Dr NELSON (12:08 PM) —It is with a great sense of satisfaction and pride that I speak in the debate on the Health Insurance Amendment (Rural and Remote Area Medical Practitioners) Bill 2000. In a former life, when I was president of the Australian Medical Association, at the time that I stepped down from that position in 1995 there were five country doctors a week leaving the bush. There were a range of good initiatives which the previous government had undertaken to try to reverse that trend, and a whole range of holistic measures are now being undertaken by this government to not only stop that but to very much reverse it.

The member for Batman spoke quite correctly about the need for a holistic range of measures or a package to attract not just doctors but nurses, psychologists, podiatrists and others to regional and rural Australia, and keep them there. The Rural Bonded Scholarship Scheme, for example, is just one part of a range of measures undertaken by this government. This year's budget committed $562 million to bridging the city-country health divide. It was a two-pronged package, which included a series of measures to address the chronic shortage of medical practitioners and a longer term strategy—of which this bill is one significant instalment—to encourage younger people to take up the practice of medicine in country Australia.

As the member of Batman alluded to, the budget announced a $210 million increase to support the number of doctors, nurses, psychologists and other health professionals. Another $162 million has been committed to providing further medical training for doctors and graduates, and there is $185 million for extending regional health services in aged care, child health, community care, substance abuse and mental health—all things that, quite rightly, the member for Batman has called for. At present in city areas and electorates such as mine we have, on average, one doctor serving 1,000 people—in fact, the ratio is less than that in my area. Once you go beyond the Opera House and the relative comfort of our major cities, you might find one doctor for 1,500 or 2,500 people.

Following the release of this year's budget, the minister said that the rural bonded scholarships would build on the government's $200 million payment scheme that currently rewards general practitioners for staying in the bush and establishes a number of new scholarships and rural support schemes. The government also announced this year an extra 50 general practitioner registrar training positions specifically for rural areas, which means that young doctors have opportunities to train specifically for practice in rural Australia. Some $49.5 million dollars was announced over four years to increase a range of services that support the retention of country doctors, including providing more nurses for general practices, more psychologists and podiatrists. Another $49 million has been allocated this year to establish the infrastructure funding necessary to take specialists out to country areas to provide services, and of course there is the Rural Bonded Scholarship Scheme, to which this bill gives effect.

We also announced in the budget the establishment of nine new clinical schools in medicine and three new university departments of rural health to ensure that every Australian medical faculty has a country training facility. Small bush hospitals and community nursing homes also benefited from a $30 million commitment to identifying and supporting private facilities and making them more viable and relevant to local communities. From that small snapshot of what the government is actually doing, it becomes fairly clear that this government and this minister—I presume, from what I have heard this morning, supported by the opposition—are taking meaningful steps to get doctors into rural Australia and keep them there.

I have practised medicine in country areas and I take my hat off to any doctor or allied health care professional who is prepared to service country Australia. I remember doing locums for country doctors. On the first occasion, the fellow and his family went on holiday and left me with the house, the cars, the practice and the patients in the hospital. I thought, `Oh, this will be a nice three-week stint in a nice country area'—it was down the Huon Valley way, with which you will be very familiar, Mr Deputy Speaker.

Your day normally starts at about 6 a.m., usually with telephone calls. People ring wanting advice or wanting to see you before the surgery starts, or the hospital calls because they want you to go there and see someone who is unwell. Even though you would leave for work at about 7.30 a.m., people would commonly—in fact, every second day—knock on the door of your house seeking treatment before you even got to work. You would then have a morning session with between 35 and 50 patients and in your lunch break—and I use that term figuratively—you would spend an hour at the local hospital seeing patients and attending to the management issues and problems that the nurses raised. You would return to the practice, usually doing a couple of home visits on the way, leave the surgery at about 6.30 p.m. and do another home visit on the way home. You would finally get home at about 8.30 p.m. and there would be more knocks on the door and phone calls. You would get to bed at about 11 o'clock and every night you would get at least one phone call.

On average every third night you would be out of bed to do a home visit. You would be looking for a red letterbox next to a log on the side of the road 40 kilometres from the house. In fact, one of the home visits I did, I drove 30 kilometres to arrive at a farm to find that the patient was a cow. The cow had hypocalcaemic tetany. I was trying to find a vein in the foreleg of this cow. I struggled a bit with that, got intravenous access, and gave this cow a calcium infusion. I said to the farmer, `Would Dr Bloggs'—the doctor I was doing a locum for—`normally do this?' He said, `Oh, yeah.' So I asked him, `Well why do you call a doctor when you've got a sick cow?' He said, `Because it's a quarter of the price of getting a vet.' In terms of wondering why it is so difficult to get doctors into rural Australia that just gives you some little insight into it. In my years doing locums I did half a dozen for country doctors and they have my greatest respect and admiration.

I will give further perspective to what this bill is about. One of my medical colleagues and friend is a great woman called Dr Leanne Rowe whom I met with her husband when they were working in a remote Aboriginal community in 1994 when I was up in the Cape. She and her husband spent 13 years practising at Bannockburn in rural Victoria. When she finished she wrote me a letter. I would like to read some of this to the House because I think it is worth reflecting on. She wrote:

This was written four years ago. She went on:

She continued:

The Health Insurance Amendment (Rural and Remote Area Medical Practitioners) Bill 2000 gives effect to that extremely poignant, graphic and accurate picture of what it was like to practise medicine in rural Australia four years ago. I am sure it is still, by and large, the same today, notwithstanding significant sums of money that have been sent there. It is, as Dr Rowe suggested, part of a long-term strategy. A total of 100 new medical students will receive $20,000 a year to study medicine on the condition that they agree to work in a rural community for six years on completion of their postgraduate medical training as a general practitioner or as a specialist.

If doctors breach the contract, they will not have access to a Medicare provider number to practise wherever they like for up to 12 years. This means that an extra 100 doctors a year will go into rural areas once the first cohort graduate from final training about six to 10 years from now. Those who breach their contract to service rural Australia can work in a public hospital, go into research, work in an Aboriginal medical service, or work in corporations and government authorities.

I think some of the criticism made of this scheme by some sections of the medical profession is petulant and being made in a vacuum of understanding of what changes are being worked into our society. The people in these communities whom these proposals are intended to serve are at the epicentre of the economic and social changes being wrought in this country. These are people who live and work in communities where entire industries are disappearing. Their hard work and taxes basically finance the education not only of medical practitioners but of a whole range of professional people whose services they so desperately need.

The worst-case scenario for someone who goes into a bonded scholarship and signs up for this—and by definition they are not unintelligent people—is not that you are going to be unemployed or lose your house or feel a sense of shame that you are of no value to society. The worst-case scenario is that you might have to work in a public hospital or go and work in a highly paid job in a private corporation or go and do some medical research or work in an Aboriginal community. There are many people I represent in a relatively affluent electorate who would wish that such things were visited upon them, yet sections of the medical profession are saying that this scheme is an aberration. Personally, I think some of my colleagues in the medical profession need to be led to an understanding that these sorts of decisions are very much in a societal interest. They should very much support them, notwithstanding some of the legitimate concerns put up by the member for Batman.

It means that 100 Australians are going to study medicine who would otherwise not have the opportunity to do so. People who would otherwise not be able to get a medical education and lead a fulfilling life practising medicine will be able to do so. The legislative nature of the scheme is necessary to ensure that Australian taxpayers receive a fair deal, a fair return for their investment. Nonetheless, there is a provision for the minister to waive, under exceptional circumstances, the period of work in rural Australia. That is critically important. I notice that the AMA has said that perhaps it ought to be decided by some sort of independent tribunal or committee. That is not something to which I am personally wedded. In the end, the minister of the day—whoever it is; whatever political party is in government—needs the authority to determine whether a waiver will be provided or not, and may well take the advice of an independent committee, if one is so empanelled. Some have suggested that the six-year clock should start ticking earlier. This would mean that inadequately and not yet fully trained doctors would be providing service in rural Australia.

The member for Batman said that this was a very prescriptive thing. There are a lot of innovative things that the government has done. One of the things announced in the budget is that, having graduated, you can work off your HECS debt for each year of service, I think up to five years, in a rural area. That is an innovative strategy which means that a person graduating from medicine can say, `I'm going to deal with my HECS debt by doing some community service in areas where I'm needed, as defined by the definitions of what is rural and what is regional.'

So we have got $20,000 per year for each year of an undergraduate course to a maximum of four years, for those in a graduate course, and six years for those in a traditional six-year program. The scholarship is taxable and the usual HECS arrangements would apply. The student must undertake six continuous years of service in a rural area. If there is a breach of contract, if you fail to graduate, if you fail to obtain a fellowship or if you do not complete the six years of rural service, a penalty will be applied. It means repaying the money with interest and not being given a Medicare provider number to practise wherever you want to practise for 12 years, minus the years already served in a country area.

This initiative was proposed by the Australian Medical Association. It was something that I promoted when I was there. I notice that the AMA is disappointed by, if not hostile to, the fact that the arrangements are not—

Mr DEPUTY SPEAKER (Mr Nehl)—Order! The gentleman should not enter through that door; that is on the floor of the House. Strangers should come in by the other door.

Dr NELSON —Thanks, Mr Deputy Speaker, I really appreciate that. It was very helpful.

Mr DEPUTY SPEAKER —I hope you were not too startled.

Dr NELSON —Yes, Mr Deputy Speaker. With respect to the criticisms that have been made by the AMA about it not being as they might have intended, I say: life is a two-way street. The people whose taxes and hard work are funding the medical education and the provision of services, and private practitioners who are working in the system underwritten by the taxpayer through Medicare, must reasonably accept that to get 100 kids into a medical course who otherwise would not get access to an education, and to get them to service areas where they are desperately needed by people who are losing their livelihoods in industries that are disappearing from under them, is very much a fair deal. I think the provisions in terms of compliance are ones that ought to be supported by everybody.

Debate (on motion by Mr Hawker) adjourned.