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Thursday, 26 November 2009
Page: 13120


Ms MARINO (10:47 AM) —I rise to speak on the Health Insurance Amendment (New Zealand Overseas Trained Doctors) Bill 2009, which aims to streamline the operation of section 19AB of the Health Insurance Act 1973 and to remove several anomalies. The bill will remove the restrictions imposed by the act on New Zealand citizen and permanent resident doctors in relation to their access to the Medicare benefit arrangements. It will also remove current restrictions on New Zealand doctors educated at accredited medical schools within Australia and New Zealand. Under this legislation they will no longer be subject to the 10-year moratorium on access to Medicare benefit arrangements and will be removed from the classifications of overseas trained doctor and former overseas medical student.

The bill will also change the start time of the moratorium for other overseas trained doctors, who are currently required to have both residency or citizenship and medical registration before the moratorium begins. Under this legislation the moratorium will start from the time doctors receive medical registration with consideration given to doctors’ working visas before obtaining residency or citizenship. Another change is the introduction of the time period in which medical practitioners can appeal against the refusal to grant a section 19AB exemption or a decision to impose conditions in connection with an exemption that has been granted. Currently, the act does not have a time limit to apply for the review of a rejected exemption application. This amendment will create a provision in the act that will allow applicants to apply for a review of a decision within 90 days of that refusal. The legislation would also include a 90-day period for a review of a decision to impose one or more conditions on that section 19AB exemption.

This bill could be considered uncontroversial—and it is—with major stakeholders including the AMA, rural doctors and the RACGP supporting the bill and considering it a positive change. Furthermore, the Senate Standing Committee on Community Affairs had no comment to make on this bill and it has not been referred to a senate committee for inquiry or report. Overseas trained doctors and former overseas medical students have generally been restricted from providing professional services which attract Medicare benefits for a period of 10 years commencing on the date that the person becomes a medical practitioner and a permanent Australian. However, overseas trained doctors and former overseas medical students may be granted an exemption from these restrictions.

Plans to increase the number of medical student places is extremely important, as we have heard in this House today. Attempts to increase the supply of Australian trained doctors in the future is also very important, but, as we know, given the amount of time it takes to train a doctor the effect will not be felt for many years. It should be noted that increasing the number of graduates will not necessarily result in increasing rural, regional and remote practising doctors; the two are not a mutual arrangement. It does not necessarily happen that those trained doctors will actually go out to rural and regional areas like my own.

As the Bills Digest states, in the mid-1990s doctor shortages in rural and regional and remote areas, such as my electorate of Forrest, became increasingly obvious. An article in the Sunday Times on 15 March this year stated:

… new figures show that WA has fewer doctors, as a percentage of population, than any other state or territory in Australia.

That is certainly the case in my electorate in the south-west of Western Australia. According to a West Australian newspaper article from July this year, there were at least 54 vacancies for GPs in country WA and regional areas. When you consider the distances involved in accessing medical attention in the regions, this is a really significant number. And despite an increase in medical students in Australia, rural, regional and remote communities in Western Australia continue to rely on overseas trained doctors, like those from New Zealand. This is largely due to the two requirements that must be met before an overseas trained doctor is considered eligible for employment in WA: the location must have been classified as an ‘unmet area of need’ by the WA government and a ‘district of workforce shortage’ by the federal government.

One of the well-known and experienced doctors in my electorate recently reinforced the importance of overseas trained doctors in our particular area. He is a person with a great interest in the medical profession and sees it right across the state. He said, ‘Overseas trained doctors are the backbone of general practitioner services in country areas.’ For those of us who live there, there is no doubt that this is the case. The general practitioner shortage is so severe in my electorate of Forrest that a medical attraction task force was developed as a result of the work of Dr Ron Jewell, who saw a particular model operating elsewhere in Australia and believed that this was what we needed to attract and retain GPs in Forrest.

The medical task force got together to address the challenge of sustaining the services of medical practitioners in communities right across the south-west. The greater Bunbury area, which is the largest population centre in my electorate, is currently classified as an area of unmet need for GPs. The doctors have also stressed the terrible situation that faces many smaller country towns. Even Bunbury itself, which was voted the Best Tourism Town in WA in 2009, still cannot attract general practitioners. I noted the comments of the previous speaker, and Bunbury is also a part of the world that one would expect could attract and retain professionals of all types, particularly doctors. I understand that the shortage of doctors in the Bunbury region is largely contributed to by the fact that GPs service not only the Bunbury area but also the smaller surrounding towns. So many people from around the area actually make appointments to see the doctors in Bunbury itself, so their workload is quite significant. Also, disturbingly, in September 2006 it was estimated that Bunbury was short of at least 10 medical practitioners and that the average age of general practitioners in the area was mid- to late-fifties.

Let us look at what has actually happened from the task force that I referred to. I will quote from an article from my local newspaper by Lee-Maree Gallo. I am really pleased that the South West Medical Attraction Task Force has reached stage 3 of its objectives. It has been working hard at implementing a plan to get GP and specialist practitioners into the region and to retain them there. According to the article:

Twelve local government councils in the region are involved including Bunbury, Capel, Harvey and Dardanup.

Consultant Alison Comparti was quoted in the article as saying that at the moment in the south-west there was one GP per 1,700 patients when it should be one GP per 1,200 patients. ‘Some areas have enough doctors but then others don’t,’ Ms Comparti said, and Bunbury is one of those areas. She also said:

… the taskforce had several ideas to entice practitioners to the region such as using the Bunbury Regional Hospital as a training hospital for medical students, professional linkages for spouses and partners of practitioners and linkages with educational facilities for spouses and children.

“Medical graduates are more likely to return to the region if they have had experience down here,” Ms Comparti said.

“We also want to set up a network with local schools to ensure the children of doctors can gain a place at their preferred school.”

I note that the task force will release its report next month.

It was interesting that one of the reasons for the shortage given at the forum that I and the member for Bunbury, John Castrilli, who is also the Minister for Local Government; Heritage; Citizenship and Multicultural Interests, were part of was that, even when doctors were attracted to the area, they looked around at the facilities and opportunities not only for themselves but for their families—and that could also include the professional opportunities for their partners—and made judgments on that basis. So these are all part of the assessments that a doctor might make when considering where he will locate and choose to practise.

A doctor in my electorate also stressed, as I said, the terrible situation for many small regional towns. Often these are overlooked. Our major centres often attract more doctors than small regional centres, where you will find perhaps a GP or even two working so hard and such long hours to service the needs of their patients. And they do take it very personally. I know the Western Australian government has tried various methods, including funding grants for general medical practices to extend their opening hours. However, it often comes down to the simple fact that rural, regional and remote areas cannot even attract enough doctors for adequate services during normal working hours, let alone those outside normal working hours.

I am still concerned that some of the proposed youth allowance changes could work against increasing the number of medical students. I was contacted during this time by a sole income earner with eight children. She provided her financial details to show the impact that the youth allowance changes will cause to her. She said that the total cost for her to send one child to university is nearly a whole year’s income. She is ineligible for any assistance under the youth allowance changes and will have to find an alternative way of financing her children’s attendance at university. But they are intending to become doctors.

We really need to encourage and foster young people from our regional areas who want to become professionals to go away and train but come back to our regional areas. Their knowledge and experience of, their empathy for and their commitment to their own regional area could not be questioned. We need to get these bright young people to train to become GPs but come back to our rural and regional communities. The government’s expectation of a student who wants to study medicine that they will take two years off to become eligible for independent youth allowance and then complete at least a six-year medical degree really does compromise this outcome.

Retaining and attracting doctors is really vital and it is of immediate need. An article that appeared in the Sunday Times in Western Australia during March of this year quoted that more than 60 per cent of doctors working in rural and remote WA have been recruited from overseas. The article went on to say that the doctors are being used as a last resort to relieve pressure created by the severe shortage in the region. They include eight New Zealand doctors working on a part-time basis.

The main provision of this legislation is in relation to the removal of current restrictions applicable to New Zealand permanent resident and citizen doctors who obtain their primary medical education at an accredited medical school in Australia or New Zealand. Effectively this will mean that these doctors will be excluded from the classification of overseas trained doctors and former overseas medical students under, as I said earlier, section 19AB of the Health Insurance Act. It should be noted, however, that, like all Australian trained doctors, New Zealand graduates of Australian medical schools will be required to gain postgraduate specialist medical qualifications or be in approved placements before they are eligible to access Medicare.

In conclusion, I support this legislation in its aim to streamline the operation of section 19AB and remove the anomalies. Given the impact that additional numbers of overseas trained doctors from New Zealand could have on my regional and rural electorate, let alone other similar electorates throughout Australia, I certainly support this legislation.