Rural health woes- If you can’t find the answer it’s time to change the question!

The headlines in today’s Weekend Australian Newspaper (Jan 30) laments the billions of dollars spent and the ongoing failure to fix rural GP shortages nationally. Yes, the country has indeed devoted decades and billions of dollars to address intractable GP workforce shortages outside of metro areas.  But we haven’t been able to find the answer, so it’s time to change the question.

The question has been: “How do we get Australian doctors to do something that they clearly don’t want to?” That is, how do we get them to establish and sustain a lifelong career as a country GP.  Those who seek a career in medicine are highly aspirational and ambitious, so it makes no sense at all for them to go bush.  A brighter and more rewarding future will always be found in large population centres where the career opportunities exist, and the financial rewards of hospital specialism abound. It is fanciful to think that enough of these young doctors can be convinced otherwise. The evidence is irrefutable. Financial inducements, policy incentives, selective entry, ruralised training programs, targeted recruitment and the co-optation of overseas trained doctors is not working at sufficient scale. A huge billion-dollar industry has grown up around this, but it’s not delivering adequately. We haven’t been able to find the answer so it’s time to change the question.

Instead of asking how we can induce or force Australian doctors to go bush we need to ask how we can sustain rural health services in the face of this grinding reality.  By reframing the question, we are taken to a vastly different place in our thinking.  Yes, we know that rural and remote communities face entrenched health disadvantage, but trying to recreate some illusory past that would see each small town with its own dedicated country doctor practice is futile. Rather, what we need to do is engage technology, new models of service delivery and a locally-based ancillary health workforce to get the job done.

We can do this! It requires that we engage deeply, honestly and respectfully with rural and remote communities so that they can shape what needs to happen next. This will be better for patients but will also build rural economies. Importantly also, we will be protecting the well-being of those doctors maintaining an ongoing commitment to rural practice. Many of the existing supports to rural doctors will need to continue but should be delivered in the context of new and sustainable service models and models of care.

This is in no way a criticism of existing over-worked country doctors (both Australian and overseas-trained), heroic in their efforts to keep essential services in place, but rather an acknowledgment that we should take a different approach.

There are plenty of examples nationally and internationally where new ways of working can deliver a meaningful and sustainable scope of health service to people living in rural and remote areas. Invariably these models incorporate rurally-focussed medical services projected purposefully from larger centres. No-one is suggesting that medical services are not needed but rather they should be provided differently. The rural communities that I have been dealing with tell me that they no longer want to be held hostage to an unreliable and unpredictable supply of itinerant overseas-trained doctors. This is not sustainable for anyone including the doctors themselves. The arrival of the COVID era is an exacerbating factor which may well interrupt the supply of international medical graduates for rural Australia.

If we fail to respond it will be a failure of imagination not an inevitability that sees the health disadvantage of people in the bush deepen further.