24/01/2020
'Extremely challenging': lack of rural doctor trainees causes the shortage
Dr Marian Dover is training to be a general practitioner with a difference. She is training to be a rural generalist, so as well as training in general practice she must also have emergency medicine skills and one advanced area, and she’s chosen obstetrics.
“I get really great fulfilment from that continuity," said Dr Dover, who is living and working in Taree on the Mid North Coast of NSW. "I get to know women through their pregnancy, I deliver their babies and then see them at the shops."
But Dr Dover is slightly unusual in her love for rural practice, as there is a national shortage of junior doctors applying to rural generalist training programs.
“Nowhere in Australia, NSW included, are we getting enough new or younger doctors into the regional areas. It’s extremely challenging,” NSW Health Minister Brad Hazzard said.
To become GPs, doctors need to complete the three- or four-year Australian General Practice Training Program, and can take a general or rural pathway.
In the last three years the general pathway intake has remained steady between 767 in 2018 and 744 in 2020, but the rural pathway intake has steadily dropped from 609 in 2018 to 486 in 2020.
"Some towns have no doctors, some towns have some but they're not necessarily wanting to work in a hospital environment, and the challenge is to establish how we can encourage GPs ... to be in those regional towns," Mr Hazzard said.
Rural Doctors Association of Australia chief executive Peta Rutherford said with the number of people graduating from medical schools around the country there should be more than enough junior doctors to meet the needs of rural communities.
“What we’ve seen is that new graduates are either staying in the hospital system or applying and getting jobs within other non-GP speciality areas,” Ms Rutherford said.
So what is stopping young graduates moving to the country? Firstly, Ms Rutherford said the doctor training system works against rural and regional areas, with doctors forced to complete their medical training at large regional centres or cities.
“All these doctors are moving back into these hospitals, and that’s very influential about where they stay,” she said.
Secondly, Ms Rutherford said there are misconceptions about what rural medical training can provide - often, rural trainees received "much more hands-on clinical experience" than their urban counterparts, and supervision and support was "often one-to-one".
Dr Dover said another benefit was being first in line to assist with procedures, whereas juniors in the city could be fifth or sixth in line.
However she said there were difficulties unique to rural practice, including being able to maintain caesarean skills in smaller towns with fewer births, or being able to take time off to continue training when there are not as many doctors around.
In mid-December Mr Hazzard announced 50 scholarships worth $3000 to encourage junior doctors towards the rural general medical training program.
He said it was a positive step to be able to host the first bilateral NSW and federal government meeting on regional health in Wagga Wagga, attended by Deputy Prime Minister Michael McCormack, NSW Mental Health Minister Bronnie Taylor and the federal Regional Services Minister Mark Coulton.
"My view is this problem is so complex that there needs to be a collaboration to the greatest extent possible between state and territory governments and the federal government," Mr Hazzard said.
Besides the NSW scholarships, there are several initiatives to either boost rural doctor numbers or improve work for those already in communities, including spending to promote and build tele-health systems and the federal government's recent announcement of a rural medical school being built in Orange.
In 2018, the National Rural Generalist Taskforce recommended more incentives should be tailored to support trainees and rural doctors "who deliver the extended scope of services required to meet the needs of rural and remote communities”.
Royal Australian College of General Practitioners President Dr Harry Nespolon said the college was working with the all levels of government to address the shortage of rural GPs.
“The rural pathway and the Rural General Policy are designed to encourage GPs to work in areas of Australia that have traditionally struggled to attract and keep appropriately trained GPs," he said. "We know that GPs who train and upskill in rural or remote settings are more likely to remain there caring for their patients, so this is vital.”
The number of junior doctors applying to train as rural GPs is dropping as governments work to fix the issue.
