DPA change making rural GP recruitment harder

Jolyon Attwooll

12/08/2022 4:02:21 PM

With much of Australia now classified as a priority area for doctors, rural health leaders say they are already noticing a rise in pressures on recruitment.

Rural medical clinic
The recent reclassification of Modified Monash areas is reportedly making it more difficult to recruit GPs to remote parts of Australia.

There has been ‘an immediate impact’ on the GP workforce in rural and remote areas following a decision to expand Distribution Priority Area (DPA) status, newsGP has been told.
Last month’s Federal Government announcement means that GP catchments in Modified Monash 2 (MM 2) areas, which include most large regional towns, now automatically have DPA status.
Some outer-urban areas within large cities, classified as MM 1, have also gained DPA or partial DPA status.
At the time, RACGP Rural Chair Dr Michael Clements warned that it would mean doctors would leave remote posts to work in clinics in urban areas.
Now, the CEO of the Rural Doctors’ Association of Australia (RDAA) Peta Rutherford says that scenario is playing out.
‘We’re already seeing the withdrawal of applications and a reduced number of overseas trained doctor applicants,’ she told newsGP.  ‘It’s having an immediate impact.’
There have been a small number of clinics that have already reported doctors leaving due to the DPA changes, Ms Rutherford said, while other doctors have flagged their intention to move. 
She believes it is now going to be significantly more difficult to attract doctors to remote general practices with vacancies. 
‘We’ve seen adverts of corporate practices where they’re saying, “If you’ve got a provider number with restrictions on it, you can now work in Hobart, or Canberra, unrestricted”,’ she said.
‘If a doctor does leave, the chance of filling that position is going to even be less likely than it was before.
‘Let’s face it, we were already in a rural workforce shortage crisis, this decision is only making the situation worse. Recruitment and retention of rural doctors has been made that bit harder.’
Dr Clements meanwhile says a doctor has resigned from his clinic on Magnetic Island, which is categorised as a remote MM 7, and decided to transfer to Townsville, which now has DPA status.
The changes mean that much of Australia, with the exception of inner-urban areas in large cities, is classed as DPA, allowing practices to recruit from a larger pool of doctors, including international medical graduates and bonded Australian-trained graduates.
A statement provided to newsGP by the Federal Minister for Health and Aged Care, Mark Butler, was critical of the original introduction of the DPA system by the previous government. In 2019, DPA replaced the District of Workforce Shortage (DWS) classification, which was based on GP-to-population ratio.
Minister Butler said it ‘arbitrarily axed the ability of a long list of communities to recruit overseas trained doctors to fill gaps in general practice in those outer suburbs and the regions’.
He also pointed to other Government investments and incentives to help attract doctors to rural parts of the country.
‘We have deliberately not changed the regional incentive payments that doctors receive for working in remote Australia, exactly because we recognise the importance of providing additional incentives for doctors to work in those remote and regional communities,’ Minister Butler stated.
‘We are also investing $146 million to attract and retain more health workers to rural and regional Australia through improving training and incentive programs, and supporting development of innovative models of multidisciplinary care.’
It is that election commitment, aimed at reforming the Workforce Incentive Program medical stream, that Ms Rutherford is hoping to accelerate to address the current recruitment challenges.

DPA-impact-article.jpgA small number of clinics have already reported doctors leaving due to DPA changes.
As the director of Doctor Connect, a Western Australia-based GP recruitment company, Dave Bell is better placed than most to observe how policies are translating to the real world.
Mr Bell said he has already noticed a shift in employment patterns prior to the recent change. In January, all MM 3 areas were also automatically granted DPA status, and the results of an appeals process introduced last year were also coming into effect, allowing new areas to gain DPA status.
‘I think it changed more in January and February when the bulk of the initial DPA appeals were announced,’ Mr Bell told newsGP.
He gives the example of the impact on Kalgoorlie, a mining town 595 km inland of Perth, which he says is now struggling to attract doctors since a shift to DPA status for Bunbury – a coastal city 420 km closer to Western Australia’s capital.
‘Maybe it’s a case that those [Bunbury] practices will fill up and then there’ll be more likelihood [doctors] will go to Kalgoorlie,’ he said.
However, Mr Bell believes the bigger issue for the recruitment of overseas doctors is bureaucracy.
While acknowledging the imperative of proper oversight of medical professionals, he says the current system is ‘over-governed’ and that there are ‘multiple layers of people doing the same thing’.
He also cites the extra personal expense facing overseas doctors going into the new Fellowship Support Program (FSP) as a likely barrier to increasing the number of available GPs.
The self-funded FSP, run through the RACGP, is due to start next year. It replaces the Practice Experience Program (PEP), in which applicants’ funding costs were subsidised by the Department of Health.
‘At the very moment we’re saying there’s a massive shortage of GPs, we’ve got this workforce of overseas-trained doctors who are already in Australia,’ Mr Bell said.
‘They know the conditions, they’re committed to living in this country, and they will go … to our rural places, but compared to six months ago, they’re now sitting with a bill of $30–40,000 [to achieve Fellowship].’
Ms Rutherford says she expects to talk about rural doctor shortages with Minister Butler next week – and hopes present challenges could lead to longer-term solutions.
‘I don’t think there was much thought as to what the ramifications [of the DPA changes] to rural and remote Australia would be,’ she said.
‘It’s been a policy we’ve relied on, not necessarily one we’ve liked.
‘From an RDAA perspective, we don’t want doctors to work where they don’t want to work, or be forced to, so now’s an opportunity for the Government to really look at what the issues are and what they need to put in place to make rural general practice a career of choice.’
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Dr Anna Lindsay   13/08/2022 7:02:34 PM

As a British medical graduate I am appalled that some Australia doctors might support the 10 year moratorium for those trained overseas. I have put it to the British colleges that Australian doctors should have similar restrictions placed upon them in order to work in the UK but this was dismissed as too crass. The recruitment by Australia of UK trained doctors has been discussed in the British Parliament as there is a backlash against recruitment at the expense of the British tax payer and in particular at the lack of protection afforded British doctors working for sponsors in Australia..
The 10 year moratorium needs to overturned and doctors should not shackled to sponsors. It is a disgrace. Australia needs to take responsibility for training and recruiting its own doctors to work in regional areas

Dr Tawhid Mohamed Sayed Hassanien   20/08/2022 4:37:27 PM

Dear Anna
I agree it is crass to put it in a polite way. The 10 moratorium has not solved and will not solve any problem with doctors distribution or less doctors willing to work in rural areas. this 10 moratorium is affecting the mental health of at least 40% of GP work force and their families. We have two GPs organisations ACRRM and RACGP for good reason. I am worried we may need another organisation to represent the interest of OTD . I would suggest the following points for the coming leadership :
1- work hard to abolish the 10 years moratorium immediately. Let the market dictate its forces like any other profession
2- introduce the quota system, where the number of doctors is restricted by population density. look at UK model
3- introduce more OTD into the RACGP hierarchy
4- GP practices to use partnership rather than current " employment" system which is not fair and sometime is exploitive to OTD.
5- we urge the RACGP to stop portraying GP as money hungry