Red tape amid a rural health crisis: Why it can take years to recruit a GP for the bush

Doug Hendrie

3/02/2021 5:06:38 PM

Practice owners and recruiters bemoan sluggish GP recruitment as the rural workforce shortage worsens.

Pen leaning against a high stack of paper.
Practice owners and recruiters say the process to recruit GPs is too long.

How long does it take to recruit an international medical graduate (IMG) to work as a GP in rural or regional Australia?
Up to two years – and the long lag time means the rural health crisis is likely to worsen, according to rural practice owners.
The news comes as a NSW parliamentary inquiry has heard doctors in the country are effectively running a ‘crisis medical service’, in part due to workforce shortages.
NSW locum GP Dr Phillip Jolly wrote in a submission to the inquiry that there is a ‘crisis in recruitment of medical personal in these towns … rural people need access to medical practitioners in their towns’.
Medical recruiters have told newsGP the problem is as bad as they have ever seen it, with thousands of vacancies unlikely to be filled.
IMGs make up half of Australia’s rural workforce, but bringing in overseas-trained doctors is a time-consuming process without a guaranteed outcome.  
RACGP Rural Chair Dr Michael Clements told newsGP that rural practice owners have been finding it harder since COVID struck.
‘We are seeing very significant – clinically significant – shortages in rural areas right now,’ he said.
‘Most rural practices have been experiencing long timeframes from the identification of a vacancy through to getting boots on the ground. There are multiple delays through that process and COVID has stretched that even further, with both uncertainty and procedural delays.
‘That’s confronting for us, because rural sites have relied on IMGs for many years.’
According to Dr Clements, solving the problem will require a commitment to reforming the process.
‘We need the different agencies involved in the movement of these doctors [to] commit to streamlining the process – from the Federal Government and visas, to AHPRA and recognition, as well as the GP colleges committing,’ he said.
‘Practices are agile and quick and can adjust, but they rely on these big bureaucracies for the processes.’
Dr Clements said the staffing crisis has been exacerbated by intermittent internal border closures due to the COVID-19 pandemic, which have played havoc with the traditionally mobile locum workforce.
A 2012 Federal Government inquiry into the challenges for IMGs titled ‘Lost in the Labyrinth’ handed down 45 recommendations to ‘reduce red tape, duplication and administrative hurdles faced by IMGs whilst ensuring that the Australian standard continues to be rigorously applied’.
While the Federal Government last year moved to fast-track visas for IMGs in a bid to address the immediate shortfall of locums who often work across state borders, medical recruiters and practice owners say the path remains onerous. 
Despite encouraging signs of interest from GPs in training in the new Rural Generalist Pathway designed to boost GP numbers in the bush, the pathway will take time to work.
In the interim, practice owners are struggling to recruit, with towns like Katherine seeing vital practices close their doors – though a new clinic has since opened, and another is due to open soon.  
In a submission to the ongoing NSW inquiry into regional health outcomes and access seen by newsGP, Taree, NSW, GP and practice owner Dr Simon Holliday laid out his long and difficult effort to recruit.
‘Over my years as a rural GP, my major cause of headache has been medical recruitment and retention. Yet, many rural GPs are far worse off than me,’ he wrote.  
‘There is an urgent need for some communication between the different state and federal regulating bodies involved in this process.
‘“Kafkaesque” is how processes unfold, rather than how the system works.’

RACGP Rural Chair Dr Michael Clements said the shortages have become ‘clinically significant’.
Dr Holliday gave the example of recruiting a South African GP, a process that took 22 months.
‘At least three times, when requirements were arbitrarily changed, we relied on our federal member to negotiate the deadlines and managed to salvage the process by a couple of days or weeks,’ Dr Holliday wrote.
‘An example of the inflexibility was how APHRA required [him] to fly to Australia to attend the APHRA office in person to present his identification documents.
‘They refused to allow the Australian Embassy in South Africa to witness them. He flew to Perth and then had to either stay in Australia for a minimum of six weeks without working or return home, which he did.’  
Another recruitment effort was delayed for several months while the overseas-trained GP worked to have his immigration sponsorship transferred.
‘This took five months and during this time he was unable to work anywhere,’ Dr Holliday wrote.
‘We were very stretched at the time trying to construct and establish a GP respiratory clinic and it seemed bizarre that, due to bureaucratic delays, our community could not access his services and he could not earn a living.’
Dr Holliday told newsGP his story is ‘not remarkable’.
‘It’s the same story writ large across rural Australia. Everyone says they’re going to do something, b but it’s too big for any one particular person to be responsible for or care about,’ he said.
‘If we are overstretched, don’t be surprised if people in the bush die younger, and if more care is in the emergency department with late diagnoses or emergency management of chronic illness.’
Martina Stanley, Director of medical recruiters Alecto Australia, told newsGP this is the most difficult it has ever been to bring overseas-trained doctors into the country. Her agency has almost 1000 vacancies for GPs with ‘absolutely no hope of filling them’.
‘We have so many clients who are desperate and we can’t fulfil the need,’ she said.
‘We are going to see a significant decline in numbers of doctors available for rural and outer-metro areas in the very near future as a result.
‘There’s no quicker pathway for people to go rurally rather than metro. There’s no shortcut. It’s a really, really long process. And this has nothing to do with coronavirus – COVID is delaying our ability to recognise what’s really going on.
‘People don’t want to listen to us [recruiters] because of our commercial incentive. Yes, we have that incentive, but we also have a knowledge of the sector that’s quite unique.
‘Often it’s us as recruiters who are the only ones who have oversight of the whole pathway. We’re the ones who have to guide doctors through each step. If they don’t do it the right way, they can get stuck right at the end.’
Ms Stanley said her industry is becoming more and more frustrated by the delays. Alecto Australia and a number of competitor companies are now exploring ways to access the political system to be heard, she said.  
The situation has become so bad, according to Ms Stanley, that she will now only take on clients where there is a chance of successfully recruiting a GP. 
A 2019 Deloitte Access Economics report commissioned by Cornerstone Health estimated the GP shortfall to be almost 9300 by 2030.
‘The undersupply of GPs is [partly] driven by a lack of Australian-trained graduates and the recent policy change that has significantly restricted access to overseas-trained GPs,’ the report states.
The Department of Health did not respond to requests for comment. However, a spokesperson for Federal Health Minister Greg Hunt recently told The Australian the Government had allocated $550 million in the 2018–19 budget to attract doctors to the bush.
‘After the first two years, more than 800 additional GPs and 700 additional nurses are working in regional and remote areas,’ the spokesperson told the paper.
‘Since 2013, the number of GPs in Australia has been growing at 2.5 times the rate of the population.’
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Dr Michael Lucas Bailey   4/02/2021 7:27:00 AM

The mining industry doesn’t have the same struggle. It even leads to booms in small towns. Simply pay medical staff double what they would get in the city and there would be no staff shortages.

Dr Dhara Prathmesh Contractor   4/02/2021 7:48:26 AM

Recruitment crisis are in rural locations, completely agree. But population is small too.
Unfortunately, getting general practitioner VRGP!
Is unfortunately a bigger nightmare and the population to cover is higher and the demands from recruitment agencies and doctors themselves get higher too.
The ever so not understandable issue by myself is:
1. An IMG is okay to work on rural communities and no is fellowship needed.
2. An IMG can work on rural population with minimum experience in Australian medicine guidelines and protocols.
3. An IMG deems to keep the rural population safe by themselves in almost minimum supervision scenario and where there is no major tertiary facility available nearby.
4. An IMG needs to have 10 year moratorium to help rural population without supervision.
Same IMG if they wish to move to metropolitan— then comes the restrictions showing them how unskillful they are for metropolitan area if not VRGP!

Dr Jean-Marc De Maroussem   4/02/2021 8:19:48 AM

Significant tax deductions/exemptions should help fill these vacant rural GP positions.

Dr Ian Mark Light   4/02/2021 12:12:23 PM

They have to offer more places for a four year Rural Medicine Course and also Diplomas in Rural Medicine for Urban GP’s with experience and impact as a spiritual reward and remuneration as a material reward .
Nurse Practitioners and Physician assistants would also help out .

Dr Wei Cheng Chen   4/02/2021 12:31:45 PM

Obtaining a medicare provider number is one of the problem for IMG to work in rural setting. there are various issues for certain states that do not endorse the applications for Medicare Provider number from the potential GP because he/she has got into AGPT training but did not achieve his/her GP Fellowship yet.

Dr Anna Lindsey Glue   4/02/2021 6:22:43 PM

We need to train more Australian GPs - also means we need to offer less medical and surgical specialty trainee jobs - we desperately need more GPs, we do no need more medical and surgical specialists ( especially in capital cities).

Dr Georgina Anne Webb   4/02/2021 11:56:45 PM

Well, I am an Australian trainedGP qualified in both anaesthetics and obs and I wanted to work in a regional/ semi rural area and my husband is a school teacher.You would think a great combination, but because he has a PhD schools have to pay him more, so TWICE he went for job interviews in the country and didn’t succeed so we stayed in the city! There needs to be jobs for spouses too if you want to attract more GPS to the country. I was only working PT for a while when having children. Now I am nearing retirement so I don’t want to move now! How can rural communities expect to attract qualified GPS if there are no jobs for spouses!In the UK they have overcome this obstacle! Communities have to work together if they want to attract doctors. My experience with IMGs in the city is unfavourable as they are not properly supervised and are allowed to practise! I am proud of our GP training system!

Dr Dhara Prathmesh Contractor   17/04/2021 10:07:48 AM

I completely agree and no second thought to say:
Australian teaching and training systems are one of the best in the world. And I am proud of the system too.
Just voiced a few biases which might help to simplify recruitment bias.