Australia runs short of rural doctors
When former horse breaker and truck driver Dr
Tony Lian-Lloyd won Australia’s rural doctor of the year
award, he fitted the bill in more than one way. As a solo
practitioner in the Flinders Ranges town of Quorn, South Australia
(population about 1500), who dips into anaesthesia, surgery, and
obstetrics in hospitals up to 90 km away, Dr Lian-Lloyd epitomised
the jack of all trades outback doctor. When the Australian
Broadcasting Corporation reported that he was having trouble
finding a locum to cover for him so that he could collect his
award, his difficulties pointed to rural Australian
medicine’s other outstanding feature: a lack of manpower.
Australia’s rural areas are short of
doctors, and the problem is getting worse. Unless something is done
soon to encourage practitioners to move to the countryside, rural
healthcare could be impaired for years, the Australian Medical
Association (AMA) has warned recently. About a third of
Australia’s 20 million people live outside its major cities,
but the nation’s doctors appear less impressed with its vast
empty spaces, and only a fifth of them work in regional or remote
areas. Furthermore, many of them are old and nearing retirement. A
2003 study found that 40% of rural general practitioners were aged
over 50.
“There are fewer doctors still working
out in the bush now. Those there are older and, as they head off to
retire, there are too few new younger doctors coming to replace
them. This means patients have to wait longer, go to another town,
or not see a doctor at all—and this is not good for the
health of rural communities,” said the medical
association’s president, Dr Mukesh Haikerwal, launching a
package of recommendations.
The problem dates back to the 1980s and 90s
when the government decided that medical schools were training too
many doctors and restricted the supply to avoid a surfeit.
Australia is not alone in its troubles. Balancing supply and demand
with such a long lag time is difficult. Predictions of a dire
shortage of family doctors in the United Kingdom have prompted the
government to increase medical student throughput as well as
salaries, with new contracts making British GPs among the best paid
in the world.
For the moment, Australia, like Britain, is
leaning heavily on foreign trained doctors to keep its system
afloat while it waits for an increased medical school intake to
bear fruit. A quarter of the doctors in the 2003 rural practice
study were trained overseas, many of them in Britain, Africa, and
Asia, and a new recruitment drive is aimed at pulling in more of
those young workers to fix the immediate need.
But, as Dr Haikerwal says, overseas doctors
are not the long term solution. With this in mind the Australian
Medical Association has called on the government to target home
students from outside the cities for medical school places, in the
hope that they will be more likely to seek jobs back in the remote
and regional areas when they have qualified.
The association also wants all trainees to get
out into the bush to see what rural medicine is all about.
Sydney’s Daily Telegraph even quoted the association’s
Dr David Rivett saying that placing young doctors in the country
might lead on to the establishment of eventual relationships and
encourage them to stay put. Crafty planning like this may well be
needed for what seems an uphill struggle. “Doctors are no
different to any other professional group and evidence throughout
the western world shows that attracting young professionals to
rural locations is extremely difficult,” the AMA notes in its
recommendation package.
studentBMJ 2006;14:1-44 January ISSN 0966-6494
Toby Reynolds London
