Rowan Ramsey (Grey, Liberal Party) Share this | Hansard source

I rise to speak on the Health Insurance Amendment (Enhancing the Bonded Medical Program and Other Measures) Bill 2021. The amendments in this bill will make welcome changes, as the member for Cooper said, to a scheme that is designed to attract more doctors to work in rural and regional areas. Anything that can attract more doctors to rural and regional areas must be welcomed. Although it's unlikely to be the silver bullet that will fix up all the problems of the past, it's certainly designed to make things more flexible. We know that it's a great concern to young people in particular that they're having to tie themselves to a particular area for a long period of time, and that makes them uncertain about signing up to work in a rural or regional area. I thought about when I first went on a hospital board and decided it was in about 1980; it may have been 1982 but it was certainly at least 30 years ago, although that would make it almost 40 years ago. One of the first issues we had in the days when hospital boards existed in each hospital in South Australia was the lack of doctors in regional areas. I watched the whole episode unfold as the numbers of trainee doctors entering universities was curtailed because we had a problem in Australia, and that problem was overservicing in the cities—in fact, chronic overservicing in the cities. At the time a decision was made to cut the universities' intake of trainee doctors with the eventual aim to dry up the surplus of doctors, as it were.

Even at that time we had great difficulties in attracting doctors to rural areas. It certainly was not as difficult as it is now, but it was difficult enough. As a local hospital board we would manage the advertising for medical staff and we would do the interviews. We would chase people from one end of Australia to the other, and at times we would seek to bring trained doctors to Australia. But with the training stream drying up, the foot was kept on the neck of the intake for too long, I would have to say, and eventually we had a shortage of doctors in Australia. Then we began bringing large numbers of overseas trained doctors in to meet that shortfall. As someone who comes from the country and represents a part of remote and regional Australia, I would have to say that those doctors saved our lives. Is it the perfect solution? No, it most certainly is not. But the great advantage of bringing doctors in from overseas is that you can place limitations on where they practise as part of their immigration process. You can ensure that they go to a remote service or a regional service for a certain period of time and so receive the service you need for that population, which is not the case for our local trainees, who maintain that they are private businesses and can go and set up virtually whenever they like.

It takes a long time to become a doctor. There has been a great emphasis over the years on trying to recruit an oversupply or to tilt the scale in favour of regional students because we know that more of them are likely to end up in the regions, but it's far from an ironclad solution. In fact, many regional students, particularly if they've done a couple of years of senior secondary education in a major city, with maybe eight years of training to get their standard doctor's certificate and then GP training after that, might be away from the country for anywhere up to 15 years before they actually qualify to the state where they can come back and serve. By that time, so many things can have happened in their lives—they could have formed partnerships and relationships and may have had children. The whole world can change in that time, and I'm very grateful for those who do decide to return to rural Australia.

In fact, there are a whole host of programs that the government is already running to help bring doctors to rural Australia, including rural bulk-billing incentives. I might point out that under the Monash model it's not uncommon for an extra $10 to be delivered on a bulk-billing incentive package for the needy or for those on pensions, health care cards or whatever. In some places it might be well over a 100 per cent increase in the amount of money per Medicare item for a service in rural Australia. There's the Approved Medical Deputising Service Program, a heath workforce, a scholarship program providing anything up to $10,000 a day, the Medical Outreach Indigenous Chronic Disease Program and the Rural Locum Assistance Program. We have the More Doctors for Rural Australia Program, the Rural Health Outreach Fund, the Rural Health Workforce Support Activity, the Remote Vocational Training Scheme, the Remote Vocational Training Scheme extended targeted recruitment pilot—and there's up to $200,000 a placement available on that one—the Practice Incentives Program and the Workforce Incentive Program. It goes on; there's more there.

The point I make is this. Many doctors don't like to publicly express how much they're earning, but it's not uncommon for them to be earning in excess of $400,000 or $450,000 a year. I don't know how much extra money makes a difference, but I've come to the conclusion that it's about the only tool we've got, quite frankly. We need to recruit more doctors to rural and regional Australia. Statistics will tell us that, on a per capita basis, Medicare item numbers are accessed in regional Australia at roughly half the rate that they are in the city, and this is a really interesting statistic. I live in regional Australia. I live in a small country town that has an irregular doctor service. We have struggled to recruit and retain doctors. We have a hospital, and it's a struggle to keep services up in the hospital unless you have a doctor. It's a struggle to recruit workers in other industries to the town unless you have a doctor. It is absolutely essential that we have a doctor, and yet we don't need twice as many doctors as we've got. This overservicing in the city is already a large problem that is eroding the sustainability of the federal health budget, and I think it's something that requires some deep analysis.

I think we need to understand what a fair shake is in Australia. We don't need more doctors in eastern Adelaide. We need more doctors in northern and southern metropolitan Adelaide and we need a lot more doctors in remote South Australia. We don't have a shortage of doctors in Australia. What we have is a distribution problem. I have argued for some years that we should have a postcode-specific Medicare provider number. I've come to the conclusion in this place—I've been here 14 years now—that I'm not going to get my way. That is not going to happen. I think it probably should, and I know there are some difficulties that surround it, but I take it that we probably won't see progress in that area.

I have reached the conclusion that money is a blunt tool but it's about the only one we've got. I think we need an increased rate, even over all the incentive programs I just read out, for service in remote Australia. It could be worked out based on the Monash model, and that's not a bad idea. I actually prefer postcodes because then we can really drill down and find out which communities are not getting the service they require, and it's very easy to identify those that are getting more service than they require.

Once again, this is not a policy that the coalition government has adopted, but I have suggested that what we should be doing to fund those extra payments in rural and remote Australia is reducing the payments from the places where we've got overservicing. If we don't address the overservicing, eventually it will swamp the budget. If we don't start putting parameters on where extra doctors can provide extra services—it's not hard for doctors to generate extra income: 'Mrs Jones, I've just changed your drugs; I want you to come back next week; I'm not going to issue a repeat.' And when she comes back next week: 'I'm going to send you to my friend the pathologist down the road, and once you've got that report, you come back to me and then we'll analyse it and I'll put you on something else.' It goes on and on and on, and it's very hard, on an individual basis, to call that out. In fact, I don't think anyone would want to call it out. But it's not hard to do on a postcode basis, where you can see that one area is getting so many more services than, say, the little town where I come from, where there's an absolute imbalance in the health budget. Rural and remote Australia deserves a better deal.

So I've come to the conclusion that's the way to do it. I'm not sure I'm going to win that argument, either.

I think the learned member on the other side is incorrect, let me say. What we need to do is make a change. This legislation today is a small step in trying to do other things.

I've also been championing a proposal—a rural and remote medical academy, to be based around a number of centres in Australia that will train doctors for the remote areas in combination with the RFDS, with the Aboriginal doctor workforce and with the University of Adelaide. I hope we can find our way, as a government, to funding a number of these positions. One such academy in my electorate would be at a place called Port Augusta. Although Port Augusta has a population of 14,000 people and services a larger area, even areas like that don't have enough doctors. In Port Lincoln—I don't know how many House of Representatives members have been to Port Lincoln, but it's a very attractive community on a beautiful harbour and it's got a lot going for it—even there we struggle to attract doctors to regional areas. It's got a good hospital—a lot going for it.

This legislation today helps. It's another program. As I said, it won't be a silver bullet. As a parliament we need to make an absolute commitment to rural and regional people that this imbalance in health services in Australia is not going to continue, that we're going to do something fair dinkum about fixing it. I don't think we can do something fair dinkum about fixing it unless we tread on a few toes. We've been dangling carrots in front of people for a long, long time. I think we're going to have to take a bit of stick. If that's what it requires then I think that's what's required. But we certainly do owe it to that constituency to provide a better service than they're getting at the moment.

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