Ban specialists from Medicare in over-serviced areas? Regional Australia wants city doctors to go bush

Medical politics

By Geir O'Rourke

14 Jul 2022

Specialists should be refused access to Medicare rebates if they set up in areas where there is already an excess of doctors in their field, it is being argued.

The controversial idea has not been adopted by the Federal Government, but it was floated by geriatrician Dr Mark Yates last week following the closure of a medical practice in the Victorian town of Smythesdale.

Dr Yates, the director of clinical studies at Deakin University’s Ballarat Clinical School, admitted the proposal would not be “popular” among his specialist colleagues.

But a new system was needed to tackle the lack of specialists in rural and regional areas, which was as much a problem as the rural GP workforce crisis, he said in an interview with the ABC.

“The question I think we have to ask ourselves as a community is if you have got 50 cardiologists within 5km of where you live, do you want your taxes to pay for the 51st to put up their shingle?”

“My view is I don’t think I want to pay for the 51st [cardiologist] to put up their shingle in Kew because we could do a lot better if they put their shingle up in Ballarat.”

“There is no driver in the system to make that happen.”

He added: “I think we are not saying enough about the need for specialists to get out of metropolitan Melbourne and get into the regions.”

“What concerns me most is that 50% of general practitioners are—and we are lucky to have them—coming from overseas-trained environments where they have to work in the country.

It’s not the first time the issue has been raised, with IMGs already receiving GP Medicare provider numbers restricting them to practice in areas of workforce shortage under the Federal Government’s rural health strategy.

And in a speech last year, Commonwealth Department of Health head Professor Brendan Murphy argued more needed to be done to tackle maldistributions, particularly given only a third of the 3700 doctors graduating from Australian medical degrees each year were opting for general practice.

“A lot of our Australian medical graduates are going into metropolitan practice, and more are going into some [non-GP] specialties than perhaps we need,” Professor Murphy said.

“We have a number of medical specialties which are now significantly oversubscribed in the big cities — such as emergency medicine — and yet we have serious deficiencies in many of those specialties, as well as shortages of GPs, outside of those metro areas.”

“If we get our settings right and manage to get our doctors to go and work in the specialties and the geography where they were needed, we will progressively have less of a reliance on IMGs.”

Training, not conscription, the answer

Regional Medical Specialists Association secretary Associate Professor Stephen Flecknoe-Brown agreed it a was a major problem but said the answer lay in rural training, rather than provider number restrictions.

The haematologist, based in Port Macquarie on the NSW mid north coast, added it was already clear there were flaws with the restriction on IMGs, saying most moved to cities as soon as they were able.

“The solution, then, is to recruit medical students from the bush, put them through a rural-based medical school and then ensure that they can get as much of their post-graduate training in the bush,” he told the limbic.

“That way most of them will stay, amongst their family and life-long friends. And who knows? Maybe the occasional Nobel Prize winner will emerge from this previously untapped resource.”

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