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Thursday, 25 August 1994
Page: 395

Senator WEST (4.15 p.m.) —I am delighted to hear Senator Troeth talk about setting up programs, but I would like to know what sorts of programs. I would also like to know what the opposition's policy is on this issue, along with other issues—but I suppose that will have to wait until a directions policy gets launched, if it ever does.

  This is a very important issue. It has been a very important issue for at least 30 years. It is 30 years this year since I left school and started nursing in a country town. In the country town I lived in there were six or seven GPs. There is still that same number today. Over that 30 years, surrounding country communities have had the problem of getting doctors to come to and stay in their towns. As has been said, many communities have instituted a number of very generous schemes and proposals to assist doctors to practise in their towns. There have been income guarantees. Accommodation has been provided next door to the local hospital. Every effort is made to provide all the assistance that is necessary to attract doctors.

  We have an oversupply of doctors in this country. But there is a maldistribution of these people. If we go to the eastern suburbs of Sydney, if we go to the North Shore of Sydney, if we go to the plush areas of Melbourne, or Adelaide, or Perth, or Brisbane, we will find that there are doctors on almost every corner. That is a slight exaggeration, but there are plenty of doctors. If we go to the western suburbs of Sydney, we will find that there is a shortage of doctors. There is also a shortage of facilities in those places. It is bad there, but it is even worse in the country areas.

  The Commonwealth government has set up a number of proposals that already have been canvassed by the minister, by Senator Lees and by Senator Troeth. We are aware of what is available in respect of assistance, but the problem is one of maldistribution. It is a problem that is not only the responsibility of the Commonwealth government; it is also a responsibility of state governments.

  The health policies of state governments impact upon whether a doctor is willing or tempted to accept a position. The state will not permit deliveries to be carried out in the hospital at Walgett, New South Wales. The closest hospital for most people in Walgett is at Dubbo—three hours drive down the track. Women in labour have to arrange their own transport and be driven three hours down a sealed road. These are the sorts of impacts that can occur. People are right when they say that we have to look not only at what the Commonwealth is doing, but also at what the states are doing.

  The states are doing other things that impact upon the quality of life in some of these communities. They have removed the support services. There are fewer people working in community affairs, or whatever it is called in the various states. Doctors with patients from families with child abuse problems are on their own. They have to cope with these problem families. There has been a reduction and removal of support services. The nature of transport services, such as rail, which the states have coverage of, impact very much on how desirable a community is to live in. These considerations affect the whole family structure and family life.

  We heard that there is a shortage of doctors in country areas. There is also a shortage of occupational therapists, speech therapists, physiotherapists, social workers and dietitians—the whole para-health professional group, with the exception of nurses. Nurses and doctors in some areas are out there carrying the burden. But the whole health professional support network is not there.

  We are expecting doctors to give bandaids to people. If someone who is in crisis with an emotional psychological problem comes in to see a doctor in a small community, the doctor has to say, `Sorry, the social worker or psychologist is busy today and is busy for the next three weeks. Just hold your crisis for three weeks.' Meanwhile, the nurse or the doctor in the area is left to support such clients until somebody can see them. These are the sorts of problems that are being faced by doctors in their efforts of provide health care in country areas.

  The training levels of doctors has been briefly mentioned. They may well spend one or two sessions away from the large teaching hospital with which as students and interns they were associated but they keep going back to those areas. When doctors finally finish their internship they know very clearly the drug regime for a cardiac transplant. But they are not quite so sure and confident when it comes to looking at a small child who is unwell with perhaps a case of otitis media and glue ear because those things do not come into the teaching hospitals and, if they do, they go to the children's hospitals. Again, it is a very specialised area and not the general area that doctors as interns and residents see.

  Whilst I am not being critical of the doctors for feeling that inadequacy, I would feel it myself if that was the situation with which I had to deal. It is something that has to be addressed. We also have to ensure that the universities look at how they provide these services. Also we must support and congratulate universities like Newcastle, which is not just looking at the HSC and TE score results but at the whole person, and Sydney University which is looking at people who might not have got such a wonderful TE score in the HSC, but who have actually gone on and got a graduate degree, to enter medicine. These are the sorts of people who will provide us with good medicine and want to be not just the professorial students and professorial residents and registrars but who will have a commitment to the average person out there, to the family out there who wants someone who will observe them and care for them as a whole family unit.(Time expired)