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Monday, 9 December 2013
Page: 1885


Mr RAMSEY (Grey) (11:22): I thank the member for Kingston for her motion for, while it is certainly making some partisan political points, it does express at its heart a desire to address some of the critical medical staff shortages around the nation. It is very timely for me because it was only last week in this place that I raised the shortage of general practitioners in rural and regional areas. In fact, in my own town of Kimba and in the Elliston community on the state's far west coast, GP services are to be cut from full time to three days a week, and I will have a little more to say about this in a few moments.

Turning to the motion I can only concur with the member's concerns when she points out that we need to support a modern, proactive medical system with a sufficient and well-trained workforce. That is why, over the last 10 years, there has been such an increase in the number of medical undergraduate places.

It was said that, in the term of the previous government—and the member for Kingston once again gave this impression—the moves to address the doctor shortage, for instance, only came from her side of the parliament when in fact the figures I have here refute that. In fact, in 2003, there were 1,511 medical undergraduates in Australia; by 2006, there had been a 30 per cent increase to 2,071; and by the time of the change of government there were over 2½ thousand—a ramp-up of 1,000 or around 40 per cent. So the problem was well-recognised within the Howard government and addressed. In fact, since that time that number has grown by another 700: not as much as the initial increase; only about another 25 per cent. So both sides of politics have recognised the issue and done something about it. But it is like an oil tanker on the ocean: it takes some time to turn around.

I think it is something of an embarrassment to Australia that we have been reduced to poaching doctors and other medical professionals from all around the world to fill our shortfall. We should be very proud of our ability to train overseas students and, whether they then return to their country of origin or stay here, this world and Australia is a better place for it. But we should not have to actively entice fully trained doctors to come to fill a shortfall in Australia.

During the eighties and nineties I was a chairman of a local hospital board that has since been abolished by our state government in South Australia, a Labor administration, and we are far poorer for the event because it was part of the local board's job—their remit, if you like—to attract doctors into our communities. That chore has now become the responsibility of Country Health SA, and it is debatable how effective they are. After all, this government body is trying to attract people to live in communities that they do not live in themselves. It is far easier to be a champion of your local community than to try to tell somebody else how great it is when you do not live there yourself. However, in the eighties and nineties, there were plenty of doctors in Australia, and we had just a distribution problem—that is, there were too many in the city and not enough in the country. This in turn led to over-servicing and was at least part of the reason that the undergraduate intake numbers were cut.

Like an oil tanker, as I said, it takes time to turn around, and the tendency to overreach is not limited to the training of medical professionals. So by the time it became obvious we were going to run short of doctors, it took almost 10 years to fix the problem. But we will approach that point in the next few years.

The member's motion expresses concerns that funds to support clinical training are frozen. She should fear not, because the coalition is acutely aware of the need for training and placement. The reason we are so aware is that, collectively, we represent regional Australia, and it is regional Australia that is the canary in the coalmine when it comes to medical workforce shortages. It is our communities that suffer first, and so we have a great commitment to addressing the shortages. I assure the member that the funds have not been cut despite her party leaving the Australian people the worst set of government debt figures ever and leaving Australian industry on its knees and unable to compete internationally, suffering the burden of new taxes and market regulation that they on her side have personally been responsible for. She should have no fear because the coalition is committed to delivering the same funding deal for training as was the case under her government, and that is the deal that continues through to 31 December 2014.

All government expenditure is under review to identify waste and inefficiency. In fact, the government has established an audit commission to do exactly that across all arms of government. Considering the long list of underachievements and policy and delivery failures under the previous regime, we would be failing the Australian people if we did any less. However, the funding is earmarked and it will flow, and those questions are answered. Beyond that point—that is, December 2014—I point out to the member for Kingston that that is why we have a budget, and it will come soon enough.

I was speaking earlier about the rural doctor shortage and, as I said, we are once again heading for a time when we have sufficient numbers and, quite probably, a surplus in Australia, but we should be considering measures that will curtail this and—even more importantly—address the acute shortages around rural and regional Australia.

We all know the difficulties in finding GPs for country practice, and the problems and obstacles seem to be growing by the day. Backup, on-call, partner's opportunities, feminisation of the workforce, children's education, and training opportunities are just some of them. Perhaps a straight desire to live in the city close to elite sport, the arts and more dining options is another. I understand all that, and there is nothing wrong with people—doctors or anyone else—making those decisions about their lives.

However, there is much that is good about country practice, and many of my friends who are GPs and live and work in the country tell me they relish the hands-on responsibility for people's lives and the opportunity to practice their full range of skills and not take the accepted and peer-induced pressure to refer many of their clients to specialist services simply because they can.

The financial rewards for country service are well in front of city practice. Recently a rural based doctor in solo practice told me that he did not know why doctors were so reluctant to tell others what they earn in single-doctor practice. But in any case he was happy to share that he earned $300,000 to $320,000 a year after expenses but before tax. In that case it is difficult to see that money is the issue.

For mine, it is time we started to look at what we as taxpayers are receiving for the vast amount of money we invest in the health system. I was always taught that the customer is always right. Perhaps it is time to look at who the customer is and what it is they want. It could be argued that the customer is the patient, and certainly to some degree that is right. It is not hard to work out what the patient wants. They want a good local service, and that is amplified in country Australia. We want the service where and when we can access it. That goes for doctors, hospitals and the whole bit. We accept that not every service can operate everywhere, that communities need a certain minimum size for these services to exist. But where those pre-conditions exist and viable practices are on offer, we want them staffed.

Even further, though, it can be argued that the primary customer is the taxpayer as the funder of the service. The taxpayer pays for the service and it should be what we want, when and where we want it. Why would we as taxpayers, having largely paid for the training of the doctor, then allow the doctor to set up a business in an over-serviced area like North Adelaide? Why would we not, as the purchaser, insist the service be delivered in Kimba, or Elliston, or Hawker, or Coober Pedy or anywhere else where we require the service.

I believe it is time we seriously considered making Medicare provider numbers postcode specific. That is, if doctors wish to access Medicare subsidies, they will have to go to a location where a vacancy exists and not be able to set up anywhere they think looks a nice place to live, and then begin to compete for a finite market. Sure, there would be all kinds of issues surrounding practice assets. Obviously such issues would require extended transition periods, but it is worth remembering many of these traditional assets are not worth what they once were. Just try selling a small practice in a city area, with the advent of superclinics and 24-hour practices, and you will see what I mean. Almost certainly the medical profession will vigorously defend the current arrangements, but, after all, why would we give someone a subsidy to supply a service where they want to live and not where we want the service?