Sharman Stone (Murray, Liberal Party) Share this | Link to this | Hansard source

I move:

That this House:

(1) celebrates the success of Rural Clinical Schools (RCS) around Australia, commenced in 1999 by the then Minister for Health, the Hon. Dr Michael Wooldridge MP, and continued by his successor, the Hon. Tony Abbott MP;

(2) notes that:

(a) RCS were designed to overcome the maldistribution of all doctors including general practitioners across Australia, which left country regions short of general practitioners and other specialty doctors;

(b) students undertaking training in rural locations have academic results that are equal to or better than their metropolitan counterparts;

(c) published data from public universities show high rates of RCS graduates working in, or intending to work in rural areas; and

(d) the information gathered through an independent project tracking all Australian and New Zealand medical students—Medical Schools Outcomes Database—demonstrates that long term placements in a rural setting through RCS have a significant impact on the vocational choice and intention to practice in a rural or remote setting as well as future career specialty focus; and

(3) calls on the Government to:

(a) continue its support for these excellent initiatives; and

(b) examine opportunities to increase intern and postgraduate training places in rural locations to enhance the future of specialty medical service delivery with a focus on general practitioners in rural and regional Australia.

I rise to commend this most important motion to the House. I believe this motion will have bipartisan support, given that the previous government continued to support and encourage rural clinical schools following their establishment nearly 14 years ago. I thank all speakers to this motion, including members of the opposition. Ensuring there are adequate medical services in rural and remote areas in Australia is beyond party politics.

The 2013 fact sheet of the Medical Deans Australia and New Zealand reported that there were 18 medical schools in Australia, which doubled the number of commencing medical students from 1,660 in 2000 to 3,469 in 2010. Despite these numbers and their steady increase, peaking and plateauing in 2014, when it is expected there may be 700 unemployed doctor graduates, most people will tell you there is shortage of doctors in Australia. But this is not true. The reason some country patients have to wait weeks for a GP appointment or hours in an accident and emergency centre is that we have a chronic maldistribution of medical practitioners across populations.

The very good news is that things are dramatically improving due to our rural clinical schools. In 1999 the then Minister for Health, the Hon. Dr Michael Wooldridge, introduced the concept of rural clinical schools. These were bold in concept. They required medical students to spend a significant amount of time out of the cities training in rural settings. Today, in places like Shepparton, Wangaratta, Ballarat and Alice Springs, we take this rural training situation for granted. But in in 1999, students, mostly born and bred in our cities, had to be gently nudged out of their comfort zone into rural hospitals and clinics. They were exposed to life in country towns and to work in small communities and larger regional centres. Impressive amounts of Commonwealth capital built state-of-the-art rural clinical school campuses and accommodation in these regional settings. Leading academics were attracted from the metropolitan medical schools or from overseas to lead in the establishment of these new clinical schools.

On 5 August 1999, John Howard turned the first sod for the building of a rural clinical campus at Shepparton. It poured rain that day and then failed to rain for another 10 years, pretty much, but no-one regrets that momentous sod-turning on that very wet day. Today there are 17 rural clinical schools associated with 16 universities, funded by the Commonwealth in every state and territory but with significant state collaboration and cross-university and health service cooperation. It is not just general practice that is involved but all of the specialties. Every Australian medical student now undertakes a rural clinical placement, while, as a consequence of the rural clinical schools, at least 25 per cent spend a year or more training and experiencing the culture and different health perspectives of a rural population.

Although it takes 10 to 13 years to produce an independent practising doctor, there is now good data to show that these rural clinical schools have succeeded beyond expectations. While the first urban campus based students had to be cajoled to go bush, now there are waiting lists, for example, at the University of Melbourne's medical school, as students vie for a place at the Shepparton campus. It is the same with other universities. The medical student outcome data, the MSOD, surveys every medical student in New Zealand and Australia at the beginning of their studies, upon exit and three years after graduation in order to have a comprehensive understanding of the student, graduate experience and destinations. This data is showing that, as a result of at least a year's rural training experience, a significantly greater number of students now convert from intending to practise in a city to wanting to practise in a rural area.

University of Melbourne data shows that 40 to 45 per cent—that is nearly half—of their rural clinical school graduates are training or working in an RA2+ location six years after graduation from the 2006 graduating cohort or earlier. While this university, like so many others, is targeting rural-origin students for its medical student intake, it has found that, as a consequence of its rural clinical schools, the conversion of urban-origin students to preferring a rural practice after graduation is now very high. Published data from rural clinical schools reports that students from Flinders University, the University of Queensland, James Cook University, the University of Western Australia and the University of New South Wales all show high rates of rural clinical school graduates working in or intending to work in rural areas. These students have also shown a change in intended medical discipline as a result of their rural training experience. At the commencement of training many students wish to become surgeons. At the end of their medical training, many more instead want to become general practitioners, obstetricians, gynaecologists, paediatricians, anaesthetists and pathologists. University of Melbourne data that compares examination results of rural clinical schools and urban clinical schools has found that students in the RCSs performed better than those from the urban clinical schools.

But there is more. The University of Melbourne realised that it was very difficult to find training places in one- or two-person private GP clinics, often with an ageing couple of doctors in small country towns. So they embarked on a further innovation, building with the Commonwealth's assistance a Shepparton GP training medical centre. This is the first purpose-built general practice for clinical training. It is located on the rural clinics campus across the road from Goulburn Valley Health, also known as Shepparton Hospital. The operating costs are self-funded, so there is no additional cost to governments. The medical centre has 20 consulting rooms and two procedure rooms to enable parallel consulting, where a medical student is first responsible for assessing the patient on their own prior to the academic GP supervisor input.

The 40,000 strong Shepparton-Mooroopna community, with its large Indigenous and multicultural population, has embraced this medical student focused and supported service. There are over 6,500 active patient cases on the books. At the most recent Shepparton Chamber of Commerce Business of the Year Awards, the community voted this clinic the best enterprise and service provider of the year. So much for worries about having a medical student diagnose your child's flu or broken ankle! Waiting times at the hospital emergency department across the road have been reduced. Bulk-billing is the norm and needed in this community, where the food-manufacturing industry has been the major employer and where 25 per cent are now on welfare support.

This purpose-built GP clinic, which provides excellent service to the community at the same time that it facilitates medical student training, is clearly a model to be emulated wherever there is a problem in placing students in private GP clinics in country towns. It also provides a successful alternative model to the superclinics, which are having troubles. The good news is that this is just the sort of innovation and evolution that is typical of the university's rural clinical schools across the country.

The University of Melbourne has also partnered with one of the last public pathology labs in regional Victoria—in fact, one of the last in regional Australia. This vital piece of medical infrastructure, which includes a blood bank, employs some 95 medical scientists in GV Health. Their jobs and critical services are now secure as a result of this partnership and collaboration. Again, this is typical of the cooperation which local hospitals and clinics in regional Australia experience when they have the good fortune to be located near a regional clinical school.

The original vision of Michael Wooldridge, followed by successive health ministers Tony Abbott, Nicola Roxon, Tanya Plibersek and now Peter Dutton, has delivered us a way forward in training health professionals who want to practise in the bush. However, there is a roadblock in this otherwise triumphal story. Unless there are intern places and specialty training places in regional and remote settings, the investment in these regional training experiences for undergraduates can be lost.

In the Review of Australian government health workforceprograms, dated April 2013, the author highlights this problem. In summary, she says that we have to also have specialty training places in rural and regional Australia. She says:

In the other specialties, this lack of rurally-based intern positions is further hampered by limited rural training opportunities for trainees seeking fellowship of a specialist medical college, noting that the—

Commonwealth—

STP … has made some difference in this area.

A recent Senate inquiry came to a similar conclusion. The problem is not hard to understand. If you have to return to a capital city for a number of years to do your specialist training at a critical stage in your life, you are likely to stay. Your partner will want to work there, your children will want to go to school there and you will tend to stay.

All we need—and it is simple—is adequate specialty training places relocated to rural centres. We need these places for GPs, general surgeons, obstetricians and gynaecologists, general medicine, emergency medicine and anaesthetics. We have the proven RCS model with its infrastructure, excellent staff and well-established cooperation and coordination with local hospitals and health alliances. We can overcome this final hurdle in the maldistribution of medical practitioners in Australia.

I commend this motion to the House. We do not need more medical graduates; we need graduates who are able to seamlessly move between metro, outer metro and rural. We have achieved this. Our maldistribution continues now not as a consequence of lack of will or ignorance about the joys of country life but because we need the supporting specialty training places. (Time expired)

Bruce Scott (Maranoa, Deputy-Speaker) Share this | Link to this | Hansard source

Is the motion seconded?

Nola Marino (Forrest, Liberal Party) Share this | Link to this | Hansard source

I second the motion and reserve my right to speak.

Warren Snowdon (Lingiari, Australian Labor Party, Shadow Parliamentary Secretary for External Territories) Share this | Link to this | Hansard source

I thank the member for Murray for putting this motion on the books and I thank the seconder for doing the right thing by her and us. I will make some observations, although I will come back a little later to the substance of what the member for Murray said earlier. She mentioned the maldistribution of doctors. I will refer to that as we go through. She mentioned roadblocks, the number of training positions and the need for specialists—all of which I concur with. I just want to give some sort of picture here of why this is so vitally important.

Where I live, Alice Springs, probably is the most remote major regional town in the country and has amongst the sickest population in the country. We know—the data is there for all to see—that people in the bush, regardless of where the bush is or what your definition of 'the bush' is, are more likely to suffer from chronic disease, have a shorter life expectancy and experience higher rates of death. The main contributors to these higher rates of death include coronary heart disease, other circulatory diseases and chronic obstructive pulmonary disease. Compared to their metropolitan cousins and their brothers and sisters who live in the cities, they have a shorter life expectancy by one to two years in regional areas and up to as much as seven to eight years in really remote parts of Australia, such as in my own electorate. Of course, health outcomes for Aboriginal and Torres Strait Islander people in the bush are the worst of all. The picture here is not a good one. For example, nowhere else in the developed world are there such high rates of endemic trachoma as in Australia. We are on track to defeat it by 2020, but the fact is that we still have not.

People in remote areas are unfortunately and quite sadly more likely to smoke, more likely—and sadly, again—to engage in risky alcohol consumption and more likely to be sedentary. This places them at greater risk of developing preventable illnesses associated with smoking, alcohol and lack of exercise, and chronic and acute injuries. Rates of asthma, arthritis, bronchitis and some preventable cancers, such as melanoma and lung cancer, are higher in rural and remote areas.

Part of the rural-urban health disparity in Australia is caused by inequalities in access to health care. For example, as noted in the Australian Journal of Rural Health:

Part of the rural-urban health disparity in Australia is caused by inequalities in access to healthcare, for example, in timely access to life-saving cardiac catheterisation services and availability of medical practitioners, particularly specialists.

That concurs with the member for Murray's view. This suggests we need better service delivery of health care for people who live outside the metropolitan centres. Part of the problem is the undersupply of trained health professionals in rural areas. Whilst we are concentrating on doctors, we need to understand that we have shortages across all health disciplines in the bush.

A 2008 audit by the Department of Health and Ageing found a persistent workforce shortage in the supply of doctors, nurses and other health professionals in rural and regional Australia. Rural Australia has experienced medical workforce shortages for a considerable period across the full range of health disciplines. Numbers of GPs in proportion to the population decrease significantly with greater remoteness, with the lowest supply to very remote areas. That concurs again with the member for Murray's observation about the maldistribution of medical practitioners.

One strategy to combat this has been to restrict Medicare provider numbers for overseas trained doctors to encourage them to work in rural areas where there is a workforce shortage. Currently 41 per cent of all rural practitioners are doctors who were trained overseas—that is a staggering figure. We have a real issue here about making sure that Australian trained personnel get the opportunity to live and work in the bush and be trained in the bush.

The rural clinical schools provide a way to overcome this maldistribution, as suggested by the member for Murray, including general practitioners across Australia, by increasing the exposure of Australian medical students to training and to getting work in a rural area. It was an initiative of the Howard government that has been continued by successive governments. Ten RCSs were established in 2000-01 and a further seven in 2006-07. We now have 17 rural clinical schools across Australia, managed by 16 universities. The need for greater coordination between the university medical schools—where they are operating and how they are operating; what they are doing, in fact—is an issue that I hope to come back to.

The RCS program is part of the broader Rural Clinic Training and Support program, which is the amalgamation of the Rural Clinical School and the Rural Undergraduate Support and Coordination programs. This program, as the member for Murray mentioned, mandates that 25 per cent of medical students must be from a rural background and that they must attend an RCS for at least 12 months.

We know that people who are trained in the bush are more likely to stay in the bush. From my own discussions with people outside this place, in my electorate of Lingiari there is the Northern Territory Remote Clinical School, which was established in 2005 and has sites in Alice Springs, Katherine and Nhulunbuy. It is part of the NT Medical Program, which is a partnership between the Flinders University School of Medicine and Charles Darwin University. This program provides training and placement opportunities for Flinders University and James Cook University students and for interstate medical students from other universities, including ANU, Melbourne—you name it. They are all ending up in the Northern Territory, which is good. It allows students to spend up to six months or more in a rural location, exposing them to a different learning environment that adds to their broader clinical experience.

In my home town of Alice Springs we have had the development of the Centre for Remote Health, a joint centre of Flinders University and Charles Darwin University. It is one of a network of university departments of rural health funded by the Commonwealth Department of Health and Ageing to improve the health status of populations in rural and remote areas by appropriate preparation of the health workforce, thereby improving recruitment and retention levels. The schools have a valuable role in providing opportunities to increase intern and postgraduate training places in rural locations to enhance the future of specialty medical services delivery, with a focus on general practitioners in rural and regional Australia. I believe that the impact of the Remote Clinical School in the Northern Territory has been a very positive one. It means that more students are spending time in rural and remote communities.

It is true also that we have a large number of people seeking training, because of the number of training places that were put in place by the former Gillard and Rudd governments. We have doubled the number of training places currently available from that in 2007. That is remarkable in itself, but it means that, working together with universities and medical practitioners in the bush, we can get people into the bush and trained in the bush, ideally in places like Alice Springs and the member for Murray's city of Shepparton, which I have visited—I have visited the RCTS in Shepparton. It is very important that we undertake to reinforce our desire to see these continue.

I will make an observation: we should not be preoccupied just with medical practitioners. There are shortages across the whole range of health professions, not just in the specialties across the areas that the member for Murray spoke about but in physiotherapy, audio services, audiologists, all the health sciences you can think of—those allied health professionals who are essential to getting people to recover. What we are seeing more of is that GPs do not work on their own; they work as part of a team, which might include a physiotherapist or a speech therapist or one of the other allied health professionals. So it is important that when we think about this training we think about encouraging university departments of rural health to think about having team training, to think about making sure that when they are putting these doctors in these places for training they provide the resources where possible to train allied health professionals alongside them, because they will be working alongside them. I am sure it is the experience in Shepparton. I know it is the experience across Northern Australia. It is certainly the experience of doctors in Central Australia, and I know how highly they value these partnerships with allied health professionals, because then they can provide effective treatment for the sickest people in this country. That is what this is ultimately about: getting better health outcomes for the poorest people and the sickest people in this country—in my case, in my electorate of Lingiari. If we can continue to work with these programs, we will get the outcomes we all want over time. I say to the honourable member: whilst I understand paragraph 3(b) of her motion, I would prefer to have seen it expanded across all the health professions. (Time expired)

Debate interrupted.