We are in a rural healthcare crisis, and it’s literally sending rural Australians to an early grave.
Across the country, communities outside of the cities are facing widespread doctor shortages and GP clinic closures. Remote areas are losing basic services as their chronically low GP numbers continue to fall.
The inevitable result is ever-worsening health outcomes from a system already afflicted by chronic infrastructure, logistical and funding issues. People are dying from preventable diseases and patients are forced to travel hundreds of kilometres, and pay for accommodation under record inflation prices, to undergo basic medical procedures. Rural people’s life expectancy is now more than 10 years lower than their city counterparts.
How UNE is part of the solution
Even Armidale, where UNE’s main campus is located in the New England region, is not immune. Recently, eight GPs left the city in quick succession, leaving an estimated 6000 patients without a doctor, including some from other doctor-deprived towns who had relied on Armidale’s GPs.
However, UNE’s Dean of Medicine and Health, Professor Jen Williams, says she and UNE are committed to help resolve the crisis.
“The loss of several long-standing and highly respected general practitioners from Armidale’s medical community will have a significant adverse effect on the health and wellbeing of our citizens,” she says.
Government must support rural universities like UNE to enable sustainable delivery of primary medical qualifications to students from rural areas, in rural areas, to generate a pipeline of future rural doctors.
Government must support rural universities like UNE to enable sustainable delivery of primary medical qualifications to students from rural areas, in rural areas, to generate a pipeline of future rural doctors.
“UNE’s New England Virtual Health Network (NEViHN) is an innovation designed to maximise health professional education opportunities and practitioner support in regional areas. Funding such innovations as NEViHN, supporting selection of students from rural and regional locations to train where they are from, and reframing of Medicare, are all required in order to tackle the rural health crisis.”
Part of UNE’s ongoing strategy to improve the rural health workforce, NEViHN will give students access to clinical practices, patients and working environments in real-time. The virtual network is designed to also improve health outcomes for regional patients.
From the country, for the country
Another component of UNE’s contribution to solving the rural GP workforce crisis is the innovative pilot program launched last year called the Longitudinal Integrated Clerkship program (LIC).
The LIC is designed to attract senior medical students to rural generalist practice and have them work as apprentice GPs in small towns for one semester (19 weeks). UNE Senior Lecturer, Dr Maree Puxty, is the academic lead of the program.
“We’re targeting people who have ambition to be rural GPs,” says Dr Puxty. “We know from the research that if you want to increase the number of rural general practitioners then you need to attract students who have grown up in the country, and make it attractive for them to train in a rural centre.
In effect, we’re trying to grow our own rural generalist GPs.
Typically, post-graduate doctors spend a few years at a hospital before deciding their vocational path. The majority go into a non-GP speciality, such as psychiatry or paediatrics, rather than joining the general practice training program.
“We need about 45% of graduate medical students to join the general practice program just to maintain the number of GPs we currently have. And that’s not succession planning, that’s just maintenance,” says Dr Puxty.
And that’s not succession planning, that’s just maintenance.
“Unfortunately, general practice at the moment is not seen as an attractive option for post-graduates, and the current level of interest for recently graduated doctors is down to about 13.6% - meaning only 13.6% of new graduates want to become GPs.”
How did we get here and what’s next?
There are myriad reasons why students are not choosing the general practice pathway.
One, is the 10-year freeze on the Medicare rebate, which has not kept with the Consumer Price Index and lowering what rural GPs can charge in consultant fees, appropriate to regional patients’ expectations, as other business expenses soar.
Another is the high hospital locum fees, where hospitals can pay over $4,000 per day to cover for workforce shortages - a number that regional practice simply can’t compete with. Because of these reasons, among many others, regional GPs earn less for consultations but pay more in taxes and business expenses compared to their urban counterparts.
Additionally, hospitals are funded by State governments while general practice is funded federally. Consequently, any upcoming doctor who wants to pursue a rural GP vocation will lose all entitlements earned from working in hospitals – this includes long service leave, maternity leave etc.
UNE remains committed to addressing such systemic disincentives for new GPs through continual lobbying of government and support of innovative projects such as the single employer model, which has State and Federal Government working together to enable seamless transition between hospital and general practice training placements.
UNE has been advocating for the New England region to be one of the 10 new pilot sites for the single-employer model, with the NSW Government announcing that an agreement has been secured to see this pilot program go ahead in the region this year.
