Archive Article: Doctors In The Bush. 13 Nov 98.
December 23, 2008

The Australian Government and Opposition have both promised to give more attention to the concerns of rural Australia. One of the problems is how to deal with the shortage of rural doctors.

The NSW Farmer’s Association and the Local Government and Shires Association of NSW commissioned an extensive study by Monash University’s Dr Bob Birrell on the “The Distribution of Doctors in Non-Metropolitan NSW”. The report makes grim reading. In short, although there may be many lifestyle advantages of living in the rural sector, there will be an increasing shortage of doctors willing to work there and indeed, as some doctors retire they may not be replaced. Incidentally, GPs practising in non-metropolitan NSW are older than their metropolitan counterparts and so will be retiring sooner.

There are nearly twice as many persons per doctor in non-metropolitan NSW compared to Sydney. Within non-metropolitan NSW there is a further disparity in favour of the larger urban areas relative to rural and remote regions.

The situation may also get worse because female GPs are said to be reluctant to work in the non-metropolitan areas because of concerns about personal safety, lack of a peer group, lack of emotional support and lack of family support. Additionally, female GPs prefer part-time and convenient locations which fit in with their husbands’ work. Women tend to become GPs, while men tend to specialize, and so there is yet another reason for concern about a shortage of rural GPs.

Given that the GP’s role is to serve as the first point of contact between patients and the medical system, there ought to be a rough equality between the distribution of GPs and the resident population. Indeed, in an ideal world, there is a strong case for the location of more GPs per head in the rural areas because the relative absence of specialists means that GPs must, on occasion, perform specialist functions which cannot be delayed by a long trip to Sydney either because of cost or emergency factors.

The Australian Government has taken a number of recent decisions concerning the supply of doctors. But these have all had only a limited impact. In essence, the Government cannot easily force GPs to work in particular areas. I cannot see any easy way out of this problem. I suggest that there are two major reforms but both would have electoral consequences. First, the Government could abolish Medicare bulk-billing. GPs are in Sydney because there is so much trade to be conducted and they can do well by bulk-billing. If bulk-billing were removed, with the consequent drop in patients, then GPs would be obliged to look for patients – in which case the bush would not seem so bad.

Alternatively, the Government could learn from China and its “barefoot doctors”. 80 per cent of a doctor’s patients have a limited range of problems. Therefore, China has produced doctors with basic skills. Perhaps we will see an upgraded form of nurses, almost akin to GPs, in the rural sector. The implication is that rural people will have a lower level of medical care.

As I say, there is no easy answer to solve the shortage of country doctors.

BROADCAST ON FRIDAY NOVEMBER 13 1998 ON RADIO 2GB’S “BRIAN WILSHIRE PROGRAMME” AT 9 PM, AND ON NOVEMBER 15 1998 ON “SUNDAY NIGHT LIVE” AT 10.30 PM.