Rural and regional Australians starved of local medical specialists
Nearly one third of Australians live in non-Metropolitan areas. Yet less than half of general practitioners (GPs) live and work there, despite the wonderful life rural GPs have. In the case of medical specialists, it is one-tenth. This gross inequity has not received much attention in the public media, perhaps because so many more GPs are needed than specialists.
Less medical graduates are expressing a preference for General Practice than ever before. This may be due to the capping of Medicare rebates for GPs, resulting in general practice becoming financially unattractive. This is what industrial and academic representatives of GP claim. It is also likely that the continued influence of metropolitan-based medical schools and post-graduate training programs makes specialist practice appear “sexier” than general practice.
But these influences also affect the preferences of medical specialists. After 6-7 years in a metropolitan medical school, then another 8-10 years training for specialist credentials, even the most dyed-in-the-wool country boy or girl is likely to have sent down roots in the city and be reluctant to leave.
This is why the Commonwealth is exerting pressure on Universities to set up Medical Schools based in rural and regional areas. Evidence published in the Medical Journal of Australia in May this year confirms the beneficial effect of rural medical schools on return to rural areas by graduates. The additional benefits of extending this to include rural-based internships, resident and specialist training was presented to the Regional Medical Specialists Annual Conference in Wagga Wagga in May this year.
The Australian Medical Council (AMC) has recently advised specialist training colleges that, from now on, their accreditation to remain a specialist training organisation will depend upon what proportion of their trainees are receiving training in rural and regional centres. They must make serious efforts to increase the number of trainees based in regional areas, aiming for parity with the proportions of Australians living there. Associate Professor Kerin Fielding, an Orthopaedic Surgeon based in Wagga Wagga, presented the Royal Australasian College of Surgeons’ blueprint for meeting this requirement.
The Australian Constitution prevents governments from forcing doctors or dentists to work where they don’t want to work. This constitutional change followed the ‘Civil Conscription’ referendum in the 1950s, and has been affirmed by the High Court twice since then.
Successive governments have depended on International Medical Graduates (IMGs) to fill the widening gap since then, by requiring that they work 10 years in areas of medical workforce need before being allowed a metropolitan-based Medicare Provider Number. This has been a failed experiment. The first 5 years are usually consumed by the need for the IMG to become familiar with Australia’s complex, heavily-regulated medical system. Then, after the 10 years has expired, the doctor returns to his family; usually living in an inner city suburb where many of his/her first-generation countrymen also live.
The solution, then, is to recruit medical students from the Bush, put them through a rural-based Medical School and then ensure that they can get as much of their post-graduate training in the Bush. That way most of them will stay, amongst their family and life-long friends. And who knows? Maybe the occasional Nobel Prize winner will emerge from this previously untapped resource.