Don’t blame health inequity solely on shortage

REGIONAL Australians experience poorer health outcomes than those living in major cities. Generally speaking, the more remote you live, the worse your health will be.

It has also been the case for many years now that we have fewer rural health workers across the spectrum. This basic supply versus demand dilemma poses huge challenges in terms of meeting the health needs of rural and remote communities. 

As outlined in the AMA Position Statement: Regional/Rural Workforce Initiatives 2012, there are both systemic and practical reasons why fewer health workers take up rural practice. 

The statement’s proposed policy prescriptions are however largely already in place, whether it be HECS reimbursement, incentive payments, increasing rural student intake, supporting rural clinical training schools and so on. Until we manage to fully train the requisite numbers of doctors, recruiting IMGs under the 10- year moratorium scheme is likely to remain a staple instrument in addressing Australia’s current workforce maldistribution.

One of the single biggest factors identified by the AMA in attracting doctors is the lack of amenity and family disruption a move to the bush often entails. These are things that cannot be mitigated against; higher pay might satisfy some but not others.

The current government has on the whole continued the regional health workforce initiatives started under the former Howard government. 

Through the GP training program, half of all registrar places are now rurally based. The real test will come when these registrars complete their training.

Every stakeholder will read with interest the national training plan presented to the health ministers’ Standing Council on Health last month by Health Workforce Australia. 

The HWA’s plan emphasised the strong support for a push towards a rural generalist or GP proceduralist training model.

This is a welcome addition to the existing specialties with a rural focus but we must remain vigilant that merely extending scopes of practice is not a panacea to the fundamental issue of workforce shortages. It is critical we recognise that every rural community is different. If we are to devise any meaningful solutions we must do so with this in mind.

The rollout of Medicare Locals and Local Hospital Networks risks the ability of local communities to develop services and other arrangements that might address their unique needs (as the former divisions of general practice did). 

Although it is still too early to judge, it is difficult to see how more layers of large regional bureaucracies will be able to adequately and sensitively manage local health needs. 

It would of course be futile trying to address workforce challenges without looking at the underlying causes of poor health in rural and regional communities. It is self-evident that access to primary health care services, backed up by timely and clinically appropriate tertiary care, is essential. 

Workforce shortages alone cannot be responsible for the significant health inequity that exists. 

The Coalition is committed to bridging the city/country health gap. As we develop our policies we will of course continue to demand that current programs and infrastructure projects meet stated objectives. 

Dr Andrew Laming, MP

Shadow Parliamentary Secretary for Indigenous Health and Regional Health Services