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Thursday, 25 August 1994
Page: 392


Senator LEES (Deputy Leader of the Australian Democrats) (4.00 p.m.) —I too have taken a strong personal interest in the declining number of general practitioners prepared to practise in rural Australia, and I thank Senator Sandy Macdonald for bringing the matter before us today. It is a matter on which I have spent considerable time over the last 2 1/2 years. I have travelled extensively in rural South Australia, and in particular I have talked to GPs, specialists, specialist doctors, hospital administrators and directors of nursing, as well as to people in hospitals and health centres.

  In my home state of South Australia over the last three years we have managed to bring the vacancies for doctors down from 30 to 25. The Minister for Family Services (Senator Crowley) has given us some examples of how the federal government has been working to help in this regard, one example being rural practice grants. In particular I commend those working at Modbury Hospital in the rural practice unit. There is certainly a lot being done in South Australia but unfortunately we are barely holding the tide. We are looking at a situation where many doctors are approaching if not retirement age then certainly burnout age. They are looking forward to greater periods of time with growing families and also to greater leisure time for themselves.

  As Senator Sandy Macdonald has already said, Australia-wide we have somewhere between 400 and 500 vacancies for general practitioners that cannot be filled. At the same time we remain in a situation in some suburban areas—my home state, the eastern suburbs of Adelaide, for example—where we are well and truly over-supplied with doctors. It is not just a rural problem. In Adelaide's northern and southern suburbs there is also a drastic shortage both of doctors who are prepared to practise there and locums who are prepared to go there to fill in.

  At this very time there is a conference taking place in Alice Springs which is looking at the whole question of rural medicine, and particularly the shortage of doctors in rural areas. It is highlighting, for example, the situation in the Northern Territory which was described to my office this morning as being at crisis point and getting worse, particularly in areas where Aboriginal people need additional health support.

  This is not a problem we can simply lay at the feet of federal government. I emphasise the role that a couple of state governments are playing in this area. Shaking the foundations of rural hospitals is perhaps the quickest way to make sure that doctors do not want to go to rural areas and also do not want to stay. The closing of rural hospitals has already occurred in my home state, and it is a problem, but there is also the threatened downgrading, downsizing and underskilling of rural hospitals. I recently visited a hospital where there is only one nurse on duty at night. The stress on the nursing staff as well as on the medical practitioner can best be described as extreme.

  As Senator Crowley has already said, this really does not come down to just money. In some parts of South Australia we are looking at packages where up to a quarter of a million dollars has been offered for a doctor to practice there. We are looking at rural communities offering housing and family incentives such as support for the children to go away to school, but still they cannot get a doctor. From surveys of doctors, both those practising in rural Australia as well as those who do not want to go there, we see a list of problems which includes the inability to get locum relief; the lack of opportunities for spouses in regard to employment; social isolation of the spouses; and also their own future medical education as they are worried they will never be able to get away to upgrade or update their skills. There are also concerns about their current levels of expertise.

  I will return to this later on, but there is a problem with trying to attract the right quality of doctor into rural Australia. There is also concern about educational opportunities for doctors' children, particularly post-primary education. It seems that primary education is not such a great problem, but once children get to high school many doctors see a need to be back in one of the major cities.

  So what are some of the possible solutions? In the four minutes I have left I will briefly run through a few of them. In regard to training schemes, I will look at what is happening at Modbury and at other suggestions for supporting rural students to study medicine. It is a great idea but with the rural crisis many students out there cannot get Austudy and, if they can get Austudy, their families still cannot afford six or seven years of income and housing support for them to go and study medicine, despite the fact they have the points at matriculation. We are looking here at some sort of Commonwealth program that will either offer scholarships or some other level of support for rural students who have the qualifications but not the finance to study medicine.

  Whilst I do not support these kinds of suggestions, I think we need to run through them. It has been suggested to me that we may need to change the immigration laws to enable doctors from other countries to fill some of the vacancies. One of my problems here is that we are often attracting doctors who are desperately needed—often in rural and remote areas—in their own countries to meet a problem here that we should be able to solve ourselves.   Then we can move to specific Commonwealth action as opposed to just offering incentives. We need to have a very close look at what state governments are doing with rural hospitals. Yes, that might mean taking over the funding of some of these hospitals. If that is what it means, so be it, if we are to ensure services in rural areas.

  We need to look at putting pressure on the medical profession. I acknowledge the role of the College of General Practitioners, the AMA, the Doctors Reform Society, the Rural Doctors' Association and virtually every other group one could name as I think they now understand and support what the government is doing to get doctors into rural areas. However, we have to face the fact that we are barely stemming the tide. We are treading water in most states. In some states, such as in the Northern Territory, we are not able to do that.

  Australian taxpayers are contributing to the education of these people, in many cases for seven or eight years, and all taxpayers are entitled to benefit from the kind of money we are putting into medical students. I think we would have to say that there is a limit to how much taxpayers' money one can look to by way of incentives and grants. Perhaps we could start to look at the possibility of bond schemes or other ways by which we could directly tie doctors after graduation to a set number of years in rural areas.

  Following on from the minister's comment about a basket of services, perhaps greater authority should be given to nurses to prescribe certain drugs or to conduct certain medical treatments without medical supervision. I understand there is a program running in New South Wales at the moment that is looking at additional services which could be provided by nurses. Hopefully if that is successful we will see an immediate spread of those opportunities across rural Australia.

  I guess this is fairly controversial, but there is also the possibility of allocating some Medicare numbers. Rather than allow doctors to come out of college and decide they want to set up in Toorak, Paddington or somewhere else, they should simply be told very clearly that there are no vacancies in those suburbs. It is done in the cases of teachers and other professionals. We have to look at Medicare provider numbers as a last resort if we cannot get doctors into these areas. Some of these are not terribly palatable solutions, but I think we are fast reaching the point where we have to acknowledge that the free market and the incentives have not worked and that if we are to get medical services into areas of Australia that critically need them then the Commonwealth government really has to take some action.