Why some towns can attract GPs while others go without

Anastasia Tsirtsakis

4/11/2021 4:42:12 PM

Part of the transition to college-led training is addressing workforce needs across the country, but GPs say more support is needed to attract doctors.

Aerial view of a small town in South Australia.
GP workforce shortages in small rural towns across the country is a growing problem.

This week, the community of Wudinna, a small town on South Australia’s Eyre Peninsula with 549 residents, found out it would no longer have a GP.
Dr Scott Lewis, who has been the town’s only GP for 14 years, resigned citing frustrations over the lack of support.
His and the town’s experience is not uncommon. It was only in November last year that Dr Peter Sparrow decided to close down the only general practice in the Northern Territory’s town of Katherine.    
Workforce shortages, particularly in rural parts of the country, have been a growing concern with the COVID-19 pandemic only making matters worse.
RACGP Rural Chair Dr Michael Clements, who recently visited South Australia to better understand workforce concerns, says there is a significant issue with maldistribution. He noted a trend where rural locations with good supports in place have no issue attracting doctors, while other smaller towns have no doctors at all.
‘Port Lincoln is struggling at the moment and the the doctors [have] removed themselves from the hospital,’ he told newsGP.
‘There are a few towns on the Eyre Peninsula where there are no GPs at all and the small hospital clinics are managed remotely by a GP elsewhere.
‘Yet on the other side of South Australia, there are places that are doing quite well.
‘Berri has got quite a good model with GPs working with hospital, [while] Clare Valley on the other hand has a good GP workforce. It’s a highly desirable location to live, it’s got a good network and a collegiate group of doctors, and so that has less trouble.’
Similarly in North Queensland, workforce shortages are leaving GPs with no choice but to work long hours and delay retirement to service their communities, with the RACGP warning just last month that a failure to invest adequately could result in continued increases in overall healthcare costs.
In the Northern Territory a number of towns face a similar fate, with a shortage of GPs in private practice and at Aboriginal Medical Services, while hospitals thrive.
‘Across the country, we’ve got some towns with more than enough hospital doctors, but not enough GPs, and then other towns where there are lots of GPs, but no hospital doctors,’ Dr Clements said.
‘It’s a wicked problem.’
As part of the transition to college-led general practice training as of February 2023, the Department of Health (DoH) has opened a consultation to get industry feedback on the Australian General Practice Training (AGPT) Program GP Workforce Planning and Prioritisation activity.
The aim is to ensure that future GP workforce needs are met, with the DoH set to advertise a grant opportunity for workforce planning and prioritisation activities to help inform targeted distribution of AGPT training.

AGPT-distribution-targets-Article-1.jpgRACGP Rural Chair Dr Michael Clements (left) meeting with GPs to discuss workforce shortages during his visit to South Australia. (Image: Supplied) 
Dr Tess Van Duuren, Chair of the RACGP’s Education and Workforce Committee, told newsGP while she welcomes all consultation on the matter she does hold some concerns.
‘This is building on the work that the RTOs [regional training organisations] are currently doing well across the country, so it’s a change,’ she said.
‘Part of it is trying to work out how this is going to work, and how the colleges are going to then interact with these new organisations to actually understand the workforce planning and undertake placements for registrars.
‘I think at the moment, we’re probably lacking sufficient detail and clarity to fully understand how this is going to work to inform training into the future.’
Dr Clements is of a similar mind. He says identifying and addressing workforce shortages is particularly complex, from the location of the town and its proximity to other health services, to its socioeconomic status and whether hospital-based doctors can assist.
‘It’s good to seek feedback,’ he said. ‘But I imagine it’s going to be very difficult to come up with a consensus about how to decide whether a town needs more doctors.
‘We often see hospitals advertise for more doctors in their towns purely to manage a roster, not necessarily because the clinical need is higher.’
While a key component of college-led training is to deliver and maintain quality general practice training and supervision, the other aspect is workforce allocation.
A position paper outlining the RACGP’s vision, published in April, includes a plan to address workforce maldistribution and attract more graduates.
Dr Van Duuren says the college’s strength in this area is that it has insights from its large member-base to take a national approach, and understand workforce requirements and capacities.
‘[This] does allow us to have that ability to utilise some centralised planning and standardisation, but also optimising it at a local level with regards to training,’ she said.
‘So getting some efficiencies out of that, but also literally being able to get more flexibility in the system.’
However, Dr Clements says that once workforce needs are established, the next question is how to convince doctors to move to an area of need in the current funding environment – which he says is ‘very limited’.
‘There’s no point us doing the training and being told we have to send doctors to Tennant Creek [in the Northern Territory] if we don’t fix some of the remuneration issues and challenges,’ he said.
‘We can only achieve [that] if we’ve got adequate remuneration and adequate support from the Federal Government to actually incentivise it.’
Dr Van Duuren agrees, and says this is where everyone needs to work together.
‘We acknowledged that we can’t be the whole solution for workforce issues,’ she said.
‘This has been a problem for years; it hasn’t been solved yet and we’re not necessarily going to be able to do it in isolation; it’s obviously got to be part of an entire system.’
But Dr Van Duuren says it is clear that addressing workforce maldistribution has reached a critical point – both for the sector itself and for communities to access the healthcare they both need and deserve.
‘There are a number of paths to do it … but it has to be done,’ she said.
‘It is absolutely clear that a very robust primary healthcare workforce is what’s required. There needs to an emphasis on generalism, because if you are regional and rural you need someone who’s got broad generalist skills to be able to provide their services.
‘Currently Australia’s heading towards subspecialisation, which won’t necessarily serve these kind of communities.’
Consultation on AGPT distribution targets is now open and closes on 17 November. To participate, visit the DoH’s Consultation Hub.
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Dr Anthony Cletus McCarthy   5/11/2021 7:31:34 AM

Training should not be used as a workforce solution. Putting trainees in failing models of practice is unlikely to help anyone in the medium term.
While it is difficult to generalise across the whole country, Workforce problems are generally related to remuneration and work conditions, particularly after hours arrangements.
Hospitals access and support are key to sustainable truly remote practice, and hospital funding and infrastructure needs to be supportive of GP’s, whether that is in the same town or just the closest one.

Dr Fiona Jane Henneuse-Blunt   5/11/2021 6:33:06 PM

I worked for 10 years in a Remote, Rural area of Scotland, on an island . We had a hospital which had 30 beds to admit patients into. We ran a 24 hour roster. One Gp on a 24 hour shift with 6 colleagues for a population of 7000 patients. We were adequately salaried by the NHS above the standard GP remuneration . We had a day off completely after our 24 hours on call shift. We used helicopters overnight if the emergency was too great to admit and ferry during the day. We gained lots of emergency medicine and GP experience. Real cradle to grave medicine. We had a fantastic lifestyle since housing on the island was cheaper than the mainland and we were paid approximately twice as much as a FT GP. Remuneration made the difference . Otherwise , despite the positive experiences there were certainly terrible ones I would not wish on any GP . We were also Police Surgeons so dealt with sudden deaths . Some very unpleasant. If I was undervalued and unsupported I doubt I would have stuck it out.