Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

I'd like to talk a little about the shortage of primary care providers in all our communities. It goes around Australia, but it's worse in some areas. Certainly in rural and regional areas it's quite difficult. But it's also very difficult to access an affordable general practitioner in the outer metropolitan areas of our major cities. This difficulty in accessing primary care through our general practitioners has been decades in the making. Traditionally in Australia, for many, many years, we have imported doctors from overseas. Every year, almost half of the newly practising doctors in Australia are doctors who've been trained overseas. That has equity issues because some of those doctors come from very disadvantaged nations with low national incomes. They spend a lot of their national income on training their doctors, yet we've encouraged them to come here. So there are certainly equity issues about training general practitioners. In the last couple of decades in Australia, our new medical schools have more than doubled, and it has been difficult for our own students to train in our medical schools because of the difficulties in admissions. Some would say that we've made it too hard for people to train as doctors.

We also have an ageing population with more need for doctors. In that ageing population, we have the development of chronic illnesses, like cardiovascular disease, diabetes and dementia, as we're living to older ages, requiring more medical input. So there has been this societal evolution of a greater need for medical services. We need to train more doctors, but we also need to get more doctors moving from areas of advantage in the inner cities to areas of need. This has proven to be extremely difficult.

Part of the problem is that the incomes of general practitioners have not been as high as those of many of the specialties. For example, when Medicare was first introduced, the rebate for an initial consultation with a specialist physician like me was about $85. In comparison the rebate for an initial consultation with a GP was only around $22. So there was a discrepancy in the incomes of GPs compared to specialists. Also, people in disadvantaged areas often have multisystem disease and require a lot of support. Yet the Medicare rebates for those patients were the same as the rebates for those healthier patients who generally live in more advantaged areas. So there has been this pressure on people working in disadvantaged areas and in general practice to try to maintain practice viability, especially compared to those living in wealthier areas.

We also have had a strange situation where, when we train our doctors in the general practice streams, if they leave a position as a hospital registrar to be a GP registrar, they lose all their entitlements available through the public hospital system. This includes things like sick leave, sabbatical, study leave, maternity leave and all the other add-ons that they can get working in the public hospital system, with overtime for extra hours et cetera. So there was a disincentive for many of our medical students to go into a general practice training scheme, knowing that they would actually be paid significantly less—about 40 per cent less—working as a GP registrar compared to a hospital registrar working in cardiology, neurology et cetera.

So I am actually calling for a rethink of the entire GP training scheme and how we fund our GPs. We have worked beyond crisis point. This is something that has evolved over decades. Our government is doing what it can to improve people's access to primary care and take pressure off our hospitals by introducing things like urgent care centres and by increasing bulk-billing incentives, but this is only partly changing the problem and will take years to work. We need an entire rethink, and I'm calling for this tonight. We need a rethink of general practice and how we recruit and train our general practitioners, and we need it on an urgent basis.