Dr Kerryn Phelps, AMA President, with Graham Robinson, ABC Radio Mid North Coast

AMA President, Kerryn Phelps is, my guest.

PHELPS: Good morning, Graham.

ROBINSON: What are you hoping this campaign will do that hasn't been done before? Hasn't been covered or said before?

PHELPS: I think the ground is shifting all the time and the important thing is that we have a group of general practitioners out there in the community all around Australia who have contact with their local MPs on a formal basis, for getting information about what's happening politically constantly from the AMA and they're able to take that information to their MPs who can take it to Canberra.

ROBINSON: What sort of message at the moment do you think needs to get through to the Government?

PHELPS: I think the main message is that the GP workforce is under quite a deal of threat. There are a number of factors of course that have been threatening the rural workforce particularly in general practice, that there are major problems, particular around procedures that GPs are able to do like obstetrics, anaesthetics, if they are doing surgery. This of course is the mainstay of many rural medical services. And because of the medical indemnity crisis, that's causing a great deal of difficulty for GPs as well. They're having to give up that procedural work. They are having to give up obstetrics and this is meaning that rural communities are missing out.

ROBINSON: Is it also a lifestyle choice in that you talk about some of the practices, but also a student coming through may view the role in the rural area as not being that opportunistic in the sense that the person can practise in all these areas. So really they look to specialise in the cities so we are losing any possibility of bringing people through so that they have the opportunity of doing all these different services?

PHELPS: I think Government needs to be aware, as you have said, that general practitioners with a wide range of skills are extremely important to comprehensive practice and to the communities that they serve. That if general practitioners are not able to conduct that wide range of work, then rural practice does become less attractive to them because, quite often, that's the sort of work that attracts people to rural areas so that they can in fact have that very broad spectrum of activity in their medical work.

ROBINSON: Obviously the collapse of UMP is a major blow to again fighting the campaign to get people into, or doctors, into regional areas. Once we get over this issue, what can you do, do you think, to start convincing doctors that the rural base is a good place to operate?

PHELPS: Well I think that part of that is going to be medical students and junior doctors being able to spend some time in supervised work in rural areas, to be exposed to rural practice at an early stage in their careers. And I think there's particularly a case for incentives for people who come from rural areas to go to medical school and then to do at least part of their training in rural areas so that they can see the type of practice and for many people that lifestyle is very attractive to them.

ROBINSON: I have asked in previous interviews, in terms of this issue, with rural doctors of both politicians and in other areas, whether there should be something set down so that a doctor coming through, a student doctor, does have to spend time in a rural or regional setting. That doesn't ever seem to be something that anybody agrees on. Would you like to see anything like that where there may be a two year timeframe they must spend in a rural or regional area or is that not really relative?

PHELPS: I think incentives rather than compulsion are important. There are lots of reasons why medical students may not be able to spend that sort of time away from their family. For example we have a large number of students now going through who are post-graduate students. They are mature age students. They may well have children, family that is established in the city areas, and it's very difficult on a compulsory basis to uproot the whole family and send people somewhere. That sort of mentality really had a significant…

ROBINSON: It doesn't work.

PHELPS: It doesn't work and had a negative effect on the teaching profession and we don't want to see that becoming an unattractive option for people thinking about going into medical training.

ROBINSON: Locally the mid-north coast I guess has had some good news in terms of rural doctors to date. Three new doctors are going to be commencing work at the Dorrigo area, but they had been without a doctor since their long-term doctor left in January so it's been still several months. And they really struggled to find - now fortunately they found three doctors. But it really is a struggle, isn't it?

PHELPS: It is a struggle. The reason is that there has been this myth around that there is a big supply of GPs who are all sitting around in the city twiddling their thumbs and just waiting for the right incentives to go bush. That's not the case.

The AMA conducted a very extensive survey of demand and supply which was conducted by Access Economics and they looked at a very sophisticated analysis of how many GPs we have and how many we need. And their conclusion was that in almost all parts of Australia, there wasn't an over-supply. In fact there was an under-supply and that wasn't limited to rural areas. It was also in the outer suburban, outer metropolitan areas.

So rural areas are also competing with the better resourced outer metropolitan areas. And I think one of the things that we have to do is look to our State and Federal Governments to ensure that our rural medical services are very well resourced.

ROBINSON: The Federal Government certainly has come out over the last two or three years saying that rural doctors are a priority, getting rural doctors. But we're not seeing anything really constructive over that period. As you mentioned, I guess things do change. Do you think they're doing enough or are they applying themselves to the issue as strongly as they should?

PHELPS: It's not just about doctors going to rural areas. You need to look at the broader infrastructure in rural towns. It's difficult to get professionals across a broad range of fields from teachers to lawyers to accountants, to move into rural areas. And I think that we need to look at the whole infrastructure issue. I mean is there a banking service in town? Are there Medicare offices? Is there a physiotherapist that a doctor can refer to? Do they have other allied health professionals? What is the referral base for specialists? How professionally isolated is the doctor?

So it's not just a matter of attracting the doctor. The doctor is going to look at the professional support around them and the infrastructure for their families, the employment opportunities for their spouse, the educational opportunities for their children. So I think that the Government does need to look at a holistic view of the infrastructure in rural areas and see what can be done to support that.

And of course, you know the old adage, if they build it, they will come.

ROBINSON: You've also raised concerns that the Federal Government might be putting further loads on GPs including an administrative load in relation to prescribing. What exactly may come forward in the budget? What exactly are you concerned about there?

PHELPS: Doctors are becoming asphyxiated by the load of administrative red tape that they have to deal with in their day to day practices. And we're finding that the more government regulations that come in, the more paperwork you have to fill out, the more load of administration you have to do and the less time you can spend face to face doing what you want to do, which is working with your patients.

Smaller practices can't afford to have practice managers and in the past doctors always managed their own practices with the assistance of perhaps a receptionist who did the administration in the practice. A lot of that administration now has to be done by the doctor and that is becoming increasingly difficult because there is so much more of it.

So we do need to have an urgent assessment, and we've been putting this to government for some time, an urgent assessment of the amount of red tape that is consuming GP time at the moment and see how much of that is unnecessary and I can tell you, as a GP, a lot of it is unnecessary.

ROBINSON: And obviously the bottom line is the more time you spend on paperwork, the less patients you'll see so the spiralling amount of numbers of patients who will need to see a doctor grows, I guess.

PHELPS: That's right. There's a lot more non face to face time that doctors have to spend.

ROBINSON: Just on slightly a different issue. The Medibank Private sale or potential sale. Does that concern you if it is sold off?

PHELPS: We're having a look at that at the moment. I'm not really in a position to argue the case strongly one side or the other at the moment until the AMA has had a chance to analyse the effect it might have on the market. But we will be in a position to make a comment on that probably within a couple of days.

ROBINSON: Is it fair to say the entire health industry in Australia - maybe world wide, but certainly in Australia - is really in a state of not so much, well flux possibly, but everything seems to be spiralling one way or the other. There's no period where we seem to be settled and going forward.

PHELPS: It's a very uncertain time for the medical profession. This medical indemnity crisis has really hit the profession very hard. And doctors are desperately hoping for a solution to come and it will have to come by 30th June because otherwise we'll have thousands and thousands of doctors in NSW and Queensland unable to work.

That is a matter of absolute urgency. There are a vast number of other issues that are impacting on medical practice at the moment. I'd have to say medical indemnity is the biggie at the moment. But also we need to talk to government about a review of the Medicare Benefit Schedule because gaps for patients will be getting larger. If the Medicare rebate is not revised, medical fees are going to have to go up. Medical indemnity costs are just one of those practice costs that have to be fed into the fees that are charged to patients. And as the gaps go up, they're not covered by the Medicare rebate going up so patients are going to have to pay more from their household budgets.

ROBINSON: I thank you for joining me this morning.

PHELPS: Thank you, Graham.

ROBINSON: Dr Kerryn Phelps, the President of the AMA. And I guess there's some worrying news there in terms of spiralling costs if these things do continue in the health industry.

Ends