‘Doctors will move from remote areas’: DPA change under fire

Jolyon Attwooll

21/07/2022 4:37:33 PM

In light of the policy shift, the RACGP’s Rural Chair has urged government to expedite measures to address the broader GP workforce crisis.

Magnetic Island general practice
Remote general practices, such as this one on Magnetic Island, could find it harder to recruit under the changes.

‘This will absolutely lead to an immediate migration of doctors out of rural and remote areas.’
That is RACGP Rural Chair Dr Michael Clements’ blunt assessment of a new Federal Government decision to expand distribution priority area (DPA) status in Australia.
Under the changes, which were announced on Thursday, all GP catchments in Modified Monash Model 2 (MM 2) areas – which include many regional towns – automatically gain DPA status with immediate effect.
It means everywhere from MM 2 catchments to very remote parts of the country, categorised as MM 7, now have priority status, allowing them to recruit from an expanded pool of doctors, including international medical graduates.
The shift in classification will also mean a number of MM 1 catchments will be classified as DPA, although inner metropolitan areas remain automatically categorised as non-DPA.
It is a change that will channel doctors away from areas where the shortage is most acute, according to Dr Clements. He does not believe using the DPA classification system is the correct means to address well documented GP shortages in rural areas.
‘It’s a distribution tool, not a workforce tool,’ Dr Clements told newsGP.
‘It’s a tool that sits there to help direct the few numbers of doctors that we’ve got to the areas of most need.
‘This policy essentially takes any distributed capacity out of it – you’ve made most of Australia a “priority”.’
The Government’s announcement describes the move as ‘delivering on one of its core election commitments to make it easier for thousands of Australians in outer suburbs and regions to see a GP’. It stated that 700 areas will now have either full or partial DPA classification.
However, recently a number of GP practices have closed down in rural and remote areas – and Dr Clements expects more doctors to move imminently. 
His own practice is in Townsville, which is within an MM 2 catchment. Under a new exceptional circumstances review system introduced last year, a bid for DPA status was not supported – but that status is now automatic.
‘I certainly feel that unless we do something dramatic and new, we are going to see more rural practice closures, because people just won’t be able to recruit,’ Dr Clements said.
‘What’s going to happen immediately is that doctors will move from rural-to-remote locations, where they’ve been required to work under the DPA rules, closer to big cities … as a direct result of this.
‘This will absolutely lead to an immediate migration of doctors out of the rural and remote areas because MM 2 is generally more desired.’
However, Dr Clements also recognises the acute pressures in many MM 2 areas and urged the Government to put in place measures to address broader workforce shortages and entice doctors to more remote areas.
‘We need to figure out programs and policies that are going to increase the total number of doctors, not just change the distribution of them,’ he said.
‘We must see immediate action taken to increase the incentives to draw people back out to rural and remote.
‘We’ve always been more supportive of carrots rather than sticks.’
Dr Clements says he would have liked to have seen more substantive measures in place to boost GP numbers before the DPA changes were announced.
‘What we would have preferred is that they invested in the rural incentives before they made the change,’ he said.
‘We would have preferred to have seen some of the $1 billion that’s been promised.’
Greater streamlining of overseas doctors’ visa applications would be another welcome step, Dr Clements said.
‘If I was to … recruit a doctor who’s overseas right now and might want to move to Townsville, the whole process is between 12–18 months, and roughly $20–30,000.
‘So you can see that … any immediate change is really just going to be drawing people out of the rural areas.’
The DPA classification system came into place from July 2019, replacing the District of Workforce Shortage assessment areas. Initially it was only the most remote areas MM 5–7 that automatically received DPA status.
From the start of 2022, regional and rural towns classified as MM 3–4 were granted automatic DPA status, a move undertaken by the previous government and supported by the college at the time.
However, the Dr Clements said the college again warned at the time that changes to the assessment of DPA status did not address the broader problems of workforce shortages.
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Dr Raymond Weng Yat Yeow   21/07/2022 11:11:11 PM

This will teach the rural electorates to vote for the National party, and thus have no voice in the new Commonwealth government.
"......The Liberal Party has lost seats to both Labor and the “teal” independents.
But the National Party has lost no seats (although Flynn is still very close) and its vote has declined only marginally. ..."

Dr Horst Paul Herb   22/07/2022 6:47:05 AM

Not so sure it will lead to a mass exodus. I mainly work in MMM6 or 7 regions (Cape York and Kimberley). I do so exactly because MMM2 holds zero appeal to me - wouldn’t work in Townsville for the same money I get in Bamaga, and no amount of money would get me to work in Sydney. There are others like me. Those who work in more remote regions because they have no choice are rarely the type of doctors that are useful for those regions.

I see no point in coercion. Make rural and remote places more attractive, and more doctors will work there too.

Dr Mylapanahalli Krishnappa Shivashankaraiah   22/07/2022 7:02:08 AM

Medical workforce shortage is an artificially created situation in Australia due to improper distribution of workforce. This is being addressed right now. Yes, it is not a workforce tool but it is getting there. Australian medical graduates are immune from from any such distribution and only IMG's are made to go through this process. Dr Clement should have a proper plan to put across to the Government rather than criticizing.

Dr Philip Ian Dawson   22/07/2022 7:53:12 AM

Importing more doctors from countries that need them more than we do is not the solution! Australia graduates enough doctors, but they do not want to work in Geneal practice nor do they want to work in rural areas. Unless this is addressed this will only get worse. There is a glut of doctors in some inner city areas in some specialties as well as GPs. As they all draw on Medicare to some extent some restictions on provider numbers is necessary to protect the taxpayers investment.

Dr Francisco Rodriguez-Letters   22/07/2022 8:06:30 AM

Yet another tone deaf and ham fisted bungling by the government. This is going to be wildly counter productive. Were any rural GPs at all counselled regarding this idiotic plan? I doubt it.

Dr Javier Armando Campuzano Ortiz   22/07/2022 10:44:43 AM

well, the RACGP alleges advocacy for all GPs and yet they are fully behind these measures that effectively treat international medical graduates as second class citizens even if we are Australian citizens. It was about time. Now the precious local graduates will have to go to places where they don't want to go. Let's be honest the reason this forced workforce distribution exist is because they want to force the overseas graduates to places where they will not go, they are too precious for that. why they have to educate their children in the bush when you educate your children in Sydney. Call it like it is the RACGP is just another mafia like organisation. I don't know how this is advocating for its members. They only advocate for "certain members" the local graduates never wanted anybody else here, they are not welcoming and they RACGP never wanted them they were forced to take them and that is reflecting in everything they do.

Dr Sudeer Rajbally Mahadeo   22/07/2022 5:41:16 PM

There’s a GP shortage everywhere and the needs of the many outweigh the needs of the few. GPS like any other essential service should not be restricted but rewarded for providing services in areas of short supply. The pharmacist s have a great model creating a radius around practices preventing other gps from opening a practice within a radius of another existing practice will in my opinion be much better

Dr Javier Armando Campuzano Ortiz   25/07/2022 11:40:35 AM

well I agree with Dr. Dawson Medicare number restrictions but now for Australian Graduates.

Dr Tawhid Mohamed Sayed Hassanien   30/07/2022 4:18:49 PM

I have a suggestion which might help contribute to solving workforce distribution in Australia. I would suggest a "Zones system" where the number of doctors is restricted to say x/ per capita. this will have the following effects:
1- stopping creating new medical centres in areas over saturated by doctors
2- Doctors ( local or IMG) will move to the next unsaturated zones
3- Encourage corporates to invest in outer areas and attract doctors there
4- stop the legal discrimination against IMG as workforce , demand and supply will dictate doctors movement
5- Government should provide incentive to outer zones practices