Mr RAMSEY (Grey—Government Whip) (17:34): I raised an issue in the party room a couple of weeks ago about a doctor distribution problem that we have in Australia. We don’t have a shortage of doctors, we have a doctor distribution problem.
This was raised by a good article in The Weekend Australian Magazine here, I think about three weeks ago. They highlighted the fact that governments have collectively spent about $2 billion on this issue. It’s not that finding doctors for rural areas is unrecognised but, try as we might and try as the various schemes do to bring about some kind of parity to entice people into the country, it is just not working. We’re just not recruiting enough doctors into rural practice.
Incidentally, at the moment we are no longer recruiting enough doctors into general practice, full stop. The positions open for general practice at the end of last year were 15 per cent undersubscribed. It seems to be the aim of the modern person drawn to medicine that they wish to be specialists—that’s where the big bucks are. I think that’s an inherent problem in our medical system. Gone seem to be the days when your GP actually was a general practitioner. More and more they are becoming referral services.
That leads to another issue: when doctors become referral services it leads to churn in the system. It provides jobs for people but no better outcomes. The practitioner may not be getting enough work so he says: ‘Mrs Jones, I think you’d better go down the street to see my friend the pathologist and we’ll run some tests on you. Then, once you get those tests back, you come back in next week and we’ll review your medication. Next week we’ll just change it a little bit and then I want you to come back in the week after that. Then you can go off and have another test.’
If you think that’s not happening, I know it can be exposed. I’ve spoken to the health minister about this. This kind of information—the number of Medicare items that are being accessed by a person on average—is obtainable. The latest information that I’ve seen is that Medicare items are being accessed in the city at double the rate they’re being accessed in the country. I live in the country and I can tell you that we need more doctors, and that we need them desperately, but I don’t think we need double the number we have now. I don’t think we need to double our medical access. It proves the point that we’re now seeing gross overservicing in the cities.
I’ve been around this topic of providing health care for people who live in the country for most of my adult life. I was chairman of a hospital board by the time I was 26. One of our jobs at the time was looking for doctors. I remember that in the 1990s governments and universities, in their wisdom, wound back the number of GP placements—of medical students coming into the system as undergraduates. That was because we had overservicing in Australia. The foot was kept on the neck of the throttle, if you like, for too long and it wasn’t opened up quickly enough—and back in those days we still didn’t have enough doctors in the country—but the oversupply was solved. Then, to meet that undersupply issue we started importing trained doctors from overseas. Let me tell you, they have saved many, many lives. But it seems ludicrous that in a nation like Australia we can’t train enough doctors for ourselves. The great thing about the overseas trained doctors is that they come, by dint of their immigration arrangements, and serve in a locality. But, of course, once they’ve done their five years or so then they too seem to want to run off and live in the cities.
For some time, I have proposed that we should be looking at a system of postcode-specific Medicare provider numbers. I’ve been touting that idea in parliament for some years now and I guess I’ve got to admit defeat. I’m not going to win on that game for one reason or another. It would be difficult to implement, but let me tell you that we have a serious problem here. What I’m proposing now, though, is that we should have graduated payments for medical service through the Medicare system, depending on where you provide those services and where they sit on the Modified Monash Model. For instance, if you were working in the country and you were at Monash model 8, which is right up there, you would receive a Medicare item with maybe a 30 per cent loading. And bear in mind that the places which have these shortages are the places that have the least ability to pay a gap, so we gift higher pay where there’s a shortage.
I think we should attack the other end of the model as well. Where we’ve got clear overservicing, we should clip the rate. You don’t get 100 per cent, you get 90 per cent or 80 per cent because there are too many services of this type in this region. It’s pretty hard to go round saying this. We can’t tell singular medical practitioners that they are overservicing Mrs Jones. We need to keep out of that space—these are their decisions—but we can send a financial signal that there is general overservicing in this area. That is the only way I can see that we will get doctors to start looking around and saying: ‘Actually, it’s too hard to make a living here. I need to go where my services are required.’
There are other factors at play here. I have met with the vice-chancellor of the University of Adelaide and with the dean of medical science there. I suggested they should alter their UMAT—that is, their entrance examination, I suppose. It sort of categorises medical students as to whether they would be suitable. I think there are probably too many people that come in now that are more interested, particularly given those things I’ve told you about the specialisation of the service, in financial reward and prestige than they are in giving a service to humanity, if you like. There were many doctors of the old school who were absolutely driven by vocation. I reflect that I don’t think I see many nurses that are driven into the service of nursing by either prestige or the prospect of outrageous reward. Maybe we would be better off selecting our undergraduate doctors from the nursing stream! But I made the point with the university that they should actually be trying to fashion a workforce fit for the task at hand as, at this stage, we clearly do not have a workforce that is fit for the task at hand, because roughly 30 per cent of Australia is completely underserviced. It’s a pressing issue.
I commend the government on the moves they made in the formation of the Murray-Darling Medical Schools Network, for instance. At the moment I’m working on trying to get a proposal up between the Royal Flying Doctor Service, Adelaide university, the Rural Doctors Workforce Agency and the Indigenous Doctors Association that would see specified training in centres around Australia for people to go into remote medicine. All of those are good things, but what I seem to say repeatedly when these schemes are announced is: ‘It’s a good idea. We should give it a go, but I don’t reckon it will be enough.’ The longer I’m here the more I think it won’t be enough and we’re going to have to do something else about this issue.
I want to pass on a message about how difficult this is becoming. I had the minister for regional health, Mark Coulton, in my electorate last week. We met with a number of doctors, mayors and local governments, and this really is the No. 1 issue for them. We came across a situation where practices are withdrawing their services from hospitals so that they don’t have to be on call and all the other things that go with it, because they are basically burned out. So when one practice withdraws its services from the local hospital, it’s then left to the remaining two practices, let’s say. That puts a bigger load on those two practices, and eventually another one of them drops off. And then finally the final practice withdraws its service from the local hospital. The state government needs to keep the hospital going, so what it has been doing—it hasn’t got much choice really—is going into the locum market to make sure that the hospital is staffed. One doctor told us that one week he was servicing this particular hospital, and then his practice decided that they would no longer do that service. The next week SA Health rang him up and said: ‘Can you come back in and do a locum service to look after the hospital’s needs? It’s the same job you were doing last week.’ They offered him four times as much money as he was being paid the week before. In some places we’re even seeing doctors moving out of their practice and offering locum services elsewhere because of the money. We’ve got a problem. The minister is listening and I will keep working on it.