Media Conference, Dr David Rivett, Chair of AMA Council of General Practice, Parliament House, Canberra

At the moment we have a government review into red tape, and this really isn't providing - isn't going to provide any answers. We need a cut back in government red tape and a lot more dependence on professionalism but the profession regulating itself. Medicare rebates, if you look at Medicare rebates now $24.50, it's a joke really. You can't provide quality care to patients on those sort of levels. This is Mary Stavropolou from urban Melbourne and she's going to tell you how she sees things from that neck of the woods. Thank you.

DR MARY STAVROPOLOU: Thank you. My name's Mary Stavropolou from Melbourne. In even metropolitan Melbourne, where I work, patients are suffering because Medicare is starved of funds. There is a drought of GPs in this country because general practice is so under-funded.

RIVETT: This is doctor Ian Taylor from Geraldton in the north-west. He's going to give us a run down of his main problems and he sees them as a rural practitioner.

DR IAN TAYLOR: I'm Ian Taylor, I'm a procedural GP from Geraldton, and that's a little town of 30,000 people, 420 kilometres north of Perth on the west coast of Australia. I am a procedural GP in that I also do obstetrics, I deliver about 50 babies a year and I provide an anaesthetic service as well for our surgeons. I only spend about 50 per cent of my time in the actual office, seeing patients as a GP, because of my anaesthetic commitments and because of my commitments to the emergency department for serious emergencies. Despite working a 60 hour week, my patients still have to wait three to four weeks for a routine appointment and this is going to lead to poor health outcomes. My patients are suffering because they cannot get to see me when they need to be seen.

RIVETT: This is a problem that's going to become all too common throughout Australia, not just in rural Australia, in the very near future. It's not a problem confined to just outer rural Australia, it's something that's happening in a lot of inner urban areas and outer urban areas alike. And it's something that needs to be addressed as a matter of great urgency by the government if our patients aren't to suffer. Can I open the door for the questions at this point in time?

DR SCOTT ARNOLD: My name is Scott Arnold, I'm a GP from Taree on the mid-north coast of New South Wales, and I've taken time out of my practice today to come down to this meeting because I'm very concerned about two major points. The first is that if one compares the costs associated with running a general practice with the current Medicare rebate, the current Medicare rebate is just not in touch with the realities of what costs to run a medical practice. The second is that we, in New South Wales, are seeing a decline in the number of GPs available to do the work. And I'm very concerned about this and I think one of the major reasons is that people no longer find general practice an attractive career.

People are sick to death of having their hands tied behind their back by government red tape. And when you're trying to practice quality medicine and do the best by the patient that's sitting in front of you, if you're continually obstructed it's distressing and frustrating and we're seeing a decrease in number of GPs available to do work because people just don't want to play the game any more. I think the government really needs to take a good close look at what's going on, because there's a crisis around the corner.

RIVETT: If we could hand the meeting back to the floor and take questions at this point in time, thank you.

QUESTION: Your essential request is for an increase in the medical benefits schedule I presume. This is very costly. Are you at all optimistic of getting this in the current budgetary environment?

RIVETT: While we have a wall budget and no budgetary surplus for the treasurer to play with, certainly we can't say we're optimistic. It's something that's essential if we want to look at the health of Australia in 10, 20, 30 years time that Australians can get accessible, top quality primary care. It's much cheaper than tertiary care down the track, patching people up in hospital after they've already broken down is far more expensive. This is something that needs to be addressed as a matter of urgency. The realisation that there's an under-supply of GPs needs to dawn on the government immediately, not in a year's time or two year's time. The damage is already done by the misleading figures that they've taken as correct in the past in saying there's been an over supply of general practitioners throughout Australia.

It's not just about money, it's about caring for our patients, and caring for them in the future when we're all retired and gone.

ARNOLD: I think that the thing that the government just does not yet understand is that, with respect to workforce numbers, it is dwindling at both ends. There are people leaving general practice, we have had two general practitioners in Taree close their doors in the last six months, we have also a decreasing number of people wishing to pursue career in general practice. So the numbers are dropping at both ends, and if changes aren't made to address that, the crisis is only going to get worse as the population ages.

QUESTION: I want to ask you ..... our standard of living as general practitioners is going down. The increase of rebate of Medicare is 2.5 per cent this year. My surgery increased 7 per cent. Insurance increased 300 per cent. Who's going to pay for this? It's our families. It's supposed to be the community, not the - - -

RIVETT: You say the Medicare benefits increased 2.5 per cent - - -

QUESTION: Increased 2.5 per cent.

PANEL DOCTOR: And your costs increased 7.

DOCTOR: No. The surgery, I'm giving you example. Surgery increased 7 per cent. Insurance increased 300 per cent.

QUESTION: So surgery rental went up by 7 per cent?

DOCTOR: Yes. Every year. Every surgery - - -

PANEL DOCTOR: Well basically, primary healthcare is at the crossroads. It's a national disgrace where we are at the moment. What the government must do, the parliament must do, is seriously look at the level of healthcare that they believe Australians deserve. Australians deserve a very, very high level of healthcare and we have a right to deliver it. It is becoming more and more and more difficult as general practitioners to deliver that care. There aren't enough of us, and the rebates don't allow us to sustain the sort of surgery facilities and ancillary facilities including visiting nursing homes and providing home visits at the moment. It's really a very simple issue.

QUESTION: So why not just charge up front?

TAYLOR: Why not just charge up front? That's fine, charge up front. But the Australian people have, for some time now, had an insurer who paid a moiety. And what the problem we had there is we had one insurer only, and that's the government. What the government's failing to do on behalf of the public of Australia is listen to what the public are saying. The public are saying, it takes me four weeks to get into a GP. The public are saying, I can't afford to take my children to the doctor, because my insurer doesn't give me enough money back. They're the issues. You've only got to go out to the streets. Whether you go to the middle of Melbourne, Geraldton or wherever in Australia and listen to the people on the streets talk about how hard it is to get into their GP, how nearly impossible it is to get a home visit and how nurses homes are in crisis. We have really got a problem. And if we don't address it soon, then we'll have a catastrophe on our hands.

PANEL DOCTOR: The government is using foreign imported doctors as a way of making up the shortfall, and this is a very short sighted way of approaching the problem. They're trying to import doctors, and we're on a global market. Doctors in America are paid far more than what they are here, and we're trying to pull in these overseas doctors and get them into Australia, whereas we're competing against Canada, America, the U.K. and other places, which are, again, similarly facing a doctor crisis. The crisis is getting people out of universities. We need to get more medical graduates to begin with. We need to produce our own.

The government is basically pillaging the third world to pinch doctors to fill our gaps. I don't know about you, but I have a great deal of problem with that, I think it's inequitable that we should be stealing a doctor from somewhere in India where they really desperately need him, to try and get him to come and work in outback Australia, or indeed in outer urban Melbourne or Sydney. I think it's inequitable. We're a first order country, we should be producing our own graduates, not relying on the third world.

QUESTION: What other option does the government have given the quite established reluctance now of many Australian trained GPs actually going and working in those remote locations?

PANEL DOCTOR: It's got to revalue general practice. It's got to revalue healthcare, and it's got to deliver a White Paper. It's got to look and listen to what the problems are, and not just sit back and say "we know. We know because we know."

STAVROPOLOU: I just - sorry, I just wanted to make another point. In both metropolitan Melbourne practices where I work, we're having to stop bulk billing because we can no longer afford it and patients are having to foot the bill. And I think that's very sad because some of the patients we see are socially disadvantaged and can't afford to pay out of pocket.

RIVETT: Are we going to go down the American route where we have two standards of healthcare: one for the wealthy and one for the less wealthy. I mean, the beauty of Medicare has been its universal access. If we're going to walk away from that and have a two tier system, let's have our politicians tell us that now. If that's the path they see for the future, let's not do it by stealth, let's be up front and say this is what we want for Australia. Don't just keep dragging the Medicare rebate down annually bit by bit, let's say Medicare is dead, we want to see bulk billing stop. Let's be honest about it and have politicians come forward and say this is their plan, not just erode away the substance of it year by year.

PANEL DOCTOR: The only other thing I would just like to add just briefly is that we not only need to train medical students but we need to train graduates. We need adequate training places for our general practitioners so that they can be trained properly to cope with general practicing as a profession but also particularly in country areas where they need highly specialised training. You will not get doctors to go to the country unless they are properly trained and can cope with all the medical emergencies that they will have to deal with.

QUESTION: Is that the only reluctance -- I mean, isn't there any question of lifestyle with many younger doctors ...

PANEL DOCTOR: I think that the answer to your question lies in the fact that why do people do what they do? And people do what they do for higher rewards in general. You generally don't get people to do what they do on the basis of money or material things. Ultimately people make profound decisions like to go and work in a rural area because they believe it's worthwhile and worth doing. And I think therein lies the real problem is that the value of what we do in general practice has been eroded such that people no longer see it as a worthwhile career.

And I think that through whatever comes out of a white paper, this is what needs to be addressed. We need to make general practice something that is worth people doing, something that people can go home at night and sleep well rather than worrying about whether they're going to go bankrupt over the next couple of years, whether or not they're going to be able to provide for their children, whether or not they're able to do their best to look after their patients. These are the sorts of issues the GPs are facing. These are the things that are stopping GPs from sleeping at night and these are the things that are stopping people from wanting to practice GP, in general practice, either in the city and more particularly in rural areas.

QUESTION: If there's a threat of a 4 week waiting time for getting to where the country GP clinic in some - pardon me, in some town, and there's a shortage of GPs, it seems that you're in a fairly healthy position with power on the one hand. Why can't you just charge patients normally?

PANEL DOCTOR: GPs are very caring for their patients and they really don't - you can talk to them about this time and again and certainly I'm an exponent of larger gaps from a personal point of view but this is an anathema of most GPs. They really care for their patients and care how much they are out of pocket. The government's been getting them on the cheek for a long, long time and there's a great wealth of general practitioners that still want to give out as much as they can to their patients. They care about their patients endlessly.

PANEL DOCTOR: There is a simple answer to that question in the town that I come from, and that is that you cannot get blood out of a stone. There are many people I see who are simply unable to afford a gap of $10 or $15.

PANEL DOCTOR: The one thing about general practice is its family medicine. And GPs that practice quality family medicine understand the plight of families and they understand when dad's out of work or mum's working part-time that there are four or five children in the families. And I think that affects general practitioners when they look at billing their patients. It's all very well to say, isn't it wonderful you can charge what you like, but at the end of the day it's a career and a profession that you're in and you've got to be rewarded by the whole package, not just the dollar flow of income.

PANEL DOCTOR: When you look at the populous, only 30 or 40 per cent may have a healthcare card or health benefits card of some sort of another, but they comprise 60 per cent plus of consultations because they have a much greater morbidity and they're a much older age group, in as you age you spend more time visiting the doctor. So a great percentage of visits are by people who are financially disadvantaged. Like it or not, they are disproportionate to their total numbers in society.

PANEL DOCTOR: We do - sorry. We do minimal bulk billing in our practice but we bulk bill nursing home patients and those with palliative care. In other words, they're dying of cancer. We perceive that - we could charge, right, we could. But we don't because we feel for them. We know this is a really difficult time. You've got an elderly relative in a nursing home, I'm sure you'd like to think that they get good quality, prompt, attentive medical care, not dollar driven. That's the only way you can do it.

And I think GPs, as David has already pointed out, have taken it on the chin from the government for a long time and many continue to do so. But I think the point is reached where we will just rise up and say enough is enough. And then I think the government will actually feel an actual backlash because we won't be perceived to be the bad people, it will rather be the government who set the level of Medicare rebate. The blame for this needs to be shafted home to the government. Not just this government, previous governments as well who have failed to address Medicare rebates over a long period of time.

In the late '80s, Hawke and Keating for three years in a row didn't increase rebates. We've been behind the eight ball ever since and I think it's time that we stood up and be counted. Otherwise you won't have the proper GP care into the future, it's as simple as that.

QUESTION: Can I ask what people think of the policy of the Labor Party and also expert's report form the Ministerial Council in preparation of the next healthcare agreement. This idea of having differentiated Medicare rebates so if you're a GP working in an area where bulk billing has been low you would get a higher rebate?

PANEL DOCTOR: So it's your address rather than your situation that would get you bulk billing. That doesn't seem like science to me. I mean, you've got to be more sophisticated than say just because you live in a particular street you have access to a higher Medicare rebate or a lower Medicare rebate. That's not science, that's just doing it the easy way.

QUESTION: You mentioned red tape. What are examples of the increasing amount of red tape that doctors - - -

PANEL DOCTOR: I have tried to write a prescription for morphine for a patient who I've had in a nursing home with chronic pain from an arthritic - I have written this script on the computer, so it's quite legible, I have rewritten it again in my handwriting, I have sent it off to the relative pharmaceutical benefits scheme to have them put their rubber stamp on it, it has come back with a letter saying that it has to have all of the things that are already on it.

For the life of my I don't know why it's come back but I've sent it off and it has come back again and I am still writing scripts to - you know, while I'm waiting for this red tape to go through I'm still continuing to write a script every week to keep the ball rolling while I wait for the script that should last for three months to have some pen pusher stick a rubber stamp on it to say that the patient is allowed to have what I'm - what they're requiring and have been using for the last 12 months.

QUESTION: What about the government's approach on these chronic care packages that sort of move away from pure fee for service to a more sort of overall comprehensive payment to all doctors who are looking at them - - -

PANEL DOCTOR: This is often rewarding cookbook medicine and playing favourites with these entities to try and win votes at the polling station. I mean, it's not a sensible way to go forward with Australia's healthcare. Why should someone with one disease entity be rewarded through their GP getting a higher rebate than someone with a similar condition? The more you look at it, the more nonsensical it is. I think it was a vote winner by a previous health minister and I think the current health minister has got to look at it very hard.

PANEL DOCTOR: There have been two studies or at least a number of studies conducted into the area of this sort of managed care. All of the studies that I'm aware of failed to demonstrate any improvement in patient outcomes and I believe that these have been embraced for financial terms rather than good clinical science to say that they actually result in any improvement in patient care.

PANEL DOCTOR: This is a really big problem because what's happening is that GPs in central areas, often from very well-off suburbs can access all this money for these fancy paperwork driven programs, whereas people like me who are flat out in the country dealing with serious problems have not got the time to do it and do not have access to it. It allows people in nice, comfortable areas to pad out their income quite nicely.

PANEL DOCTOR: Could I also add that one of the initiatives was focused in the area of mental health. And in order for that initiative to be used, the patient first has to get through the doors of the general practice. And if there's no bulk billing and the patient knows they have to pay to get there, they are not going to get into the room in order for these brand new and fabulous initiatives to actually be enacted. And in my trips around the country, and I recently was in the Northern Territory, the biggest barrier to adequate GP care, particularly for the mentally ill in this country, is the lack of bulk billing and the fact that they are being forced by cash strapped GPs and others to actually pay before they can get care.

RIVETT: This is a large group of people that's often very socially disorganised and barely able to access a Medicare office. There's a lot of schizophrenics back in the community and other disease groups back in the community finding it very hard to cope let alone cope with billing at the doctor's surgery. We've all got a lot of those and it's not an easy way to look after a general practice on current rebates. They take a lot of time and a lot of consideration and a lot of input from GPs, and this isn't the way to approach it.

QUESTION: What's the minimum bulk billing rate for a standard GP consultation you would want? What's the lowest you would go.

RIVETT: The Government looked at this in great detail through the Relative Value Study, and they came out with a fee on today's terms of about $48.50 for 15 minutes. This is from the government's own survey, which they put five years of work into. And we felt that figure was too low at the time because they didn't take into effect quite a lot of the costs of general practice.

QUESTION: Is that the scheduled fee or the rebate?

RIVETT: No, that would be the schedule fee, so about twice the current rebate. That's from their own survey. As soon as they saw those figures coming out over the horizon they walked away from the study.

QUESTION: They're clearly not going to come at an increase that great. What could you live with?

PANEL DOCTOR: I think the question is not what we can live with. The question is what depth - I mean, the bottom line in what it costs to run a practice and make a practice viable that is unchanged. And ultimately general practice is a business that has to be viable. The amount of money you spend has to be covered by the amount of money you earned. And that is ultimately what attrition will determine people will charge.

The better question is what figure in terms of a gap fee is the government prepared to allow people of Australia to pay, because this is really what it comes down to. The issue - I mean the issue of yes, it is good if more services are bulk-billed, but the real issue is how much money is it going to cost patients out of their own pocket to come and see a doctor, and the lower the Medicare rebate and the further out of touch it is with the reality of what it actually costs to provide a medical service, the greater the gap to patients will be.

And this is the whole point of our visit today is that we are saying our patients are hurting. They can't afford to pay the gaps that we are forced to charge them if we too are to avoid becoming some of the casualties who no longer work in general practice. And this is what needs to be addressed.

PANEL DOCTOR: The other problem, the bottom line may be what can you - or how low can you - or what can you live with.

PANEL DOCTOR: And what we're really saying, it's a reassignment of the dollars. I mean, health is a multibillion dollar budget line, multibillion, but you're talking $24 or $25 for Medicare rebate. If you don't get quality primary care, as the Australian population ages, and their health deteriorates and it becomes more complex, a multi-billion dollar budget will triple because we'll have a higher demand on the public hospital sector, we'll have a higher demand on pathology, radiology and pharmaceutics. The government's got to take an approach and look at healthcare, and start with primary healthcare because if you don't primary healthcare right, you'll bugger the rest up.

QUESTION: You say the blame should be sheeted at the government, and certainly we've not seen the government pick up on the relative value study that you've mentioned. We don't seem to have heard very much of that in recent times over the medical lobbies. We have heard a lot, in fact, about the Trade Practices Act, in fact, a particular line from the lobby. Yesterday, we had in front of us the Wilkinson Report, which said that after studying this issue, that there is absolutely no reason to change the Trade Practices Act, in fact, it was rather critical of some of the medical lobbies for misleading campaigns on this issue. Now, I wonder, as well as blaming the government, if you think that your major medical lobbies -- I accept that you guys are a very genuine group of GPs - if you think that your main medical lobbies have been somewhat off message in recent times.

RIVETT: I'm not aware of the Wilkinson outcomes, if I could refer that to Dr Bain in the background. Do you want to address that, Rob, or not at this time? No.

PANEL DOCTOR: You've got to remember that GPs are out there, trying to do the very best they can for their communities. That's the issue. Delivering quality healthcare to the public of Australia. That's what we're here about, and we're here hoping that government will finally hear the plight of the Australian public. It's only going to get worse if they don't.

PANEL DOCTOR: Patients are not good discriminators as to how severe their disease entity is, either. And they can't be expected to be. They don't know if their kid with a rash has got meningococcal or something else. They're still going to want to see a primary carer who knows what he's doing in good haste, so they can get condition sorted out. And if you take away that accessibility for a large percentage of the population, as you're doing now, and just leave Medicare there for the rich that can afford gaps, you've destroyed Medicare. Which is something our country should be very proud of. The accessibility for all citizens in Australia to access healthcare in a timely manner and get quality care is a vital plank in this nation's healthcare platform. And it shouldn't be pulled away and just left to wither on the vine because of inadequate government funding and shrinking rebates year by year.

QUESTION: DR Rivett, can I just come back to the point you were making before, you used the description "cookbook medicine". What was that the phenomenon - I want to make sure that I understand what you're talking about properly - was that the phenomenon and concept of blended payments that you - - -

RIVETT: There was specifically the disease entities in the enhanced primary care payments as they're called, they're not enhanced primary care. If people are doing their job, they're already doing all those things, without going through all the red tape to attract these additional payments. They're extra payments for a lot more paperwork, basically. And they don't produce a lot of patient outcomes.

If people are doing their job they're already doing all those things without going through all the red tape to attract these additional payments. They are extra payments for a lot more paperwork basically and they don't produce a lot of patient outcomes in any shape or form.

PANEL DOCTOR: And that's linked to healthcare. Healthcare is about whole person. When you get disease specific rebates or payments you start to split the healthcare of the patient up. You can't deliver quality healthcare to people with complex medical problems by splitting up the disease entities. They all inter-relate. The drugs often interact. So you've got to treat the whole person and the whole package and rewarding bits of them is laughable.

PANEL DOCTOR: The entire - I think the entire EPCs and blended payment system needs review. Certain sections of it, the practice nurse initiatives are excellent, but other sections are just red tape and paperwork gone crazy. In the future there are plans to have certain quotas and if that bit comes in, that's going to make more paperwork, you've got to get certain percentages to receive payment. You know, if you lose out by 1 per cent you'll miss out on a payment. Things like this are going to just drive us to distraction.

QUESTION: Do you think, doctor, that there's any merit in blended plans or in the blended plan system?

RIVETT: Some blended payments will always have a place. It depends what you classify as a blended payment. It's a term that's used to cover a whole lot of payments; payments such as rural retention payments I think most of us would be in support of, but it depends how you define a blended payment. And I think the term is too all-encompassing to really say that they're all bad or all good.

QUESTION: All right. Well, which ones do you favour?

RIVETT: Payments such as rural retention payments I'm in favour of. Payments where they're supporting practice nurses in areas of need I think are good payments from government, they'll get more for their dollar that way and enhance quality care to patients. So some of them are going down the right track and some aren't certainly.

PANEL DOCTOR: Let me also add to that, that if there are going to be blended payments, they also need to be indexed. I mean, one of the things that's killed Medicare is that it was never actually indexed from the beginning. So if you're going to bring in blended payments and leave them static - and we've heard some propositions that in fact there will be blended payment options for GPs who bulk bill. If that's going to be brought in in any shape or form it must be indexed or it will just die on the vine as well.

RIVETT: A lot of the blended payments the government looks at the gross payout and they never look at the costs incurred in producing the outcomes required, like the IT initiative is paid through the practice incentive payments. They cost far more to put the computer in your surgery than it does to get the small return from the government for having those computer systems set up. They got GPs into the loop there with initial payment of $3000 and you just can't - your computer's out of date two years later and your $3000 gone and you're left with a $20,000 or $30,000 system by the time you put in a server and have multiple GPs on that and it's got to be replaced every four or five years. Huge cost. GST's brought in huge compliance costs, around $5000 per GP our AMA surveys tell us. That hasn't been factored into Medicare rebates in any way, shape or form.

Accreditation of general practice to get the PIP payments costs an arm and a leg every couple of years for GPs. All these increasing bureaucracies and red tape impositions on general practice are just making life unbearable and they're taking our time away from our patients. GPs can earn more by doing their own bookkeeping for their GST than they can earn by seeing patients face to face. A bookkeeper costs around $44 an hour, average earning for a GP is $42 an hour. So all these distractions from providing care to our patients aren't the route forward for looking after the nation's populace.

QUESTION: You dismissed the differential rebates idea for country GPs…

RIVETT: It's something the AMA is debating at the current time. Certainly if we had differential rebates we'd rather seem them go to those most in need. If the Medicare pie is going to inadequate to provide care for all of Australia's populace, surely you ought to go to those most socio-economically disadvantaged.

QUESTION: What about the Labor idea that clinics who agree to bulk bill get a special like a bonus payment or some kind of payment?

RIVETT: This is a capitation system that's been put forward by some sources in the Department and capitation really provides bonuses for GPs to do as little work as possible for as many people as possible. It's been tried in the NHS, it's been tried overseas elsewhere and it hasn't been found to have good patient outcomes. It doesn't maximise work from GPs. It's not a good way to go forward for Australia's populace.

PANEL DOCTOR: The point is, the AMA is calling for a White Paper. They want long term solutions. We're sick of having bandaid solutions. All of these little payments, all of these little crumbs are bandaids to a broken system. The traditional Medicare system has failed, we've got an inadequate supply of GPs. We've got an inadequate supply of GPs, we've heard, from urban Melbourne. We've got an inadequate supply of GPs in the country, we've got an inadequate supply of GPs in other urban areas. We don't want a bandaid, we want a comprehensive review where they can look at the problem, come up with some long term solutions that make sense for everybody.

We've got families in low socio-demographic areas who are not going to GPs who don't bulk bill and they can't afford to take the second child and the third child. The government has made the payment system so complicated if you don't bulk bill, it's keeping those people away from doctors. Where are they going? Emergency departments. It costs twice as much or three times as much to take your child to an emergency department than it does to take it to a GP. We're talking about long term solutions to stabilise the primary healthcare system in this country so we can get better outcomes. We need a White Paper.

PANEL DOCTOR: There is a looming GP workforce crisis in this country and the low Medicare rebate is definitely contributing to that. We have to get the rebate right to keep our general practitioners out in the community. A lot are leaving at the moment because the current remuneration and complexity of running a practice are really making it very unsatisfactory.

QUESTION: Can the AMA quantify the GP shortage in rural regional Australia and are there any particular areas which are worse off than others?

RIVETT: Our access survey that was conducted around Australia - all GPs were sent a copy and I think about 13,000 replied - showed a shortfall of about 700 in rural Australia and it details which areas are most hard hit certainly. You could get a copy of that, it will be freely available from the website.

PANEL DOCTOR: AMA web site.

PANEL DOCTOR: I'd suggest that's a conservative estimate, even though it's been properly done, because we've got overseas trained doctors plugging gaps and, with the greatest of respect to our overseas colleagues, the best trained doctors to work in rural Australia are Australian trained doctors because they are trained for our conditions. We have our rural colleagues working in areas that they weren't trained for. They're not getting good outcomes.

QUESTION: So that figure of 700 will just get worse?

RIVETT: If you look at what a rural doctor's got to do, usually there's no ancillary allied healthcare in town so they usually provide all those services as well. As well as doing their procedural items, as Ian's already enunciated, they're also filling in for the lack of a podiatrist, a physiotherapist, occupational therapist - they take all those tasks on hand, which AMWAC hasn't really looked at when it's factoring in how many doctors you need in remote communities. And you've got to have a sustainable mass there, I think, if you're going to have doctors in these towns. Having a single doctor in a town, I think, is quite unsustainable personally in the future. You've got to have a lifestyle there as well as payments. Money is not going to solve the problem. They've got to look at workplace issues and quality workplaces for these people.

QUESTION: Dr Rivett, that $42 an hour figure is not too big. What's the average earnings, hourly earnings for city GPs versus country GPs?

RIVETT: Again, that's all in that Access Economics report. If you refer to the web site they've got a breakdown of those figures.

DR JOHN DAVIS: Talking about the shortages in rural Australia, I mean the trouble with shortages is that they're actually rapidly approaching the metropolitan centres. I'm from Hobart which has a population of about 180,000 - not a big capital city by Australian standards but we have somewhere 10 and 20 GPs short at the moment, because what we have in Hobart, and much of the country's is the same, is we have older male GPs whose life with medicine now retiring and younger general practitioners coming through who have a change in lifestyle. Medicine is the working component of their life, it's not their life. So we've got older doctors retiring and younger doctors coming in and their working lives are very different. So it's not just raw numbers we've got to talk about, that the problem of shortages is not just in rural and regional, it's creeping into the edges of the capital cities.

CONVENOR: Thank you, ladies and gentlemen, I think we might tie that up now. The doctors are individually available for interview and comment and you'd like to pursue them now.

QUESTION: Could I just get them to go through their names again?

CONVENOR: I'd just also like to say that a copy of a media release talking about that White Paper that some of the doctors have mentioned will be dropped at 3 o'clock this afternoon with some background information.

NAMES:

DR DAVIS: Dr John Davis from Hobart.

DR IAN CAMERON: Dr Ian Cameron, Bingarra, New South Wales.

DR SOPOTHYOT: Dr Sopothyot from Bankstown, Sydney.

DR STEVE HAMILTON: Dr Steve Hamilton from Kedron in Brisbane.

DR DAVID MEYER: Dr David Meyer from Sale, Victoria.

DR ARTIE WILSON: Dr Artie Wilson, Rockhampton, Central Queensland.

DR ROSS WOODWARD: Dr Ross Woodward, Central Queensland.

DR YING PEN: Dr Ying Pen, Toowoomba, Queensland.

DR ANNETTE CARRUTHERS: Dr Annette Carruthers, Newcastle.

DR CHRIS BOYLE: Dr Chris Boyle, Raymond Terrace, Lower Hunter.

DR JOHN WILLIAMS: Dr John Williams, Adelaide, South Australia.

DR SCOTT ARNOLD: Dr Scott Arnold, Taree, New South Wales.

DR MARY STAVROPOLI: Dr Mary Stavropolou, Melbourne, Victoria.

DR IAN TAYLOR: And Dr Ian Taylor, Geraldton, Western Australia.

Ends