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SA rural GP shortage worsens


Morgan Liotta


3/08/2021 4:52:12 PM

And the Chair of RACGP South Australia and Northern Territory says the trend is fast becoming ‘an Australia-wide issue’.

Drone shot of a regional Australian town.
Rural and regional towns are finding it more difficult to attract and retain GPs.

In 2019, the RACGP was involved in developing the draft SA Rural Medical Workforce Plan.
 
Released on 29 June, it aims to ensure the continued recruitment and retention of rural GPs, including doubling intern positions and offering more training opportunities to strengthen the rural medical workforce – and its release could not be timelier.
 
All across Australia, rural communities have been facing ongoing GP workforce shortages, exacerbated by the COVID-19 pandemic and an ongoing reliance on international medical graduates (IMGs).
 
Around half the country’s rural GP workforce is made up of overseas-trained GPs, and visa requirements, remuneration concerns, and the pandemic restricting travel have seen their numbers decrease.
 
Additionally, more Australian medical graduates are also opting for other specialties over general practice, and South Australia has been particularly affected by shortages, with reports that almost 50 of the state’s regions are in need.
 
RACGP SA&NT Chair Dr Zakaira Baig told newsGP workforce shortage is ‘becoming an Australia-wide issue’, and while many efforts are being made to address it, attracting young doctors and medical students to general practice remains the biggest challenge.
 
‘They have lost interest in general practice. There are multiple reasons for it,’ he said.
 
‘[These include] the big discrepancy in remuneration for a GP and other specialists; while GPs are recognised as specialists, GPs are not paid at the same rate.
 
‘Young doctors are often in relationships, there are no work opportunities for their partners if they go rural … so they are not keen to go rural unless there are special incentives.
 
‘[There are also] limited schooling opportunities for children of rural GPs. Many move out to cities for this reason when their children grow up.’
 
More than 500,000 of South Australia’s 1.7 million residents live in rural areas, where public health services are provided by six regional local health networks. But these services are becoming harder to deliver.
 
In the mid-north regional town of Peterborough, the only GP clinic shut its doors in June this year, leaving its sister clinic in Jamestown ­– 43 km away − as the closest.
 
Jamestown GP Dr Simon Jackson told the ABC that at the time there were only three full-time GPs and two registrars providing services to the clinics and hospitals across the mid-north region.
 
‘We have to remember that the GPs in this region not only … provide coverage for the medical centres, but are also required to cover the hospitals and the inpatients, provide anaesthetics, obstetrics services, 24 hours a day, 365 days a year,’ he said.
 
With the number of GPs in the region not sustainable, more locums are expected to help fill the gaps. But there are some concerns among locals and GPs this could impact quality of care and the doctor−patient relationship.
 
Dr Baig says that past area classifications also helped to construct a non-viable system. 
 
‘For many years outer-metro suburbs were classed as “areas of need”, leading most IMGs to accumulate in those areas when in fact, actual rural areas remained neglected,’ he said.
 
‘My point is that areas 15 minutes’ drive from the CBD should never have been classed as areas of need. Although it has been addressed, it is too late now.’
 
Part of the effort to build a skilled rural workforce and sustainable models of care through a collaborative workforce includes a shift to profession-led community-based training.
 
Rollout of the training has been fast-tracked to Tasmania, where there is also a growing shortage of GPs, while RACGP Rural Chair Dr Michael Clements has vowed to take a ‘hands on’ approach to resolving workforce issues.
 
Although there are no plans as yet to fast-track the college-led training to SA, Dr Baig said RACGP SA&NT has regular engagement with other stakeholders to promote general practice ‘at every possible front’.
 
‘Engagement with medical students is one part of this, with a student representative co-opted on our SA&NT Council,’ he said.
 
‘We actively participate in Career Night, held once a year, which is well-attended by senior medical students and interns. We set up a stall and send speakers to promote general practice.’
 
In addition, the faculty offers support to medical students at Adelaide and Flinders universities, has quarterly meetings with SA’s regional training organisations to promote rural and urban general practice, and regularly meets with State Government politicians to strategise the workforce shortage issues.
 
Aside from the RACGP, AMA(SA) and the Rural Doctors Association of South Australia (RDASA) have also been working to find potential remedies for the workforce shortage crisis.
 
‘We urgently need a package that fairly values the work rural doctors do in hospitals and to provide emergency and procedural services for our rural communities, and which is attractive to the next generation of rural doctors,’ RDASA President Dr Peter Rischbieth said at a recent meeting.
 
The AMA(SA) and RDASA has put forward recommendations for a joint package of reforms to:

  • reduce bureaucratic costs by transitioning from a fee-for-service model to a basic hourly rate
  • improve pathways to increase GP involvement in decisions about hospital patient care
  • support GPs in providing training for medical students and registrars.
The recommendations, through consultation with local health networks, are hoped to further highlight the valuable skills and contribution GPs provide to their communities.
 
For progress to be made on addressing rural GP shortages, the SA Rural Medical Workforce Plan calls for collaboration across a number of sectors to ensure the workforce is able to meet and respond to the changing needs of rural communities.
 
These include local and federal governments, non-government organisations, hospitals, local health networks, Aboriginal and Torres Strait Islander communities and Aboriginal Community Controlled Health Organisations, and universities.
 
‘Collaboration with regional communities is also required to address the unique challenges facing rural communities,’ the plan states. ‘Rural health workforce challenges must be shared and require solutions through collaboration and input.’
 
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Dr Bruce Louis Coppa   4/08/2021 7:23:36 AM

Money and time


Dr Thomas Michael Ryan   4/08/2021 9:12:51 AM

The decline in rural generalist/GP numbers will not be helped by SA Health starting to persue a hospitalist model as in: https://iworkfor.sa.gov.au/page.php?pageID=160&windowUID=0&AdvertID=580207
Disrespectul and protracted contract negoatiations with resident rural doctors about the contact to supply services to rural hospitals do not add to the attraction of rural general practice for newly qualified doctors.


Dr Craig Russell   4/08/2021 10:47:43 AM

... and now throw in the new AHPRA CPD demands - "A Perfect Storm".


Dr Sally Georgina Nelson   4/08/2021 12:26:44 PM

SA Health has continued to devalue the rural GP over the past 10 years and their latest conduct in the contract negotiations has been disrespectful. GP registrars applying to work rurally in SA at all time low-not surprising!
SA Health seem happier to have non resident FIFO locums working in rural areas then to support the resident doctors-adding to the health divide between rural and urban populations.