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Wednesday, 4 December 2002
Page: 7127

Senator EGGLESTON (12:45 PM) —I want to talk today about the shortage of doctors—both of general practitioners and specialists—in Western Australia. This shortage was amply demonstrated by the results of an Australian Bureau of Statistics survey entitled Private Medical Practitioners, which was released in late October this year. Although the conventional wisdom, including that of the Australian Medical Workforce Advisory Committee— AMWAC—is that there is an overall surplus of GPs in Australia, with an oversupply of GPs in metropolitan areas and an undersupply of GPs in rural and remote areas and outer metropolitan areas, a relatively recent Access Economics study commissioned by the Australian Medical Association has challenged this and asserted that there is in fact a national shortage of GPs. Using a demand model, the study estimated that there is `currently a shortfall of GPs of between 1,200 and 2,000'. Under a conservative scenario, Access Economics estimated that the `rural shortage is estimated at 700 FTE GPs and the urban area shortage at 500'. This study took issue with AMWAC's benchmarking, stating that `most Australians do not share AMWAC's view of adequate GP supply' and that `AMWAC's assumption of the acceptability of the benchmark is not backed up with any analysis or justification'.

Under the policies of the Howard government, the number of GPs in regional Australia has significantly increased. However, demand for increased numbers of GPs is expected to continue over the next decade, with the Australian Bureau of Statistics estimating that Western Australia's population will rise by 13.1 per cent. Over the same period, the number of people aged 65 years and over in Western Australia is estimated to increase by 1.7 per cent. Elderly people generally consume more health care services than any other sector of the population and present with more complex health problems and with more chronic conditions that require management. Access Economics has estimated that the `demand for GP services based on an ageing population will increase by 1.27 per cent per annum over the next 10 years'.

The medical work force problem has been alleviated somewhat by a reliance on overseas trained doctors. In 1993-94, there were 664 temporary resident visas issued to overseas trained doctors throughout Australia. By last year, this had risen to 1,923 such visas. Western Australia is very heavily reliant on temporary resident overseas trained doctors to fill positions in hospitals, general practice and locum services; for example, the WA state hospital system is heavily dependent on overseas trained doctors and, without these doctors, the WA state hospital system would undoubtedly collapse.

In 1997-98 temporary resident doctors comprised 14.9 per cent of the WA medical work force, and 77.1 per cent of temporary resident overseas trained doctors were employed within metropolitan health services. Thirty-six per cent of Western Australia's rural medical work force are overseas trained doctors. There were 646 conditionally registered overseas trained doctors within Western Australia as at November 2001. This comprised: `unmet area of need', 427; recognised specialist qualifications and experience, 90; foreign specialist qualifications and experience and undergoing further training, 11; temporary registration in the public interest, eight; conditional registration for rural and remote general practice, 50; supervised clinical practice, 24; postgraduate training, 32; medical teaching, one; and medical research, three.

In 2002, 456 temporary resident overseas trained doctors were approved to work in general practice positions in areas of need in Western Australia. By way of contrast, only 58 temporary resident overseas trained doctors were approved to work in general practice positions in areas of need in New South Wales—with a population of 6.5 million in 2001, compared with Western Australia's population of just 1.9 million. The number of overseas trained doctors who were registered in the unmet area of need category has therefore increased by something like 380 per cent since 1996.

According to the Medical Board of Western Australia, the reliance placed on overseas trained doctors continues and it is considered that the number of locally trained doctors who take up appointments within the public health systems falls well short of meeting the needs of the community. As of September 2002, towns such as Broome, Collie, Donnybrook, Geraldton, Kalgoorlie and Mount Barker are all listed as areas of need with practice vacancies. The Access Economics report points out that due to competition with other countries, such as Canada, it will become increasingly difficult for Australia to recruit overseas trained doctors. The report notes:

As this competition intensifies, simple demand pressures will push up the remuneration that medical practitioners willing to move to the country will be able to demand.

Making matters even worse, other countries with doctor shortages are trying to poach Australian medical practitioners.

A recent study by Monash University and Melbourne University researchers Lesleyanne Hawthorne and Bob Birrell has brought into question the qualifications and fitness to practise of some overseas trained doctors. This study had a particular focus on permanent resident overseas trained doctors and revealed that, in some cases, doctors are working in public hospitals and as GPs in areas of need without having had their skills formally accredited. Permanent resident overseas trained doctors have been required to have their skills accredited by the Australian Medical Council. However, according to this study:

... in recent years this policy has been effectively thwarted as State Medical Boards have provided `conditional registration' to permanent resident OTDs who have not completed their accreditation or have failed in their attempt to gain this accreditation.

The study found that the great majority of temporary resident overseas trained doctors are from Britain, South Africa or other societies with medical skills similar to those in Australia. However, it found that the bulk of permanent resident overseas trained doctors:

... have graduated from non-Western medical schools in Asia, the Middle East and Eastern Europe. Their training varies greatly in quality, relevance to the kinds of health problems encountered in Australia and preparedness for the advanced technology they encounter in the Australian hospital environment.

These doctors can also experience difficulty in communicating with staff and patients. Surely it has to be said that English language skills are very important when it comes to practising medicine in Australia.

The President of the Rural Doctors Association of Australia, Dr Ken Mackey, has made the point that the skill levels of overseas trained doctors are variable and the continuity of care provided by the long-term general practitioner is lost. Similarly, the President of the Rural Doctors Association of Western Australia, Dr Graeme Jacobs, has said that there are some problems with overseas trained doctors and those problems are not only in clinical skills areas but also the social and cultural problems of putting overseas trained doctors into a remote area. For example, the WA Medical Board used to send overseas trained doctors to places like Meekathara in the Eastern Goldfields where there was no effective support or supervision, and the doctors concerned felt very vulnerable and exposed. It was hardly a prudent solution to the needs of such isolated towns and hardly fair to the doctors concerned, who felt they were being thrown in at the deep end.

All of this helps to demonstrate that over-reliance on overseas trained doctors is not in the overall best interests of the health and welfare of Australian patients; although in this regard it should be noted that, in response to concerns raised by hospitals, Western Australia has recently introduced an assessment procedure for overseas trained doctors seeking to be employed in unmet area of need positions in Western Australian hospitals in non-specialist and non-specialist training positions. The process is designed to reduce the potential for OTDs to be in a position where there is insufficient supervision and professional support.

The use of overseas trained doctors to fill medical work force shortages is essentially a stop-gap measure, and longer-term solutions are needed. One long-term solution would be to increase the number of Australian trained doctors. The University of Notre Dame in Fremantle has come to the conclusion that the only acceptable long-term solution to the doctors shortage problem is to increase the number of medical practitioners training and graduating in Western Australia. This is especially the case because the number of locally trained doctors who take up appointments within the WA public health system currently falls well short of meeting the demands of the community.

What is therefore required is an increase in the total number of medical school graduates produced in WA. Graduates produced in Western Australia will be more likely to practise within the state. Notre Dame University has pointed out that very few Eastern States medical graduates are prepared to spend their working lives in Western Australia. For some reason, the Nullarbor proves to be an enormous barrier. It is feared that, if there is not an increase in the number of locally produced graduates and trainees in WA, WA will become increasingly reliant on overseas trained doctors. Accordingly, Notre Dame is giving consideration to the establishment of a medical school at its Fremantle campus, using the facilities of other locations in the metropolitan area for teaching purposes as well. Notre Dame University proposes to establish a four-year postgraduate course for a medical degree.

After meeting with the people involved in planning the format of the proposed medical school, I came away very impressed with Notre Dame's case, not only on the grounds of the need to increase the number of doctors graduating in Perth but also because the focus of the curriculum will be on general practice medicine. Additionally, a new medical school would offer a choice of courses to WA students, the University of Western Australia being currently the only institution in the state that offers medicine. If Notre Dame medical school went ahead, it would be the first private medical school in Australia. It is proposed that the school develop partnerships to deliver its courses, with other universities, such as Curtin, delivering the basic medical science requirements in their curriculums. The school will also make use of the private sector for clinical placements in areas such as private hospitals, the aged sector and general practice.

It is proposed that the school will take 60 Australian students annually. If the school goes ahead, it will of course be some years before the first graduates are produced and even more before they complete postgraduate training and enter medical practice, but the importance of the initiative is that it will assist to provide a long-term solution to Western Australia's doctor shortage problem rather than the bandaid fix represented by overseas trained doctors. It is said that from small acorns great oak trees grow and, just as the now very large and prestigious UWA Medical School had small beginnings back in 1957, I am sure that, once established, the proposed Notre Dame medical school will develop into an important Australian medical institution.