PRESS RELEASE: Rural Medical Workforce – A Crisis of Policy Not GP Numbers

Commenting on a report in the Australian – Bush Crisis: Locals Shun GP careers (Oct 23 2019), Gundagai rural doctor, founder and previous President of the Rural Doctors Association of Australia, Dr Paul Mara, has slammed as “cynical” attempts by various groups to link the rural medical workforce crisis with problems with general practice.

“I have seen this time and time again,” said Dr Mara. “Powerful vested interests use the plight of rural and remote communities to argue for an increase in funds or programs only to see extra resources and any increased numbers of doctors being sucked up by huge medical black holes in cities.”
The rural medical workforce crisis is not about GP numbers but policy.

The facts are:
1. Rural practice is not simply general practice in a rural area. It is not a branch of general practice but a separate discipline. Rural practice differs in content, context and complexity from metropolitan general practice. It requires an expanded skill set to meet the demands of isolated practice, including advanced skills in emergency medicine, paediatrics and procedural medicine. This requires a different approach to training. It is not better than general practice just different. This difference needs to be recognised and accepted.

2. Traditional training programs for general practice have over at least two decades failed to understand this difference and meet the needs of rural practices, trainees and towns. Rural towns and practices have become a revolving door for GP Registrars who get can’t get a job in the cities, or as overseas trained doctors are forced to go bush. They get selected for so called rural training but then return to the cities on as soon as they can.
3. Australia has more doctors per head of population than almost any other country in the world but we still cry poor in doctor numbers. The problem is a failure of policy not numbers. A new local approach is needed that integrates hospital and community based training for rural practice and is accountable to workforce outcomes in rural communities.

4. The nature of the workforce problem is different in rural and remote Australia to metropolitan and major regional areas. In rural and remote Australia it is about having adequate numbers of doctors and other healthcare workers and the capacity to service local health needs ensuring access to comprehensive local medical services on a continuing basis. In cities the demand for doctors is driven more by increased practice numbers, competitive pressures and business models under Medicare rather than necessarily by patient needs. Simply put, the more practices you have the more demand there is for doctors to meet cost efficiencies and business models, regardless of actual patient health needs. This creates a perverse perception of actual need for doctors.

While the problem of attracting doctors to the bush is nationwide, local not centralised solutions are required.
To meet the evolving medical workforce crisis in the Murrumbidgee region the Murrumbidgee Local Health District and UNSW has developed a bold initiative that integrates undergraduate education with a six (2+4) year postgraduate rural training program, increased support for practices in rural towns and improved access to services.

A key to the initiative is a single employer model where the MLHD is the employer for the duration of training. Using existing resources, no extra funding is required at this stage.
“We could have ten doctors in the Murrumbidgee working under new flexible arrangements, getting advanced training and providing services to small rural communities in supported environments next year but the Commonwealth Department of Health, while recognising the elegance of the initiative has declined its approval, citing issues with Commonwealth – State Medical agreements,” said Dr Mara. “I’m sure that people in rural and remote Australia aren’t much interested in the niceties of these agreements. They just want a doctor.”

The problem in the bush is not lack of younger doctors wanting to take up the challenge and joys of rural practice. It is providing them with the means to get the training they need, recognition for their skills and support when they are in practice and getting the policy framework right.

“We should not link or confuse the decline in applicants for training for city based general practice with rural medical workforce. We cannot continue to feed the dragon, arguing that more doctors in the system will help rural communities,” said Dr Mara.

For further information
Dr Paul Mara 0421 665933 / 0466 665933

Dr Paul Mara has been a rural doctor in Gundagai NSW for over 35 years. He was an executive founder of the Rural Doctors Association and was President of the Rural Doctors Association of Australia. He has involved in negotiating major reforms in general practice in the 1990s and has undertaken major projects on medical workforce including the RDAA Viable Models of Rural and Remote Practice Project.
He is founder of an independent accreditation agency that accredits over 2,000 general and rural practices across Australia. This business is managed from Gundagai and employs over 20 locals.
He is a passionate advocate for rural towns and rural medical practice and was awarded an AM for his work in rural medical workforce.