Mark Coulton (Parkes, Deputy-Speaker) Share this | Hansard source

I take great pleasure tonight in speaking about the Health Insurance Amendment (Enhancing the Bonded Medical Program and Other Measures) Bill 2021. The bonded placement scheme is very important in distributing doctors across this country to where they are needed. I understand the need for this bill to iron out some problems, but we also don't want to take it away. If someone has an obligation to work in a regional or rural area, they should, unless there are exceptional circumstances, fulfil the obligation they have agreed to.

I've been listening to the debate here and I've heard a lot of talk about the problems, but there haven't been too many solutions coming forward. The member for Macarthur, who's obviously highly regarded in his field, could have gone into some of the programs that are now in place but for some reason chose not to. I'd like to touch on the complexity of the shortage of doctors in regional areas. In listening to the member for Macquarie, I have a degree of sympathy for her issues in being 100 kilometres from a tertiary hospital, but I've got constituents who are 300 or 400 kilometres from their obstetrician and have to relocate a long way from their homes for several weeks before their baby is due and then for some time afterwards for antenatal care, so it's all relative.

In my time as regional health minister I found that everyone believes they live in a disadvantaged area and has special circumstances, but it's important that we put the resources and the support where they are really needed. Over a period of time various schemes have come about. One of them, which paid locums higher rates to fill those workforce gaps, did in one way fill some of those shortages in the workforce, but in another way it actually exacerbated the problem, because why would someone commit to working full time in a regional centre when they could go and work part time in several regional centres and earn double the income of someone who had committed to the area? So the locum scheme actually created part of the problem.

When I was minister, up until quite recently, we put in five trial sites to encourage a different model of workforce. One of the partners in that was Western NSW Local Health District, because they are paying millions of dollars a year in locum fees to fill short-term gaps. They agreed to put some of those funds into creating a work environment that is more conducive for people to work there. They are paying a salary to a doctor to go and work in an area, because they're competing with the larger hospitals in the city, where you can work on a salary, have regular shifts and get holiday pay and maternity leave. With the feminisation of the medical workforce, it's a difficult decision for a younger doctor to go into a regional area, knowing that if they want to have a family they are not actually paid for that particular time.

There are five trial sites. One of them, known as the '4Ts', is four small towns in the Central West of NSW: Trangie, Tottenham, Tullamore and Trundle. Those four towns are working as a network so that there's a collegiate atmosphere and so that they're supporting each other. They know that they are not going to be swamped, given the 80- or 100-hour weeks. They know that there's other backup if they need it. But they also know that, if they're part of a generalist pathway, they will be able to work shifts in, say, Dubbo hospital as an anaesthetist, as an obstetrician or as one of the other specialists that goes with the generalist pathway. In the early stages this seems to be having some effect. They've been quite popular. People are being recruited to these models, because one of the disincentives—and it's been raised here by others on both sides—is that feeling of isolation and lack of support. To overcome that, the generalist pathway that's been funded by this government will give those doctors who are going into those regional areas a broader skill set—knowing that you might be doing primary health care, general medicine, all day, and then a carload of teenagers hits a tree that night and you need to have that extra skill set to be able to manage an emergency of that scale. That can be a daunting process for young doctors. Doctors in my home town of Warialda were the rural doctors of the year in Australia some years back because in 2007, on the last day of the school holidays, a ute with eight 13-year-olds flipped over. All except one were critically injured. Sadly, three passed away, but the others' lives were saved because of the skill set of those doctors. So we are training another cohort of doctors to come through with the skill set to handle that.

Probably at the core of the issue is the fact that general practice as a discipline is falling from favour among our graduates. Part of the reason is that during their training time in the metropolitan hospitals they are actively discouraged from going down a pathway in general practice because working in a specialty can be more financially rewarding, it can have a better work-life balance and people can work closer to the city. So one of the big shifts was the establishment of the Murray-Darling Medical Schools Network, where we are training country people in country areas to be doctors. Earlier this year I was at the first intake in Orange. Every one of those students comes from a regional area. I was speaking to some of them from my electorate. One ultimately wants to be a dermatologist because of the high rate of skin cancer in country people. Every one of those young people was committed to practising in the region.

Next year will be the first intake into Dubbo. Sydney university's campus for Murray-Darling is very, very popular. Sydney university have been recruiting locally from, probably, a more mature group—people who are already established in the community and want to advance their career into becoming doctors. They can do it in their local area. With the establishment of the Western Cancer Centre, which has recently opened, you can do your specialty in oncology or surgery or obstetrics in a regional area, rather than having to be drawn into the city. Because it's such a long process to be fully qualified as a doctor, quite often other life issues come into play. By the time you're fully qualified, you have generally found a life partner. In some cases you want to start a family. So it's important that those decisions are made where people might ultimately be established, rather than having to move a family. One of my daughters is a GP. She practises in a regional area. When she moved from Sydney to that regional area she could find work, but it took some time for her husband to find a position that was suitable for his skill set.

One of the changes in the last budget, a change that comes into effect on 1 January, is that for the first time there is a graduated rebate payment for general practice under the MBS for bulk-billing. On the Modified Monash Model, the further remote you are the higher the rebate you will receive. Understanding a lot of the smaller and more remote communities do have a higher bulk-billing regime, it's important that we reward them. It's the first time that the MBS has been altered in that way. It comes into effect on 1 January. Dr John Hall, the President of the Rural Doctors Association, said this was 'a game changer' for rural medicine.

When I was minister, we also doubled the training places in regional areas for junior doctors. Quite often, for doctors that spend part of their training program as doctors, the more time they are exposed to rural and regional medicine the more likely they are to be established in the areas they've come from.

This is a very complex issue. It is a big issue; there's no doubt about it. It's probably the biggest issue in my electorate. It's not universally the same right across it. At the moment, it's a big issue in Gunnedah, a community of 15,000 people with two practices and two or three doctors servicing that community. Others towns are doing better. It's a bit cyclical. Quite often the problem comes when a senior practitioner wants to retire. That transition to someone else coming through is quite often the difficult part.

These innovative models, I think, will very much help with that. It's the idea that people can come into a system where they'll work with and have the support of a cohort of medical professionals—allied health workers and Indigenous health workers as well—but where there's also the understanding that they're going to have some work-life balance. The days of a doctor coming to town, buying the practice and staying there for 40 years are of an era past. That's just not happening now. The cohort of junior medical professionals who are coming through at the moment want to have that work-life balance. They want to be able to have other skills or go into a more generalist pathway, and we need to recognise that. We need to know that, when that older doctor or those couple of doctors retire, it's probably going to take three or four junior doctors to replace them.

The number of medical graduates coming through is encouraging. There were over 700 applicants for 40-odd places at the Orange campus of the Murray-Darling Medical Schools Network. There is a desire. It is a slow process to go from a first-year medical student to a fully qualified practitioner. I met three third-year medical students on Friday in a little village called North Star, in my electorate. They were out helping the Royal Flying Doctor Service with the vaccination program in regional areas, and they were quite enthusiastic about the experience they were having—flying around in an aeroplane and going into smaller, remote areas. Hopefully, the positivity of that experience might get them to think about maybe enhancing their career.

We just need to be wary of short-term fixes, because quite often the short-term fix actually exacerbates the problem and doesn't solve it. I acknowledge some of the comments made by earlier speakers on both sides. We owe a great debt of gratitude to our doctors and medical practitioners for their work over the last 18 months. They've got Australia through a very difficult time. In my electorate there were over 1,000 cases of COVID but there was a very low death rate, largely because of the dedicated staff of the Aboriginal medical services, the Royal Flying Doctor Service, the health districts and the local GPs doing a fantastic job.

I support the changes in this bill and I look forward to seeing some of the other policies that this government has in place coming to fruition over the years to come as we tackle—in a methodical, professional and thoughtful way—the issue of workforce shortages in medicine across regional Australia.

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