Future of doctor shortage in rural and remote NSW still unclear


Every week it seems there’s a news story being run, about the problems with the Australian health system and the difficulties it faces when it comes to the lack of doctors and medical professionals that service this country.

But for every story that’s run, it appears that there’s usually another one to detail some new government policy aimed at combating the problem.

The doctor shortage in this country, but specifically in the rural and remote parts of New South Wales, is an issue that has plagued each successive government over the past two decades and is an issue that, to some, seems to be put on the backburner for every consecutive budget. It would appear that in the recent past, governments have been preoccupied with keeping their bottom line in the black, while the public health sector takes a battering.

But behind all the government spin, public outcry and political jargon, what exactly is being done to alleviate the stresses of so many health workers and what does the future hold for the sustainability of the NSW health system?

Back-track to August 2013, just before the last election, when the then Coalition, the Liberal Party, took over the reins of the nation.

In the midst of the Labor Government failing to live up to many of their promises, including that of health, the Coalition stepped in to offer their remedy for the immense strain on public health.

The Coalition’s policy stated that;

“Australia’s health system faces challenges due to demographic changes, increasing prevalence of chronic disease and the tyranny of distance faced by many rural and remote communities.”

“The Coalition will support our health system to meet current and future challenges. Only the Coalition has the track record of strong economic management that is needed to deliver future investment for better healthcare.”

Additionally, the Coalition attempted to demonstrate their commitment to the health sector by pledging to invest $40 million in medical internships nationwide.

Back to the present day and feelings from medical staff around the country, still don’t resonate the positivity that the Coalition attempted to instil less than a year ago.

Now, it would be overly optimistic to think that a problem as big and complex as this one could be solved overnight, but if we go further back in time, we can see that it’s been anything but overnight.

Back in the early 1980’s, believe it or not, New South Wales’ rural and remote communities were still feeling the strain of a lack of general practitioners and other medical professionals.

However, if we look solely at the mountain of data in front of us, it would be very difficult to make much of a case for a doctor shortage.

If we look at the big numbers, like the timeline of annual health expenditure, there has been a very promising increase over the past 20 years.

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As the graph shows, since in the 1982-83 budget, spending on health has increased by more than $100 billion and government spending is not the only place where there have been increases.

In 2008, the Australian Bureau of Statistics revealed that, in the 20 years from 1986 to 2006, the number of general practitioners per 100,000 people had increased from 152.6 to 178.6, while the number of specialists basically doubled, going from 57.7 to 92.

Similarly, the number of dentists increased from 40.5 to 45.7, not a huge increase compared to others areas, but an increase nonetheless. Conversely, the number of nurses fell from 1,113 to 1,048 (per 100,000 people).

The report also showed that the major cities and metropolitan areas enjoy more than twice the number of GP’s than their rural counterparts, with 204.9 GP’s for every 100,000 people.

So, even though the raw data will suggest anything but a shortage, the remote parts of Australia, like New South Wales are still feeling the brunt of the problem, a thought that is echoed by the Local Governments.

The office of John Cobb, federal member for Calare, believe that the problems facing the Australian Health System are very real and affect many people in the Bathurst district and surrounding areas and if little is done to remedy the problem, a huge number of people are at risk.

Sadly thousands of rural Australians die unnecessarily every year in one of the world’s most developed nations, simply because of where they live.  Rural Australians are more likely to have a chronic disease because of poor access to primary health care services and are significantly more likely to die from a preventable illness,” said a representative of Cobb. 

As well as being affected by the shortage itself, areas such as Bathurst have trouble benefitting from times when there are doctors available.

The rare occasions when doctors are available, they are usually sent to practices that are considered an ‘Area of need’ or a ‘district of workplace shortage’.

In the past, several practices in Bathurst have attempted to gain this label, but have been unsuccessful.

For areas like Bathurst, and surrounding districts, it’s not so much a monetary problem, more so a numbers problem. There simply aren’t enough doctors and specialists to service such a large population.

To combat the direct shortage of GPs, the Australian Government has adopted two main strategies in the past decade. Bringing overseas doctors to Australia and also contracting locum (temporary) doctors, is a band aid solution but the Government has also dedicated time and money to increase the facilities to train an entirely new generation of doctors.

While the Australian Government and public health professionals seldom see eye-to-eye, they both feel that the solution to the problem will involve a combination of a variety of factors.

On the subject of temporary and overseas trained doctors, while they are a useful fix, this strategy has a few associated problems, including the fact that it does very little for the future sustainability of the industry.

According to the New South Wales Rural Doctors Network (NSWRDN), in the 6 months leading up to the end of last year, there were still 158 vacancies in NSW. The NSWRDN also feel that no one strategy is going to alleviate the issue.

“We are all aware that the health system is under stress and that the shortage of GPs in rural and remote New South Wales continues. As well as other initiatives, there is a reliance on both Australian-trained and overseas-trained doctors to alleviate the rural doctor shortage in rural New South Wales,” a NSWRDN Public Relations Manager said.

In the 2008/09 financial year the Labor Government spent $60 million on relocating locum doctors, for use in the rural parts of NSW.

As an example, some locum doctors had been brought over from New Zealand, sometimes for only weekend work.

As has been said, this is a solution that does not have future interests in mind. Additionally, hiring locum doctors is also a very costly endeavour, on occasion, these doctors were being paid up to seven times their usual wage for the little time they work, as well as other incentives.

The Australian Government also spend a lot of money on relocating overseas trained doctors, to work in a more permanent capacity which, unlike locum doctors, does more to ensure the future of doctors in the region.

We see just how much the Government has relied on overseas doctors when we look at yet more data. In a 2008 report from the Australian Bureau of Statistics, from 1986 to 2006 the number of overseas doctors in the system ballooned from 639 to 3,586. Moreover, India overtook England as the most common country from which these doctors came.

As a result of this rapid influx of overseas doctors, GP’s from abroad represented more than a quarter of GPs in rural NSW.

Even though these findings look good on paper, this strategy has caused problems outside of our borders.

In 2012 the ABC reported that the Australian health system had been accused of ‘poaching’ African doctors, a country that has long supplied doctors to rural Australia.

It goes without saying that the only logical solution to rural NSW’s health system problems is to increase the core numbers of doctors and medical professionals in the region and the country at large.

This is something that federal and local governments, health networks and GPs all agree on.

Though the regional NSW doctor shortage dates back more than 20 years, only in the past 5 years or so has the government invested real effort into focusing on doctors at the tertiary level.

Tertiary facilities like Charles Sturt University, La Trobe University and the University of Western Sydney, as well as many other universities, offer their final year medical students the opportunity to complete their placement in rural areas. The unofficial slogan for this plan was, ‘train them in the bush and they’ll stay in the bush’.

Last year the federal government announced $8 million would go towards offering internships to medical students. With the money opening up more than 60 internships in the region.

According to the office of John Cobb, there’s no doubt student doctors will have a huge impact on the shortage of doctors in the Bathurst region, where many of these doctors are trained.

National and international evidence shows that if you train rural students to be doctors and other health professionals in the bush, they will remain to work in the bush,” said a representative of Cobb.

But just like the overseas doctors strategy, extra funding and extra students also pose a few problems.

According to a local GP at a Bathurst medical centre, who preferred to remain anonymous, injecting more students into the system has its difficulties.

“In relation to extra funding for medical students this would be fine, but the next step is who is going to mentor the students. An issue to address is the aging of the GPs in Bathurst, take our practice as an example, the 3 partners are 60 years or older and still working full-time,” she said.

The doctor shortage in the rural and remote parts of NSW is a complex and timely issue, one that has long troubled the government and stressed professionals locally.

Ultimately, the issue must be one that does not suffer during the crossfire of successive governments.

The only thing that can be agreed upon across the board is the fact that it will be a combination of overseas doctors and training a brand new generation of doctors that is going to offer the most robust solution for this pressing issue.

If the increase in funding continues to rise as it has in the past 20 years and the government continues to invest in the facilities and tools to allow a new generation of doctors to flourish, there’s no reason why in another 20 years, the issue will be a distant memory.



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