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Beyond money: what do rural doctors want?

Health economist Dr Abby Kamalakanthan writes: In an interview on ABC Radio’s Afternoons with Georgia Stynes last week and in the

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Health economist Dr Abby Kamalakanthan writes:

In an interview on ABC Radio’s Afternoons with Georgia Stynes last week and in the UQ News article ‘Incentives won’t fix the rural doctor problem’, I argued that although the Australian Government in recent times has introduced various financial incentives aimed at enticing more urban GPs to the rural areas of the country, we are still witnessing a supply shortage of GPs in many rural and remote communities.

Clearly then, throwing more money at GPs is not going to solve the rural supply problem.

It is time that the Federal Government realises this and starts looking elsewhere for solutions.

Unlike the bureaucrats in Canberra, I decided to go straight to the source (the GPs themselves) when conducting my PhD research to find out what incentives would really keep GPs in the rural areas. My survey of 1,000 GPs in four states was a real eye-opener.

What’s Available Now

The main financial incentive available to rural GPs right now is the General Practice Rural Incentives Program (GPRIP) which came into effect on 1 July 2010 and was funded in the 2009-10 Budget as part of the Australian Government’s Rural Health Workforce Strategy (see the General Practice Australia website for more information on this scheme).

Basically the program combines the previously separate Rural Retention Program and the Registrars Rural Incentive Payments Scheme, and introduces a relocation incentive grant. Incentive payments are based on the length of time a GP Registrar is placed in an Australian Standard Geographical Classification – Remoteness Area category, on a sliding scale.

The other financial incentive is the HECS-HELP reimbursement program for Australian graduates who graduated in 2000 or later. Participants in the scheme will have one fifth of their HECS-HELP fees reimbursed for each year of medical training undertaken or service provided in the Rural, Remote and Metropolitan Areas zones 3-7 (these locations include large and small rural and remote centres).

Are These Incentives Working?

A day after the GPRIP was announced by Canberra, rural doctors attacked the scheme in The Australian, saying the rules were “ridiculous” and gave doctors the same amount for moving to Hobart as to the tiny NSW town of Tumut.

Rural Doctors Association of Australia President, Dr Paul Mara, a GP at Gundagai in southern NSW, said the program was a good idea but it “falls to pieces when put into practice”, and the zones were “completely ridiculous”.

So What Do Rural GPs Really Want?

When deciding their practice location, most GPs have a tendency to compare financial incentives against non-financial incentives.

My GP survey results show that there are a number of non-financial incentives which are of particular relevance to policy-makers as possible solutions to improve rural GP supply.

These include many important factors which GPs in urban areas take for granted, such as basic orientation, support for families and good schools for children, support for further study, local community support, infrastructure support, locum relief and adequate IT facilities such as having broadband Internet access.

Younger GPs, in particular, are inclined to make decisions based on such benefits as leave entitlements, flexible working hours, and gaining recognition for teaching; and such costs as the extent of social isolation.

In addition it is necessary to provide foreign-born overseas-trained doctors with a standard accredited orientation program, give them the opportunity to enrol in the GP fellowship preparatory program, help them to understand the Australian culture, and provide them with English language support. Another suggestion is that after working in rural locations for three years, overseas-trained doctors on temporary visas should be granted permanent resident status of citizenship.

Policy-makers need to also acknowledge that rural GPs might want to return to the cities at some stage in their career because working in the rural areas may hamper their access to specialty training.

One of the policies that could be considered by Canberra is if GPs work for at least five years in a rural area and they choose not to remain in general practice, then they should be rewarded with admission to a specialist training program.

The moral of this story is without some out-of-the-box thinking in Canberra, doctor supply in rural Australia is unlikely to improve either now or in the future.

• Dr Abby Kamalakanthan obtained her PhD in Health Economics from The University of Queensland. The title of her thesis was ‘An Economic Analysis of the Supply of General Practitioners in the Rural and Urban Areas of Australia’. Her study received financial support from The University of Queensland Special Graduate School Scholarship and UQ School of Economics PhD Research Grant.

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