Regional Medical Specialists Association

Is this the way to fix rural medical workforce?

The President of the Regional Medical Specialists Association, Dr Peter Hughes, today criticised a recent decision by Medicare on telehealth consultations conducted by Metropolitan psychiatrists for patients living in rural Australia. 

Patients of a  psychiatrist practising in a regional city are limited to the old rebates when they see the psychiatrist in person. The new item provides for a Medicare rebate with a 50% bonus if the patient has a Telehealth consultation with a metropolitan-based psychiatrist. “ Does this make sense to anybody?” he said, “It seems a totally counterproductive approach to funding for rural health services. ”  

“We are fighting to improve the lot of the more than 30% of Australians living outside of Metropolitan areas.  There is definitely a place for telehealth-based consultations, but they are a poor second to being there in person.  This should particularly apply to mental health conditions, we believe.

“Psychiatrists in rural Australia either have to ask their patients to pay a ‘gap’ charge or accept a bulk-billed payment that even the Grattan Institute concedes is inadequate.  Under the new arrangement this is two-thirds that paid to their metropolitan colleagues, who haven’t even left their offices in the city.”

The President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) stated that this was a result of the RANZCP’s efforts aimed at, “Increasing the pool of psychiatrists and those in training delivering affordable services through the Medicare Benefits Schedule (MBS)”.  

He also claimed that “We also continue our advocacy to strengthen the rural psychiatry workforce”.  

This, we submit, is not the way to do it.  Instead it encourages a ‘carpetbagger’ approach to rural medicine.  In the American Old West, a city slicker would come into a frontier town and roll out their carpetbag full of shiny trinkets.  When the trinkets were all sold they would roll up their carpetbags and return to the city.  Their pockets would be full of money from the people of the town; which they would spend in the city.

Rural Australia does not need Carpetbagger doctors.  We need doctors (GPs and specialists) who will make a commitment to our rural communities then follow through honestly and sincerely.  The National Medical Workforce Strategy 2021-2023 emphasises the need to “rebalance supply and distribution” (this is their Priority two, out of five.  Priority five is to build a flexible and responsive medical workforce.  

Both of these imply increasing the supply of GPs and specialists close to where Australians live.  Flying them in and out or relying on remote technology is a Band-Aid solution.  The RANZCP, and Medicare, should be working harder on a permanent response to the rural medical workforce issue.


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