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09 Sep 2019

BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

Traffic rules are a bit odd when I am the only doctor in town. I drive to a stop sign, stop and wait. And wait and wait. The vehicle with right of way has recognised the doctor’s car and is insisting I go first. I have learned to hustle on forward.

My experience is not unique. Towns across Australia are screaming out for a doctor (sometimes singing and dancing). Once they find a doctor, the community lets you know you are welcome in simple ways – like allowing you to skip to the front of the line in a grocery store.

After years with minimal policy direction and workforce planning, there have finally been positive developments, in particular the National Rural Generalist Pathway and the National Medical Workforce Strategy.

While both of these initiatives have great potential if they are properly funded and Governments work together to enact the recommended strategies, they do not solve the immediate issues being faced by rural communities. In fact, many of our proposals for fixing rural health are long-term reforms. We won’t see the results of these initiatives for many years. Many rural towns are without a doctor today.

So, what do we do? We rural docs keep providing services, trying hard to not jump the queue, and hoping that someone else will come to take our place when it is time for us to move on.

The simple answer is that rural health services need more support through immediate investment.

The 2019 AMA Rural Health Issues Survey found that the issues have not changed since the previous survey in 2016. Funding and resources to support improved staffing levels and modern facilities and equipment at rural hospitals are still the top priorities. This can and should be done now.

The AMA recently updated the Easy Entry Gracious Exit Position Statement. The Position Statement outlines a model that works as the title states: it makes it easy for a doctor to begin practising in a town without requiring them to become small business owners and managers. The ‘walk-in walk-out’ model is not always popular, but if it gets a doctor into town then the result is positive.

Don’t get me wrong – this is a stop-gap, not a solution. In an ideal system, this model would not be required.

One of the main revisions in the updated Position Statement is the need for more support for towns adopting this model from State/Territory and Federal Governments. It should not be the requirement of rural ratepayers to prop up a medical practice that is a result of policy failure at the highest levels.

We have seen this mentality with the More Doctors for Rural Australia Program (MDRAP). The MDRAP was introduced originally as a program to help Australia’s nearly 6,000 non-vocationally registered doctors working in general practice to join a pathway to fellowship while working in rural areas. Doctors on the program will be able to bill Medicare at 80 per cent of A1 rebates, and then 100 per cent once they join a formal pathway. The AMA raised concerns in October last year that this would place a significant burden on supervising practices as many participants would require intense supervision with limited earning potential. Again, rural doctors were expected to bear the costs.

After months of lobbying the Department of Health, we have now been told that a grant of up to $30,000 will be made available for supervisors of MDRAP participants. This should be closer to $50,000 to provide adequate support for training and supervision. Still, this funding comes with an acknowledgement of what the program is asking of rural general practice.

All rural health based programs must begin by considering this: what are we asking of rural doctors and rural communities? Is it more than is asked of urban doctors and communities? If the answer is yes (and it almost always is), then there must be more funding and support accompanying it.

At the same time, we need to keep working on those long-term plans.

We want more accredited training posts and we want certainty of funding for these posts – there must be continuity.

We need to encourage all medical students with interest in rural medicine to pursue it, and we need to provide clear pathways for all graduates.

We need innovative funding and support. There needs to be jobs for partners, there needs to be access to many of the sanity stabilisers we are used to in the cities, like gyms and high-speed internet, and there needs to be support for us to travel for our CPD when we need to. I shouldn’t have to take unpaid leave to complete my rural hospital credentialing.

We don’t want to hear governments say “we funded this training scheme, so we can’t provide incentives for rural practices today”. That is akin to saying “just hold out for a few more years”, or “you can’t retire for another five years”. We want to see an acknowledgement of the fact that this problem won’t be solved overnight, so while we work out the solution, here are some resources to assist you.

Finally, we want you – the doctors reading this in the cities – to know that we keep trying to recruit you because we know you will love it like we do. The work is more interesting and varied, the patients and communities invite you in, try to find you a partner or a pet and make you feel welcome. You can see the difference you make. We just need a bit more support.


Published: 09 Sep 2019