It doesn’t matter whether you live in Sydney’s west or Vaucluse, or Melbourne’s Broadmeadows or Kew, your health needs are the same, our politicians believe. In trying to bolster services to rural Australians, the government has neglected struggling suburbs of our big cities, Callum Foote reports.
It has been widely reported that Australia is facing a shortage of GPs. But the news gets worse. With recent graduates choosing to operate in wealthier city suburbs and overseas-trained doctors being pushed into the country, poorer outer-metropolitan areas are set to be hit hard.
PwC’s General Practitioner Workforce Report 2019, the last nationwide analysis of GP supply, suggested that by 2030 there will be a 31.7% shortfall of GP hours worked.
The shortage of GPs is due to low pay compared with other specialties, along with younger GPs working fewer hours. Also, a higher proportion of women are becoming GPs. Statistically, they work fewer hours at their practices, unsurprisingly because of their home commitments.
According to PwC, the shortfall in GPs will be felt most acutely in metropolitan areas. These areas currently have 68% of the demand, compared to 62% of the GP workforce, with demand growth outpacing the workforce.
GP Synergy marked Sydney’s Penrith-Liverpool-Blacktown area as being in the top 10% of local-government areas in Australia in terms of a lack of GPs.
Overseas doctors shortfall
A contributing factor to the shortfall is the limitation of recruitment of overseas trained doctors (ODT) into these areas.
In 2019, before the Covid budget blew up, the Coalition government made changes to the Health Insurance Act, specifically section 19 AB Exemptions. At the same time, the government also limited the visas it would offer ODTs by 355 per year.
The changes to the act mandated that overseas-trained doctors must work in rural Australia for 10 years, and also reduced the number of visas on offer to overseas-trained doctors.
The reasons behind this decision are twofold. The first is to address the lack of access to healthcare in rural Australia but also to help the Coalition meet its target of ‘saving’ approximately $700 million from the Medicare budget.
Overseas-trained GPs are required to work in areas classified as distribution priority areas (DPA), which are areas that have a shortage of healthcare professionals and where there is a typically high burden of chronic disease.
The model which determines whether a GP catchment area will be classified as DPA highly favours rural areas, despite the high disease burden of poorer metropolitan suburbs.
The assumption of the model places all metropolitan areas on the same footing. Areas such as Sydney’s west or Broadmeadows in Melbourne have been classed on the same level as the rich suburbs such as Vaucluse or Kew.
As of January 2022, there are only a few metropolitan GP catchment areas that have been classified as DPA. Two in Victoria, Brimbank in Melbourne’s west and Geelong, as well as Canning in Perth.
The difference a DPA can make is startling. Brimbank, which is one of Melbourne’s poorest areas, was classified as a DPA mid-last year. Now a local medical centre is struggling to attract doctors for an entirely different reason.
“On one street, we have 11 surgeries,” says one practice manager who wished to remain anonymous. “Each one has six, seven, eight doctors. When new doctors see this they want to move elsewhere.”
However, overseas-trained doctors are not the whole story.
Independent experts
Dr Stephen Duckett, the Health and Aged Care Program director at the Grattan Institute, believes that it would be a mistake for governments to focus on overseas trained doctors as the solution to the GP shortage.
“In the medium term, the solution should not be international medical graduates. This pigeonholes the problem into something which really should not be considered the solution.
According to Duckett, the government’s failure to properly understand doctors’ incentives has led to an unbalanced Australian medical workforce.
“Over the recent few years, the government has dramatically expanded medical education in the hope that just an expansion in medical education will solve the problem that we see.”
However, given GPs earn roughly 30% less than some other specialties it is no surprise doctors are moving elsewhere.
“Surprise, surprise: docs are gravitating to high-income specialties,” Duckett says. “Not as many people are going to the specialties that are not remunerative, such as general practice.
“This is the underlying problem, which is trouble when the government and policymakers have conceptualised the solution in terms of overseas-trained doctors.”
Recruiters call for consistency
GP recruitment agencies are also frustrated by the government’s lack of understanding of the issue.
Darren Compton, the owner and principal consultant of DXC Medical Recruitment, believes that the limiting of GP supply to certain areas would not happen in other industries.
“Very simply, the government would never tell NAB and Westpac that they could only have Australian-trained bankers, that they couldn’t get anyone from Europe or America,” Compton says. “What we have here is a primary healthcare system which doesn’t have access to all the doctors in the market.”
However, more important than accessing overseas trained doctors are questions of GP training.
Doctors hoping to become GP specialists must serve as a registrar underneath a fully accredited GP. In order for this to happen, a practice must be accredited as being a suitable training location.
Compton points out the Regional Training Organisations (RTOs) are “refusing to accredit new practices for GP training, which is due to the drop in the numbers of Australian-trained doctors selecting general practice.
Compton’s experience has also shown that the lack of transparency and short-term thinking regarding DPA classification is stopping practices from being able to plan long term investment due to recruitment concerns.
One example from Compton is that in January 2021, when Ulladulla was not classified as DPA, one of his clients “turned down the opportunity to expand to bigger premises due to the lack of DPA and concerns over GP recruitment. They believed they would never regain DPA status. Even though they surprisingly regained DPA status after years without, the client confirmed that they still would not commit to expanding their services to the community, given ‘DPA could be taken away again within a few months’.
“It’s the continued short-term thinking and a lack of long-term planning by the Department of Health which is hampering medical centres in recruiting the GPs that they so desperately need,” Compton concludes.
Callum Foote was a reporter for Michael West Media for four years.