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  1. 1

    Doctor Whom

    If the AMA and the RDAA think that more cash will get doctors to rural areas then they have learnt nothing.

    Doctors don’t go to rural and remote areas because most of them don’t like the places, their wives husbands (and exes) and current lovers (and exes) don’t like the places, their teenagers don’t like the places and their friends don’t visit.

    Often the local clinic/hospital is run by a bunch of idiots, occasionally well intentioned, and sometimes sober, who exploit the doctors and penny pinch and frustrate.

    Far better to bring in a 10-year moratorium for ALL doctors, nurses and health workers trained on the public purse. Then we get rid of discrimination.

  2. 2

    Steve Sant

    The RDAA have for many years called for better supports for rural doctors. This includes better education and training support, professional support and financial support.

    RDAA workforce policy is based on evidence such as that in the viable models project (available on the RDAA website) which was undertaken about 6 years ago and more recent evidence in WHO Global Health Workforce Alliance publications and surveys which indicate over 80% of rural and remote doctors recently believe adding a significant rural and remote loading on Medicare items would assist in recruiting and retaining doctors in their communities.

    Clearly the policies of the previous and current govemnent, despite the best efforts of the rural communities and the rural workforce agencies have not provided rural communities with the services that they require as we still need at least 1800 more rural doctors across Australia.

    Financial incentives will not in themselves solve the problems but combined with better educational and professional supports they will go a long way towards improving the workforce numbers in rural australia and assist in ensuring that rural australians achieve the same health outcomes as their city counterparts. Rural practice is a great career choice and we should not be forcing doctors or health professionals to work in rural areas, instead we should support and reward them for taking on the rural practice.

    Steve Sant

  3. 3


    I was lucky enough to spend my 5 year moratorium time in a large (8 doctor) medical centre with good peer support, interesting work, and excellent nursing support at the hospital where I was a VMO. But Dr Whom is right, I hated living in the place, my wife hated it and my friends didn’t visit. I survived it because I was paid well and got lots of holiday. I left within a week of my 5 years being up.

    In neighbouring towns, doctors who had to battle language barriers and enormously higher cultural changes on their move to Australia than I did, set up and tried their best to be a sole practitioner whilst also studying for the exams. They had no on-site medical support or supervision, and no business support. I doubt they were in accredited practices, so they would not have received all the remuneration available to other rural GPs. But they were desperate to work as doctors in Australia and thus tried their best to stick it out.

    Although I don’t think there’s anything discriminatory about asking IMGs to contribute to solving a workforce problem if they want to be able to work in the country, I do feel that making that request puts a responsibility on the govt to provide all the support necessary to allow those doctors to settle and enjoy practicing in what are often isolated and difficult conditions.

  4. 4


    There are some hard facts about living in the country, up with which country people have to endure – facts which mean that I have never wished to live there.

    The smaller the town, the fewer the facilities – educational, cultural, commercial, financial, emergency services or health-care-related. I have chosen to be a city-slicker all my life because I want all of those facilities close at hand for myself and my family.

    A country town (with its surrounds) needs a certain-sized population to sustain general practitioners. The GPs need to be sufficiently numerous such that each can take time off for continuing education, for illness and for holidays. If, for the sake of argument, we agree that a GP can satisfactorily care for 1,000 patients (more or less), and if we agree that the minimum number of GPs needed to allow such time off is four (three at a pinch), then any town (and surrounds) with fewer than 4,000 people cannot expect to retain doctors over the long-haul – they will simply ‘burn out’.

    To insist that all of these small towns should have doctors is, in my view, unrealistic. Regrettably, the absence of a doctor is one of the many downsides of living in a small country town. The AMA has never been happy with my suggestion that the answer does not lie in bribing/coercing doctors into these towns.

    We need to be smarter about how we provide ‘health’ care (not necessarily ‘medical’ care) to small towns. There are ways that this can be done. Russia and China, with their vast open spaces and dispersed populations, have been training rural ‘felschers’ and ‘barefoot doctors’ for generations; a number of African countries are now belatedly following suit. Improved medical evacuations and flying doctors (for which Australia is renowned) are clearly part of the solution.

    But to harp on about supplying doctors to every small town is to fly in the face of reality. It’s well past time for a change in thinking.

    Peter Arnold, former Deputy President, NSW Medical Board; former Chairman AMA Federal Council


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