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‘More towns without a doctor’: Increase in GPs moving from rural areas


Jolyon Attwooll


13/03/2023 10:34:49 AM

Recent rule changes have exacerbated pressure on remote general practice, underlining the need for urgent reform, according to RACGP Rural Chair Dr Michael Clements.

Aerial panorama of Monash in South Australia.
Current figures indicate that the recent rule changes have left 30 towns without a doctor.

The number of international doctors moving away from rural and remote areas increased by more than 50% in the last six months of 2022, according to official statistics.
 
Last week, the Department of Health and Aged Care (DoH) confirmed to newsGP figures that were stated in Senate Estimates hearings last month.
 
These showed that in the last six months of 2022, there were 72 GP movements from rural and remote areas, classified as Modified Monash (MM) 3–7, to areas categorised as MM2, which includes all larger regional cities.
 
That compared to 46 movements in the same six-month period in 2021 and 40 in 2020, representing a 56.5% increase since changes to Distribution Priority Areas (DPA) came into force in July last year.
 
At that time the Federal Government announced that all GP catchments in MM2 areas would automatically gain DPA status, along with some outer-urban areas in large cities. The move substantially increased the number of international medical graduates with access to Medicare.
 
Federal Minister for Health and Aged Care Mark Butler said at the time that the DPA system, which came into effect in July 2019, had ‘arbitrarily axed’ many communities from the ability to recruit overseas trained doctors in the outer suburban areas and regions.
 
The only GPs included in the Senate Estimates statistics are those subject to section 19AB, which obliges them to work in DPA areas.
 
The recent shift in GP movements away from rural areas was categorised as ‘a slight increase’ by Matthew Williams, First Assistant Secretary for the Department of Health in the Senate Estimates hearing.
 
‘That is also impacted by a reduction in restrictions on movements post COVID as well,’ he said.
 
‘Some doctors in those areas who would naturally have been moving have started moving as well.
 
‘There is anecdotal evidence, but statistically there’s quite an insignificant change.’
 
RACGP Rural Chair Dr Michael Clements disagrees.
 
‘From Senate Estimates, it sounds [as though] they were trying to pretend that change wasn’t a lot. For me, that’s [around] 30 more towns,’ he told newsGP
 
‘Some towns only sometimes only have one doctor – so that’s 30 separate towns without a doctor.’
 
But Dr Clements suspects that the numbers reflected in the Senate Estimates likely ‘underplay the true shift’.
 
‘Those numbers don’t take into account people that were in the application process, or people that were applying and hadn’t yet started, and those that were making new decisions,’ he said.
 
‘We think the impact is far greater than what they’re implying.’
 
Dr Clements said he had first-hand experience of the trend, recalling that one GP resigned from his Magnetic Island practice – which is in an MM7 area – the day after the changes were announced.
 
He emphasised, however, that the RACGP does not support the system of the 10-year moratorium for overseas trained doctors, which restricts them to working in DPA areas – and said that he would prefer to see GPs move to rural areas due to the attractiveness of the role.
 
While the college warned of the likely impact the changes to DPA status would have on the number of GPs working in rural and remote areas, for Dr Clements the figures underline the urgency of broader systemic reform.
 
Government rural incentive payments, which reward doctors for the remoteness of their location and also how long they work there, are now inadequate, he believes.
 
‘Those numbers haven’t actually been increased in many years,’ Dr Clements said. ‘They haven’t been indexed.’
 
The tripling of bulk billing incentives, a measure that the RACGP supports nationally, would also help in more remote areas according to the Rural Chair – particularly given the measure is linked to rurality.
 
In addition, he said funding for the Fellowship Support Program, which helped international graduates towards fellowship, should be reinstated.
 
‘We know that the withdrawal of funding last year for overseas trained doctors who want to train in general practice had an immediate impact and an immediate reduction in the number of doctors applying,’ he said.
 
Outside of the levers that are available to Federal Government, Dr Clements said support with housing, childcare and spousal employment can all help boost the attractiveness of working as a GP in remote and rural Australia.
 
He also queried whether the shift in DPAs achieved its underlying aim of boosting GP recruitment in areas such as the Hunter Valley and the Central Coast in NSW.
 
‘What we did notice is that when everybody essentially got approved DPA, the number of positions diluted the workforce, and so people who are newly DPA have still been unable to fill positions,’ Dr Clements said.
 
Earlier this month, Minister Butler said there was yet to be any confirmed detail on the measure’s impact on the Central Coast region of NSW, a region which became a DPA in its entirety last July.
 
‘We don’t have data on that yet,’ he said in response to a reporter’s question on 2 March.
 
‘I mean, the former government essentially pretended that recruiting a GP in a community like this or in parts of the Hunter Valley was the same as recruiting a GP in Rose Bay in Sydney and it’s just not that simple – so we reversed that.
 
‘Obviously it is going to take some time for that to work through the system because the COVID pandemic, the closing of Australian borders, had a real impact on our ability to recruit workers from overseas, including nurses and doctors.’
 
In the recent Senate Estimates hearing, DoH officials also flagged a large increase in the number of overseas doctors arriving in Australia.
 
They told senators there had been a 41% increase in international medical graduate registrations in the last financial year – the equivalent of 2985 new doctors entering the workforce.
 
‘The number of new “restricted” doctors initiating practice in all MM categories has been consistently over three times larger than the movement of already practicing doctors to other regions,’ a DoH spokesperson told newsGP.
 
The DoH did not respond when newsGP requested specific detail on the number of restricted doctors recruited to rural and remote areas in MMs 3–7.
 
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Distribution Priority Area DPA Modified Monash rural


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Dr Maria Rachinskaya   14/03/2023 2:38:22 PM

Our solo doctor practice in regional VIC 300 km from Melbourne had tragically lost our nurse practitioner late last year. We have been trying to get a second doctor for years but since end of last year the situation has become desperate. Our letters of support from the local Health service, the community and a local MP seemed had no effect on escalation of the process of getting the only candidate, the OTD willing to relocate to the area with their whole family, through the hurdles of medical board. The workload for the only doctor in town is enormous. He already reduced his days due to the burnout. Whats next? Closing the clinic and moving to a big smoke to work as a contractor without the pain of caring for business to stay afloat while massively bulk billing and caring for the clinic employees salaries and entitlements...