Doctors need more incentives to remain committed to rural Australia: AMA

By Dr. Ananya Mandal, MDJan 15 2012

According to the Australian Medical Association (AMA) every rural GP and specialist should be paid tens of thousands of dollars per year in extra incentives to encourage more to commit to country practice, warning that “urgent intervention” is required to tackle a workforce crisis.

In a submission to a Senate inquiry into the rural health workforce, the AMA called for a new system of rural isolation payments and on-call and special skills loadings, increasing in line with the remoteness of rural towns, to improve the financial incentives currently provided.

The submission to the Senate committee inquiry also called for major changes to a rural classification system used to grade incentives currently available based on rurality, and for the abolition of a 10-year moratorium on access to Medicare for overseas-trained doctors, under which thousands of such arrivals are required to work in rural areas of need until the 10 years has expired.

The first tier, available to all rural doctors, would comprise an incentive payment based on isolation, starting at 7.5 per cent of the amount each doctor claimed annually in Medicare rebates, and rising in five steps, to 20 per cent for those in more isolated towns and to 25 per cent in the most remote areas. The second tier, calculated at the same rates, would be paid to GPs and specialists with emergency on-call skills, or with procedural qualifications in disciplines such as anesthetics, obstetrics, and surgery.

As many rural GPs generate well over $300,000 per year in Medicare billings, the two incentives together would be worth at least $45,000 per year for doctors the AMA argues should be eligible for the scheme, and as much as $150,000 per year if they worked in the most remote areas.

The AMA, which formulated the proposal as part of a “rural rescue package” in consultation with the Rural Doctors Association of Australia, estimated the extra incentives would cost between $300 million and $400m annually. The submission also argued for increased family compensation and support for rural doctors, such as job seeking assistance and retraining for doctors' spouses to help them find work in rural areas.

AMA president Steve Hambleton said that while the services of overseas-trained doctors were “greatly appreciated by the communities they serve ... this strategy is not sustainable in the long term”. “We need to attract and retain Australian-trained doctors in rural areas,” Dr Hambleton said. “To do that, rural practice must be an attractive career and lifestyle choice for doctors.”

The president of the Rural Doctors Association Australia, Paul Mara, said the government's decision to remove subsidies for after-hours treatments provided by rural doctors would discourage them from continuing to practice. In the first half of the year the $40 million federal program diverted 20,000 people who called the hotline from going to hospital, the Health Minister, Tanya Plibersek, said last month. This meant each diverted hospital attendance cost $1000, Dr Mara said. “This compares with the fee [for an after-hours patient] at a rural hospital emergency department by a rural doctor in a small rural community in NSW, which is $85, rising to $250 between midnight and 7am.”

A spokeswoman for the acting Minister for Health and Ageing, Nicola Roxon, said the rural doctors' calculations were misleading because the hotline was meant to provide advice, not just divert people from hospital, and served city areas as well as rural.