Meet a member - Dr Ewen McPhee AM
Emerald GP Dr Ewen McPhee AM regards his Queen’s Birthday honour as an honour for all rural doctors.
“I don’t think what I’ve done through my life is anything special,” the former President of both the Rural Doctors Association of Queensland and the Rural Doctors Association of Australia, as well as immediate Past President of the Australian College of Rural and Remote Medicine (ACRRM), says.
“There’s many other clinicians who work very hard and never get afforded recognition for the amount of work they do and the way they put their patients and their communities before themselves. So opportunities to recognise people are really valuable.”
Dr McPhee, an AMA Queensland member for 36 years, grew up in Longreach. He studied medicine at the University of Queensland and did his intern year at Royal Brisbane before moving to Charleville as a second-year doctor.
His early years, working with renowned rural doctors Louis Ariotti, Chester Wilson and Michael Muscio, were equally formative and terrifying. He credits them for giving him the resilience, the insight and the opportunity to understand what he needed to do to prepare himself to be a better rural doctor.
“Back in those days, we didn’t have training programs. We didn’t have ACRRM, we didn’t have the Queensland Rural Generalist Pathway. We had hospitals that basically gave you six weeks of this and six weeks of that and then patted you on the head and told you to go on your way,” Dr McPhee says.
“I was confronted by major trauma as a very young doctor, often had to deal with obstetric complications by myself, after six weeks in obstetrics. And dealing with cultural issues with Aboriginal people – none of that was acknowledged back in those days.
“It was very much sink or swim. I was one of the lucky ones to be able to swim. Others weren’t so lucky.”
While training pathways through colleges are now established, rural and regional areas still struggle to attract the GP workforce their communities need. Dr McPhee puts that down to a range of issues – the increasing complexity of patient care, the flatlining number of medical graduates, and the financial disincentives to go into general practice compared to other specialties.
“People are leaving their medical programs in their mid-to-late 20s, they’ve got large debts, and it’s no secret that general practice is the least-well funded of all the specialties, even though it takes as long to train to be a GP as it does for any other specialist,” he says.
“The other issue is that hospitals are sucking up many, many, many junior doctors, many of whom never achieve their dream of specialty, even if that’s what’s sold to them.
“We need to turn that around. It’s complex. It’s a bit like the slow train wreck – we can see it happening and we’ve failed.”
Invoking the ‘greedy doctors’ narrative when talking about GP bulk-billing rates has allowed successive governments to constrain the cost of general practice and the blowout of costs in healthcare, while failing to address the issues in primary care or hospitals, he says.
“The money that a doctor gets, a fraction of that actually goes into the doctor’s pocket. Most of it goes into the management of a business,” he says.
“The average GP earns maybe up to $40 an hour, but my receptionist has to earn $35 an hour. We’ve got three of them on the front desk answering thousands of phone calls every day. I’ve got two practice nurses who are looking at probably $45 an hour. Someone has to pay them.
“When you continue to suggest that Medicare is the only way you can fund health care and primary care, you’re going to see more and more people not bulk-billing. We’ve got to run businesses.”
Poorly planned proposals like the North Queensland pharmacy prescribing trial will only deter more GPs from moving to the regions, he says.
“People want to be valued and increasingly GPs are incredibly devalued by communities, by other peers, and by people we should be working closely with. Our pharmacists have a critical role in rural communities. We can all work very well together, practising at the top of our scope of practice.
“We work closely with our pharmacist colleagues in Emerald. They’re struggling as well, they’ve got no pharmacists, they’ve had to close half the time because of COVID.
“This trial is being driven by some dude at the Guild who thinks it’s a great idea and all his business buddies think it’s a great idea. It’s got nothing to do with the pharmacist on the ground, who is trying to do the best they can with what they’ve got.”