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Thursday, 25 August 1994
Page: 394

Senator TROETH (4.07 p.m.) —I too agree that the picture of rural and regional communities in Australia today which are attempting to attract and retain doctors is indeed a grim one. Approximately 30 per cent of Australia's population lives outside the capital cities, and that population is serviced by 10 per cent of doctors. There are 4,600 general practitioners in rural and remote areas. I know that my own home town of Heywood where I was on the hospital board for some years spent something like five years trying to attract a second doctor to the practice.

  Similarly to the other states that have been quoted by honourable senators, Victoria needs somewhere between 60 to 100 rural GPs. There are between 200 and 500 vacancies for rural general practitioners in Australia simply by way of placements and replacements. Medical schools should aim for something like 40 per cent of all graduates to take up a rural career to replace doctors who are either moving into retirement or who are not taking up those placements to start with. Not only that, the average age of general practitioners already in rural practice is rising. For instance, in my own home area of south-west Victoria 30 per cent of general practitioners are over the age of 55. We can only ask: `In 10 or 20 years, who will replace them?'

  Recent research in rural Victoria has shown that country people rate their preference for health services as follows: firstly, a doctor; secondly, a hospital; and, thirdly, a chemist. While I applaud and recognise the package of health services that is provided by the health professionals mentioned by Senator Crowley, it will never replace the ideal of a doctor. Why do not medical graduates want to go to the country or, indeed, stay there? The attrition rate is something like 20 per cent within five years of arrival. So even when medical graduates get there, they do not stay for very long.

  The reasons for medical graduates not wishing to go to the country have already been canvassed by other senators. I merely wish to add to this that, unlike the rosy picture presented in A Country Practice, the disadvantages of life in the country for sole practice medical practitioners are indeed real. There are few students in current medical schools with rural backgrounds and, as has already been pointed out, country students are at a disadvantage in getting there. In current medical schools there is also a high proportion of foreign-born and female students. Few of them are likely to want to leave the city for the country.

  What has the government done? Senator Crowley has already mentioned the rural incentives scheme and I will not bother to go over the details of that. However, it should be evident that money by itself is not enough to overcome the disadvantages of rural life for GPs and their families. Some of the measures introduced to correct the oversupply, such as the limitation of entry of overseas-trained graduates, have adversely affected rural communities which relied on this source for temporary relief and locums.

  It is acknowledged by the medical community itself that financial incentives alone will not work. The rural incentives scheme is largely paying those to relocate who will relocate anyway, and not enough general practitioners are taking up the offer. I gather that there is still $23 million in the kitty for this year and that only 23 doctors nationally have taken up the offer. That will not go far in addressing the shortage that I referred to earlier. It is not working, but there has been no appropriate evaluation to show why it is not working.

  The AMA and other respective professional organisations have also taken up the question of providing more doctors for rural areas. Last year in Queensland, the Royal Australian College of General Practitioners appointed a director of rural education and training. But the scheme initially only envisaged encouraging those who had already expressed an interest in taking up country practice. It is not as though these were newly converted graduates.

  It may be more hopeful to look to those entrants to medical schools who originally came from the country. A University of Newcastle study has preliminary data which suggests that students from rural origins are more likely to make their careers in rural locations than those who grew up in the cities. In addition, as has already been canvassed, incentives could be provided to secondary rural students to get into medical school in the hope that they would then return to the country.

  From a long-term point of view, the answer is to change prevalent cultural attitudes in Australia. Doctors and aspiring doctors should be educated to realise that there are attractions to life in rural Australia, and rural communities need to do all in their power to retain services. In my voluntary community worker career, I have observed with interest the power struggles and disagreements that can occur on hospital boards. This can be the last thing an overworked GP needs at the end of a long, hard day.

  As I mentioned, another key long-term strategy could be more appropriate selection criteria by universities and an understanding of and interest in rural issues by graduates. The government has signalled, by the volume of money it has thrown at these sorts of programs, that it is serious about tackling the problem, but the mere provision of money is not working. The government should take a close look at what it is doing, see why it is not working and set up programs in conjunction with professional organisations which hopefully will make some of these programs work. We must stop the drift of doctors to the cities from the country and we should look at initiatives designed to promote rural practice as an attractive and rewarding option for future general practitioners.