Sick system: The scheme causing doctors to shun regional Australia

DOCTORS are being offered the same cash incentives to work in tiny country towns as they are bustling cities under a system diagnosed as a “monumental policy wreck”.

The federal government is under growing pressure to dump its widely unpopular geographic classification scheme, which its opponents say has inadvertently removed the financial incentive for many doctors to stay in the bush and put off potential new recruits.

The introduction of the ASGC-RA scheme in 2010 saw dozens of small communities put into the same category as thriving regional centres like Hobart, Albury, Port Macquarie and Toowoomba.

The scheme is so flawed a GP would be given more money to work in Cairns than the tiny Queensland town of Cherbourg, which has just 1149 residents and is 300 kilometres from Brisbane. A doctor would also be given bigger incentives to practice in a town just six kilometres up the road from Cherbourg.

“The only people who can understand this monumental policy wreck are the people who work in their ivory towers in Canberra,” said the Rural Doctors Association of Australia president, Dr Paul Mara.

“What we know is, on the ground, it’s doing nothing to help lift the number of doctors in the bush.

“If anything, it’s having the opposite effect.”

A doctor in an area classified ‘inner regional’ is currently entitled to relocation and retention grants worth up to $27,000. Inner regional cities include Hobart - population 211,000, Toowoomba (120,000), Bendigo (86,000), Launceston (80,000) and Wagga Wagga (61,000).

Dozens of small towns with less than 10,000 people are lumped in the same inner regional category, based on a mathematical formula developed by the Australian Bureau of Statistics.

The formula relied on an area’s proximity to big cities but largely ignored population size and lack of essential services.

Affected towns argue they need to at least be classified ‘outer regional’ to have any hope of luring GPs. An outer regional area offers about $48,000 in potential incentive grants.

Doctors fear unless changes are made, precious health dollars will continue being spent paying incentives to doctors in cities where there is little or no workforce shortage. Some $34.9 million has been set aside to fund the scheme this financial year.

A parliamentary inquiry into the program will hand down its findings later this week, putting pressure on the federal government to rethink how to best encourage more doctors to abandon capital cities for country communities.

An instigator of the inquiry, Nationals Senator Fiona Nash, has fielded near-universal condemnation of the existing incentive scheme.

Senator Nash’s hometown of Young, in south-western NSW, is also battling to attract doctors, pitted against much larger regional health hubs like Wagga Wagga and Orange.

“As somebody from a regional area, I know there’s nothing more important to regional Australians than health but at the moment, we have an incentive scheme that isn’t helping the doctor shortage,” she said.

 “This is something the government can fix quite easily but some don’t seem too interested doing it.”

The Department of Health and Ageing did commission a review of the classification scheme in late 2010 after complaints started rolling in. The review found of 23 small towns lumped into the same category as larger ones, just a handful had experienced a “significant” improvement in GP numbers.

A department spokesman this week conceded there was little data available to assess how doctors had been influenced by incentives.

“The early data is encouraging, however, showing that overall the number of doctors working in regional, rural and remote areas…increased by almost seven per cent in the 15 months to 30 September, 2011,” he said.

“The data also shows that there have been increases in the number of full time equivalent doctors in the majority of large and small communities.”

Dr Mara claimed those figures were not accurate.

 “There may have been some increase in doctors going to regional areas but they are invariably overseas trained doctors who are forced to go there,” he said.

“Any country GP will tell you the increase is not down to the remote classification scheme.”

Including Hobart and other large cities had also distorted the number of doctors working in rural and regional areas, he said.

The Australian Medical Association (AMA) and Rural Doctors Association of Australia want incentives based on a doctor’s level of isolation as well as whether or not they need to work in hospitals and be on-call. The proposal would cost up to $400 million a year.

It’s understood the Senate inquiry will recommend such a move but there are no guarantees the federal government will implement it.

“We don’t think that ($400 million) is an unreasonable amount and it could have a very big impact,” said the AMA president, Dr Steve Hambleton.

Department of Health and Ageing figures show there are as few as 47.1 GPs for every 100,000 people in the most remote areas. In major regional centres there are about 83.1 per 100,000 residents. In the nation’s capital cities, there are nearly 100 GPs for every 100,000 inhabitants.

A recent University of Melbourne study found doctors would want a salary bump of between $68,000 and $237,000 to relocate to a country town. The study’s authors also called for changes to the design of current incentive schemes.


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