Practical plan needed to get doctors to live and work in rural Australia

The AMA has made an extensive submission to the Senate Community Affairs Reference Committee Inquiry into the Factors Affecting the Supply of Health Services and Medical Professionals in Rural Areas, setting out viable strategies to improve access to health care for people living in rural and remote Australia.

AMA President, Dr Steve Hambleton, said today that a broad practical plan that incorporates clever thinking and local solutions is needed to attract doctors to rural practice and keep them in local communities for the long term.

Dr Hambleton said that there is a nationwide shortage of doctors, but rural and remote areas shoulder a disproportionate workforce shortage burden.

“Rural Australia is highly reliant on international medical graduates (IMGs) to address these workforce shortages,” Dr Hambleton said.

“The contribution made by IMG doctors has been essential and greatly appreciated by the communities they serve, but this strategy is not sustainable in the long term.

“We need to attract and retain Australian-trained doctors in rural areas.  To do that, rural practice must be an attractive career and lifestyle choice for doctors.

“GPs are the backbone of rural health care, and GPs in rural areas need strong procedural skills. 

“We need to expand the opportunities for GPs and GP trainees to access advanced skills training in areas such as surgery, obstetrics and gynaecology, and anaesthetics, and we must ensure that incentives are in place to attract doctors with these skills to rural and remote areas.”

The AMA urges the Government to support the Rural Rescue Package developed by the AMA and the Rural Doctors Association of Australia, which highlights two key tiers of support:

• a rural isolation payment to be paid to all rural doctors (including GPs, specialists and registrars) to reflect the isolation associated with rural practice; and
• a rural procedural and emergency/on-call loading to better support rural procedural doctors (including procedural specialists) who provide obstetric, surgical, anaesthetic or primary emergency on-call services in rural communities.

Dr Hambleton said the task of attracting doctors to the bush is very complex.

“It is not just about money.  It extends to professional development, existing health infrastructure, family needs, education, and lifestyle,” Dr Hambleton said.

“State Governments have contributed to workforce shortages by closing down or downgrading public hospitals in many rural areas.  This leads to an environment where rural doctors cannot practise vital skills or procedures, so they are often lost to rural areas as a result.

“The AMA believes a public interest test should apply before local hospital services are closed or downgraded.

“Support also needs to be given to the families of doctors.

“More attention needs to be given to supporting spouses and family members access suitable employment and education opportunities when one member of the family moves to the bush.”

Other issues covered by the AMA submission include:

Medicare Locals

GPs in rural areas are very concerned that the introduction of Medicare Locals will result in a loss of knowledge about local health care needs.  The AMA believes that GPs must be a key part of Medicare Local decision-making structures to ensure that services are tailored to community needs.  In many cases, Medicare Locals so far seem to have been implemented with insufficient regard for the input of local GPs.

Bonded Medical Places (BMP) Scheme

The AMA is calling on the Government to abolish the draconian unfunded Bonded Medical Places (BMP) Scheme, which overseas evidence shows will not deliver sustainable improvements to the rural medical workforce.  The AMA is calling instead for the enhancement and further expansion of incentive based programs such as the Medical Rural Bonded Scholarship Scheme and the HECS reimbursement scheme.

The Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) Classification Scheme

Over recent years, the Federal Government has put extra money into rural workforce incentive programs, but there are major concerns about the use of the ASGC-RA classification system to determine the level of incentives that apply to different rural areas.  The AMA submission highlights several anomalies that are making it much harder for some towns to recruit doctors, and puts forward recommended changes to the use of the ASGC-RA that would improve the way in which incentives are targeted.

The AMA Submission is on the AMA website at http://ama.com.au/node/7450

The AMA Rural Rescue Package is on the AMA website at http://ama.com.au/node/4136

CONTACT:         John Flannery                       02 6270 5477 / 0419 494 761

                        Kirsty Waterford                    02 6270 5464 / 0427 209 753

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