Issue 16 / 8 May 2023

In order to address health care challenges in rural and remote Australia, there needs to be bespoke solutions tailored to this unique health care landscape.

To solve the rural health crisis, we can’t just come up with an urban health care model and repurpose it for rural and remote Australia.

According to National Rural Health Commissioner Professor Ruth Stewart, there needs to be a significant reform that focuses on specific solutions for the problems rural Australia faces, including bulk-billing deserts and a shortage of rural generalists.

“The model of care and the business models that we’re currently using in rural and remote Australia are based upon urban models, which, obviously, aren’t working for rural and remote Australians,” she told InSight+.

The federal government has signalled changes are imminent for Medicare, with promises that include expanding access to primary care and flexible funding for multidisciplinary team-based models.

However, advocates such as the Australian College of Rural and Remote Medicine President Dr Dan Halliday, are hoping for specific rural health reforms.

“As a specialist College committed to having the right doctors in the right places with the right skills, we advocate for bespoke funding for rural and remote general practice and increased investment in the National Rural Generalist Pathway,” Dr Halliday said.

For example, funding for multidisciplinary team models has been flagged, which rural doctors are thankful for.

“Working with multidisciplinary teams is essentially what we do in rural and remote Australia, anyway. You basically make do with who you have on the ground and what you have,” President of the Rural Doctors Association of Australia, Dr Megan Belot, told InSight+.

However, a successful rural multidisciplinary team differs from an urban one.

“Instead of emphasising subspecialisation and a narrow focus of expertise, (by) making the goal to be generalism, we’re more likely as a multidisciplinary team of rural generalists to meet the needs of the consumers,” Professor Stewart explained. “We need to recognise that each rural community is different to the next one down the road. We need to allow communities to determine what their needs are and how they can be met within a certain set of guidelines.”

Bespoke funding needed for Australia’s rural health care challenges  - Featured Image
Multidisciplinary teams are essential to health care in rural and remote Australia. Ground Picture/Shutterstock

Bulk-billing deserts in rural Australia

It’s hoped new funding models will support existing rural clinics while also setting up new ones and employing salaried health care workers in the areas where they are needed most. This would help make GP visits more affordable for rural Australians where bulk-billing is less common than in urban areas.

A recently published Grattan Institute article highlighted that in rural areas, 60% of patients are always bulk billed, compared with almost 69% in metropolitan areas.

This results in people skipping GP care because of the cost. Officially, that figure is at 3.5% but would be significantly higher in these bulk-billing deserts.

According to Dr Belot, rural practices find it hard to bulk bill because of their size.

“To run a viable medical clinic, you need to have at least anywhere between three to five full-time doctors to cover your overheads,” she explained.

“The other thing is that in rural and remote communities it costs more to provide care. The transport costs for all of your consumables are increased, the locum costs are increased. And so that adds to the overheads for any practice and that’s a disincentive for bulk-billing,” she continued.

Rural generalist workforce shortage

Another issue affecting rural health is the workforce shortage.

According to the Grattan Institute article, a single employer model for junior doctors in training, where they are employed by the state government throughout their training, could help attract doctors to rural work.

“The really challenging thing about stepping out of hospital employment and salary is that you lose all the entitlement you have as a junior doctor in a hospital. So parental leave, sick leave, long service leave, they’re all gone because you’ve ceased your employment with the hospital,” Professor Stewart explained.

“Junior doctors are telling us that a single employer model will make a big difference to the attractiveness of stepping out of the hospital system,” she said.

Another way to increase workforce recruitment is through reward and recognition.

“Monetary reward is part of what’s required. So, equal pay to rural generalists who deliver a service into a community that would otherwise be provided by a subspecialist,” Professor Stewart explained.

This includes reform around how the advanced skills rural generalists possess are funded through the Medicare Benefits Schedule (MBS) item numbers.

“Ones like mental health… (there are) MBS item numbers that the psychiatrists may be able to access, but rural generalists with advanced skills in mental health can’t,” Dr Belot explained.

In addition, the current student training model influences our rural workforce. “The more time that a student spends being trained in the rural context, with rural clinicians, the more likely they are to become a rural doctor.

“At the moment, most of our students are trained in big tertiary hospitals by subspecialists. And we wonder why we’re not getting rural doctors,” Professor Stewart highlighted. 

Dr Belot said they’re on the cusp of reform that she hopes will encourage more junior doctors to follow in her footsteps.

“I hope junior doctors see that we are trying our hardest to make change. They’ve always been wanted in rural and remote Australia. To be a rural generalist is a great profession,” she concluded.

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One thought on “Bespoke funding needed for Australia’s rural health care challenges 

  1. Anonymous says:

    Rural Generalists are a vital part of the solution to the rural health issue. But they are not the only area of glaring deficiency in the rural medical workforce.

    Every Base Hospital and most District Hospitals in rural Australia need to have specialists available, on the ground within easy access, around the clock. Despite nearly a third of Australians living in non-Metropolitan locations, for example, only 9% of Fellows of the RACP (Consultant Physicians) live and work in inner regional areas, and 3% in outer regional areas. The proportions are worse for trainees, giving us little hope that Australian-trained physicians will be available in these areas in the future.

    I don’t have the figures for other specialties, but my impression is that there is a high reliance on itinerant specialist workforce (‘Locums’) in all rural hospitals and the majority of regional hospitals.

    The only way to address this issue is for the Colleges to insist on one third of training being done in regional areas. It is the Colleges which issue the ‘licence’ to practise as a specialist. All licences and privileges come with conditions attached – this should be one of them in the case of the medical specialists of the future. As the late Fred Hollows said, “If you don’t want to spend a year of your training in the Bush, you can always train with someone else.”

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