Grievance Debate Rural Doctor Shortage
Posted on Wednesday, 19 September, 2018
Mr RAMSEY (Grey—Government Whip) (19:11): Thank you very much, Mr Deputy Speaker. I know you hail from Port Augusta and you understand the electorate very well. We have a crisis in rural Australia, particularly in South Australia and in my electorate, in the provision of doctors in rural areas. I have a history in rural health, over the period before I came into parliament. For 10 years I was on the Kimba District Hospital and Aged Care services board. I spent seven as chairman. And I spent a period as chairman of the Eyre Peninsula hospital association, and I'm very sorry that structure no longer exists. The Labor government in the state, in their wisdom, decided that hospital boards were superfluous and took all administration, essentially, to Adelaide. I finished up on that role and moved to others in the community in 1996.
While it was not specifically the hospital board's role, periodically we were the lead agency when it came to recruiting new doctors to the local town, Kimba. It was never easy but we managed to find a doctor each time. They were, at best, difficult to find. On the other side of the ledger, the nation was at that time, in the 1990s, plagued by over-servicing from doctors in the city. Eventually, to address this problem, governments decided that we would train fewer doctors. There were too many doctors at that time. So the training numbers were cut. I underline the fact that even though there were too many doctors back in the nineties we still struggled to get them out to the country. Eventually, that surplus was reeled in and doctors became even more difficult to attract to the country. As Australia's numbers dropped, I guess supply had been restricted for too long, the intake at universities. Over a fairly short period we developed a deficit of doctors and began to import serious numbers of overseas trained doctors to fuel that shortfall. It was a lifesaver for the country.
When we imported a doctor we could insist they go and practice in a certain location. We could say, for instance, 'If you want to enter Australia you can go to Port Augusta for the next five years,' or Coober Pedy or Ceduna or Kimba. So we filled the shortfall in the regions by importing these doctors. Of course, we didn't tell our locally trained doctors were to go when they completed university. They could go and set up wherever they liked.
I just want to put on the record that I thank those doctors who have come from other places in the world to serve us. Without them, we would have been in an even more dangerous situation.
It is ridiculous that Australia cannot train enough of its own. In fact, we should probably be exporting doctors to the rest of the world. So the training track was opened. To put us into 2017: 3,211 started medicine in university last year. There are 14,389 in total in our university system, so we're turning out about 3,000 a year. By my calculation, Australia needs about 33,000 GPs. We're turning out 3,000 a year. That's allocating about 700 doctors per patient. So obviously we will soon have more than enough doctors. We should, as I said, even be exporting doctors perhaps. But already—and I have been warning about this for five years—there are reports of overservicing in the cities. How about that? History is repeating itself.
At the moment, in the Grey electorate, I've had a look at the Rural Doctors Workforce Agency's website, and I've found that they are advertising for 30 doctors throughout the Grey electorate. I know of two more single-doctor practices that are recruiting, and they're not on that website, so I know we are at least 32 short. If we assume that each doctor can properly service about 700 patients, Grey should have around 170 full-time-equivalent doctors. We're 32 short. That's a pretty dangerous level. It's almost a 20 per cent shortfall.
The problem is that we are burning out the good doctors, because they're working longer hours to try and meet the demand. And what's happening is that, in some places, doctors are actually withdrawing their support for the local hospital. They don't want admittance rights. They don't want to visit people who report to the hospital. In Port Augusta, in fact, SA Health has had to employ locum doctors to provide that service. That comes at an enormous cost. I have another hospital a little further south. It's in a cluster of towns. All but one practice have withdrawn their services from the hospital, so it's loading extra onto those who are doing the right and proper and good thing.
The government has appointed Professor Paul Worley as the National Rural Health Commissioner. I've met with him on two occasions. He has a number of good ideas that he is progressing. He's a good man. I applaud his appointment. We're also investing heavily in ramping up rural training, and, hopefully, this will help. But I'm less than convinced that it will be sufficient. My experience tells me it will be insufficient.
We need to question what it is we need to entice doctors into the country. I know they don't want to come. They've got partners who are astrophysicists. They've got children who need to go to high school, and they don't want to send them to the local high school. There's a whole plethora of reasons why they don't want to live in the country. At the moment, we have about 500 registrars in South Australia, and about 250 of these are receiving training in the country. My understanding is, though, that only 50 are actually living in the country, so it brings into question what their long-term intentions are. I think it's pretty plain that they'll be returning to the city. I know of a local doctor who had brought in a number of these registrars. He said: 'We make better doctors. There's no doubt about that. They enjoy the experience, but, almost to the person, they go back to the city.'
Recently, an eight-year-old from my home town of Kimba, Edie Rayner, wrote an impassioned plea to the doctors of Australia to come and live and work in Kimba. It went viral on the internet. She was featured recently on Weekend Sunrise, where our mayor, Dean Johnson, told us that the package for a single-doctor practice in Kimba would include a free surgery; a free four-bedroom, solid-construction house to live in; and a free car. The last doctor asked for six chickens. He's willing to give them a dozen chickens, and there's a good chicken coop at the doctor's house. And it would include an earning capacity of around $400,000 a year. Clearly, money is not the issue. We need something else.
I have written a paper that I've had for a couple of years. I've been hawking it around for a few years. It's called 'The challenge of supplying doctors where Australia needs them'. It is advocating for postcode-specific Medicare provider numbers. That means that, if you want to go and practise, you can't go and set up in North Adelaide—well, you can; in fact, there's no restriction on where a doctor might set up, but you're not going to get a public subsidy to practise there.
Given that around 85 per cent of a GP's income probably comes from the public purse, surely, the public has a say in where the service is delivered? It's beyond comprehension that we would pay someone to deliver a service where there are already too many doctors. I think the time has come to say: 'Well, if you want to be a doctor you have to go and live in Port Augusta, or Coober Pedy, or Ceduna or Kimba. That's where we will provide the Medicare provider number.'
I know that the AMA and others will resist this. They will say that it's a restraint on trade and that doctors are a private business. But they're only a private business in so much as they operate their own books. In fact, they run on public money and I think it's time that the public actually got what it needed from the system. If you look at a schoolteacher, when they come out of university they can't just go and set up a school down the end of the street because it's convenient to their house; they actually have to go to the school where there's a job. If you look at a nurse, they can't set up a hospital down at the end of the street; they actually have to go to the hospital where there's a job. But in the doctor's case, we allow them to go wherever they like.
Of course, we would need a transition period; we would need some grandfathering rules. We'll protect those who have an investment in local surgeries now. But, having said that, I can tell you what most local surgeries are just about worth if they were put on the market; it's about the bricks and mortar. It's not like the 'good old days', as it were. But it's time for change, and I cannot just stand by and see my community starved of doctors.
When you have low numbers of doctors then the push comes on to restrict services in the local hospital. And if you restrict services in the local hospital, it's harder to recruit good trained staff. So when, as happened recently in my local hospital, a young lady comes in too late to get to another hospital to deliver a baby, the baby is delivered on site. But, of course, as the years go on, there will be less and less nursing staff there that have the training to deliver babies. It's a dangerous mix.
We need to get doctors back out in the country, and I think we've run out of carrots and that's why we need a stick. This report advocates just what that stick is.
The DEPUTY SPEAKER: The time for the grievance debate has expired. The debate is interrupted in accordance with standing order 192B and will be made an order of the day for the next sitting.