who is still on level one supervision imposed by the by the medical board.”
Each program has its own assessment and supervision requirements.
The Ararat practice is just two hours’ drive from Deakin University’s medical campus in Geelong, which has a dedicated rural community clinic school.
Despite the fact that the rural medical school was set up to help address rural and regional doctor shortages, Dr Connellan said he felt it had not lived up to his expectations thus far.
“The biggest concern is that none of the local graduates are doing [general practice],” Dr Connellan said.
“A number of rural medical schools were set up specifically to graduate rural doctors and well, that’s just failed.
“They’re not graduating rural doctors, they’re graduating the same amount of specialists and tertiary doctors as Melbourne University or Sydney University.”
Associate Professor Lara Fuller, director of clinical studies at Deakin University Rural Community Clinical School, said the university was aware of these outcomes.
“We’ve only just got to 10 years’ worth of graduates, because it takes a long time to do postgraduate training,” she told TMR.
“It’s good timing to be seeing where our graduates are at, and we agree that not as many of our graduates have been returning to our rural communities as we would like.”
Part of the issue, potentially, was the background of the students attending the rural medical schools.
Australian research has shown that while medical students who do rural rotations are more likely than their metro-trained peers to stay rural, medical students who are originally from a rural area and who do rural placements are the most likely to stay rural.
“We’re now setting aside places in the course for rural-background students, and then those students will be able to complete two years at a rural clinical school – so we’re putting together those two factors, rural background students and rural clinical school training,” Professor Fuller said.
“We are taking in more rural background students as a result, so that should lead to better outcomes.”
The fly in the proverbial ointment, though, is the fact that interventions at the medical school admissions level will take about a decade to pan out. And rural doctors say they need relief now.
“I always describe myself now as a grumpy old rural doctor,” Dr Connellan said.
“The supervision of medical students and undergraduates and registrars and international doctors is still being done largely by the same cohort of doctors who were doing that supervision 15 years ago.
“We’re all at the point now where we want to retire and move on, but we’re still caught in this bind of having to supervise so many doctors.”
Realistically, he said, many rural doctors don’t have 10 years to wait for rural-background students to make their way through medical school.
He called for change within the next 12 months.
“Everyone hates talking about money, but in the short term that’s probably the best incentive to have a look at, starting with how GP registrars take a 30% hit to their income when they leave the hospital system,” Dr Connellan said.
Leave entitlements and better pay conditions for GP registrars made the budget wish list for a few primary care organisations this year, so it’s feasible to imagine that Dr Connellan’s recruitment woes could be at least partly solved by this time next week.
He has a message for legislators: “The Department of Health likes spending megabucks on shiny new equipment in major centres – but if you want bang for your buck, put it into primary care.”
