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Thursday, 5 December 2013
Page: 1828


Mr RAMSEY (Grey) (16:40): I come from Kimba—the district population is about 1,200. I was born in the local hospital, something that cannot happen anymore—obstetric services have been discontinued. I had my appendix removed there when I was nine and had another procedure when I was about 20. That cannot happen anymore—surgery has been discontinued. I spent 10 years on the hospital board, seven as chair, improving the service, eliciting community support and attracting new staff, including replacement doctors to the single-doctor practice. We cannot do that anymore, because the boards were all sacked. I have continually used the local doctor throughout that whole period and, apart from short times when the community was between doctors, have enjoyed wonderful full-time service. Now it seems, as of the end of this year, I will no longer be able to do that either.

Kimba is on eastern Eyre Peninsula, on the northern end of the grain belt. Cleve is 75 kilometres to the south and Elliston is 200 kilometres to the west. All three will lose their single doctors at the end of the year. It seems, with the abolition of our local champions on the hospital boards, the job of attracting new doctors to the regions has been subsumed by Country Health SA. In the case of the Kimba practice, at least, it was well known that the doctor wished to retire. The question must be asked: how dedicated has Country Health SA been to the task? Or were they willing just to let the retiring GP soldier on, serving the community out of a sense of loyalty until he finally baulked and refused to go on?

Country Health has announced that from early next year the three towns will be serviced by three new doctors working from the Cleve practice providing just three days a week services to Elliston and Kimba. Perhaps this is the best they can do, but I am not convinced that the management of these issues from afar by individuals who are not affected by the result attracts the same kind of dedication and enthusiasm as management by someone who is affected.

For instance, imagine trying to convince a target doctor what a great community it is to live in when you have never lived there yourself or to galvanise community support to present an improved and competitive package when you are not part of that community. We all know about the difficulties in finding GPs for country practice. The problems and obstacles are myriad—backup, on-call, partner's opportunities, feminisation of the workforce, children's education et cetera—but there are great benefits in country practice as well. Many who have lived this life tell me they relish the opportunity to be a 'real doctor' making a broad range of medical decisions about patient management and working on emergency management, rather than being a referral service to specialists for anything more complex than ailments that can treated by a course of antibiotics.

The financial rewards of 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 between $300,000 and $320,000 year, taxable. Not bad! Obviously money is not the issue. After all, if $320,000 a year does not work, I am not confident that half a million would work any better.

Managing the supply of doctors has always been fraught: not enough, too many, not enough and too many again. Certainly we have come through a period of not enough. With the ramp up of medical student numbers through the last 10 years greater supply is coming on-stream. But the question remains: how do we get them into rural Australia? There is an old adage: the customer is always right. Perhaps it is time to apply this adage to the medical market.

In the end, with our Medicare system, taxpayers are funding these services. Surely they have the right to say where they want the service delivered. Why would we, as taxpayers, having largely paid for the training of the doctor, then allow the doctor to set up business in an over-serviced area like North Adelaide? Why would we not, as the purchaser, insist that the service be delivered in Kimba, Elliston or Coober Pedy or anywhere else that we might like the service presented?

While the medical profession will defend the current arrangements to the death, I believe it is time we took the bull by the horns and made Medicare provider numbers postcode specific. Doctors can still practice wherever they like, but they would not be able to access taxpayer subsidies to assist them in making what are essentially lifestyle decisions. 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? Failure to address this issue of rural doctor shortage will see a continued deterioration in the health of rural Australia and the liveability of our communities.