Hours challenge rural practice

A SURGE in the number of doctors working in rural areas could be offset by other workforce changes, including doctors’ falling work hours, experts warn.

While the number of GPs working in rural areas has increased by 23% between 2009 and 2013, from 6467 to 7975, these GPs worked 1.3 fewer hours per week compared with 4 years ago — equivalent to the loss of 250 full-time equivalent doctors. (1)

Mr Greg Mundy, CEO of Rural Health Workforce Australia (RHWA), said the figures from RHWA’s recently released Medical Practice in Rural and Remote Australia report revealed the looming challenge for rural workforce development.

“At current rates of demand and workforce productivity, hundreds more GPs will be required in rural and remote Australia simply to maintain the level of services being provided today”, he told MJA InSight.

Mr Mundy highlighted the influence of two trends in particular — the feminisation of the rural medical workforce, with female doctors tending to work fewer hours in paid work than men; and the ageing workforce, with 34% of rural GPs currently aged 55 years and over and likely to retire within the decade.

The report showed the proportion of female GPs working more than 35 clinical hours a week dropped from 45.8% in 2012 to 40.48% in 2013. The mean number of self-reported clinical hours for all GPs in 2013 was 34.4.hours a week (median, 36.0), with a mean total hours of 43.2 per week (median, 42.0).

“We know from our research that the older country doctors — particularly those in remote areas — have traditionally worked longer hours so replacing them may not be as simple as a one-for-one equation”, he said.

The figures also showed that 15.5% of the 7975 GPs working in rural Australia were registrars.

Mr Mundy said alternative models of care such as employing a nurse or allied health professional might help reduce the GP clinical workload.

Professor Richard Murray, Australian College of Rural and Remote Medicine president and Dean of Medicine and Dentistry at Townsville’s James Cook University, told MJA InSight rural areas did not just need more doctors, but also “the right doctors with the right skills, doing the right jobs in the right places”.

“The increasing numbers of doctors in rural areas in part reflects an increasing reliance on trainees and international medical graduates”, he said.

“Workforce figures don’t tell the whole story as it is also about extended generalist skills and participation in comprehensive round-the-clock care.”

Professor Murray suggested the trend to GPs working fewer hours may also be related to the growth of corporate bulk-billing practices in some rural areas and provision of special interest GP services such as skin cancer clinics in some towns.

To truly address rural health workforce needs, he said, regionally based training was essential, in consultant medical specialties as well as rural generalist practice.

“Nationwide, more trainees should be based in rural areas and doing a city rotation, rather than being based in city areas and doing a rural rotation”, he said.

“This would also help to rebalance against the trend of increasing subspecialisation, which is driven by the cities and creates doctors with limited ability to practice in rural areas.”

Professor Murray praised Queensland’s Rural Generalist Training Pathway as an example of a clear pipeline from medical school to rural generalist practice tailored to community needs. (2)

Dr Louis Peachey, a senior medical officer at North Queensland’s Atherton Hospital, made the switch to half-time work after feeling burnt out by excessive overtime.

“Working part-time is all about sustainability”, he told MJA InSight.

However, Dr Peachey suggested the future was looking brighter for his state’s rural doctors, saying working conditions and remuneration had improved considerably in Queensland’s rural hospitals.

“Fifteen years ago in Queensland Health the average lifespan of the senior medical officer was 18 months before they went into private general practice because the hours worked were so horrendous. Now we are largely managing to keep our staff”, he said.

Conditions for doctors in rural general practice were also improving in Queensland as a result of the influx of doctors through the Rural Generalist Pathway, Dr Peachey said.

“There’s a growing critical mass; because there are more doctors in a town, they’re not run ragged with on-call duties like they used to be.”

1. Medical Practice in Rural and Remote Australia: National Minimum Data Set (MDS) Report 2013
2. Queensland Health: Rural Generalist Pathway

PHOTO: Registrar Dr Candice Baker gets to know one of her young patients during her rural training in Woodend, in country Victoria. (Photo courtesy of Rural Health Workforce Australia)

Dr Aniello Iannuzzi asks if FIFO could be a solution to the rural medical workforce shortage.