When six-year-old Hannah got stung by a wasp playing outside on the family farm, her mother Abbey Strauss wasn’t immediately concerned - but she soon realised she needed urgent help.
“By the time she walked back inside, she said she couldn’t breathe and collapsed on the floor,” Ms Strauss told SBS News.
Hannah was having an allergic reaction.
Abbey Strauss says her family needs to visit a doctor up to a dozen times a year. Source: SBS
Ms Strauss, who lives with her husband and two children near the South Australian town of Kimba, immediately called an ambulance, but her anxiety grew when they then had to wait more than an hour for a doctor to drive 70 kilometres from the town of Cleve to administer life-saving medication.
“It was a bit scary because anything could have happened to him on the way to Kimba,” she said.
With two asthmatic children, the family of four need to visit a doctor up to a dozen times a year. In their remote town, roughly halfway between Sydney and Perth, that usually means a long drive to another town, or waiting sometimes several weeks to see a locum.
Ms Strauss says the lack of a local GP means it’s harder to get medication for her children’s asthma. “It’s very frustrating, and it makes me very angry that we don’t have someone like that here,” she said.
Just off Kimba’s main street, local mayor Dean Johnson points to the council-owned building set up as a doctor’s office. Inside, rooms sit ready but empty, stocked with clean dressings and bandages. There’s been no doctor to use it for three of the past four years, he says. “It’s simply not good enough.”
Port Augusta is a large regional centre about 150 kilometres away. Its mayor, Brett Benbow, is also worried about a shortage of doctors.
“We currently, from our last count, had 20 doctors in town. We’ve got 14,000 people, roughly, so that’s 700 people per doctor. That’s a struggle for any medical practice,” he said.
A national problem
With at least 60 GP vacancies listed across South Australia, the state’s rural doctor shortage is the worst it has ever been, according to Rural Doctors Association of SA President Peter Rischbieth.
“I’ve been doing this for 32 years and it’s worrying that around the state we just don’t have enough doctors who have the appropriate skills needed for rural medicine,” he said.
But the problem is a national one, impacting rural and regional areas across the country, says Rural Doctors Association of Australia chief executive Peta Rutherford. It’s not that we have a shortage of GPs, she says, but that they aren’t well distributed across the country.
“The research indicates Australia is training a sufficient number of medical students to meet the needs of our health services,” she said.
“But what we’re not seeing is students moving after university form large regional centres out into smaller regional centres and rural and remote Australia.”
Corrine Taylor, Chairperson of the Association of Medical Recruiters in Australia and New Zealand (AMRANZ), says part of the issue is that there simply aren’t enough incentives for GPs to go bush.
“Our GPs and our training programs don’t force doctors to rotate through regional areas,” she said.
“There’s a huge number of vacancies in the city, so if you were born in the city you grew up in the city you went to secondary school in the city and uni, that’s where you tend to stay,” she said.
Changes to immigration rules
Last year, the Australian government from 2300 to 2100 in a bid to reduce job competition in urban areas – a move that saved the health system $400 million dollars.
Ms Taylor believes changes to immigration rules, together with cumbersome application processes for overseas doctors, are contributing to the rural doctor shortage.
“[It’s] hugely negative,” she said. “We need to embrace the doctors that we bring in from overseas. We need to welcome them; we need to create environments where they can train our junior doctors.”
Mr Rischbieth says he hasn’t seen any data to suggest a reduction in the supply of overseas doctors is directly contributing to the shortage, but he does think they play a crucial role in rural health.
‘The overseas trained workforce are a key part of the workforce and if we hadn’t had them, things would have been much, much worse,” he said.
Who is responsible?
State governments are responsible for hospitals, but the Commonwealth government is responsible for the number and distribution of GPs, as well as policy initiatives such as setting the rate of overseas doctors.
Private general practices are responsible for themselves, says Ms Rutherford.
“I don’t think you can say it’s any one person, or just the federal government’s responsibility,” she said. “Almost everybody has a responsibility to do what they can to support the state and rural health service.”
In 2017, Professor Paul Worley was appointed the first National Rural Health Commissioner, tasked with building up a training pathway so that doctors are equipped with the specialist skills needed for rural general health.
What’s the solution?
In South Australia, Country Health SA executive director of medical services, Dr Hendrika Meyer, says the organisation is “working with local communities” to improve staffing in rural areas.
He said the state government is looking at a range of strategies to boost recruitment of regional GPs “which includes doubling rural medical intern positions and offering more training opportunities”.
Nationally, the Rural Doctors Association of Australia would like to see a funding commitment for a training program called the National Rural Generalist Pathway, to offer specialist training for rural general practitioners, and encourage more young doctors to consider careers in regional areas.
AMRANZ's Ms Taylor believes compulsory rural rotation should be introduced for student GPs. “[Training colleges], I believe, must have a process where you must rotate through a rural and regional area as part of your program to obtain your fellowship.”