Several poor rural regions are being disadvantaged by the way the Australian government identifies significant doctor shortages, while some wealthy areas are being classified as needing extra resources.
The Royal Australian College of General Practitioners has argued that the system – which determines which regions need additional resources – is flawed and is exacerbating rural GP workforce shortages.
Doctors trained overseas are crucial to easing GP shortages across the country because for their first 10 years in Australia they must work in areas of need, known as a distribution priority area, to access Medicare benefits.
The DPA system, which is being reviewed, identifies geographic areas with a shortage of GPs by examining the remoteness of an area, the socioeconomic status of its patients, and the number of Medicare billings. DPA classification is updated annually.
But rural towns on the city and regional fringes say their status is being boosted by their non-rural neighbours in the same geographic area that attract more GPs. As a result, they are missing out on DPA status and struggling to attract the international doctors they once relied on to fill workforce gaps.
Dr Farza Rastegar is the owner of the only GP clinic in Pearcedale, a town an hour and a half south-east of Melbourne in the City of Casey local government area, which is classified as metropolitan. But the town of Pearcedale itself is considered a coastal rural locality, surrounded by farms and horse racing stables.
“Zoning us as metropolitan does not make any sense,” Rastegar said.
Yet the neighbouring area of Mount Eliza, which is ranked by the Australian Bureau of Statistics as having the highest level of advantage in the Mornington Peninsula, qualified for DPA status. This is despite Pearcedale having a mixed population that includes significantly disadvantaged people, according to Rastegar. The median weekly household income in Mount Eliza is more than $500 greater than in Pearcedale, according to the latest census data.
Rastegar said since the clinic’s seven GPs had dropped down to four, the centre has not been able to replace staff with internationally trained doctors available to work.
“I already know someone who is happy to start soon,” she said. “But I can’t get him because he only moved from the UK three years ago, so he hasn’t done his 10 years.”
The centre will close on Fridays from 1 November due to the struggle to find enough staff, she said.
“It is putting the community in a panic mode. They are wondering, ‘Are they going to close down eventually?’”
Pearcedale Medical Centre applied to the government to review its area’s DPA status in May but the review found the catchment area as a whole had higher than average levels of access to GPs.
Several GP practices in rural fringe areas including towns along the Sunshine Coast such as Buderim, Caloundra, Maroochydore and Noosa, as well as clinics in the Victorian town of Wallan have also experienced staffing issues after missing out on a DPA classification.
Dr Anita Munoz, the Victorian chair of the RACGP, said Pearcedale was an “important case because it just goes to show why this classification system isn’t working”.
“The issue of the rural and regional medical workforce is a true example of a wicked problem … there will be no single one initiative that will solve this,” Munoz said.
“But until we start to sophisticate the way that we measure areas of need, we will probably continue to misclassify areas and create new gaps where others were nonexistent, and then failed to fill gaps that we’re not recognising.”
Peta Rutherford, the chief executive of the Rural Doctors Association, said remoteness modelling was often a “blunt instrument” and it was significantly affecting patients on the fringes of capital cities or larges regional centres.
But Rutherford distinguished: “If you’ve got no doctors in a rural town, you’re not traveling three suburbs away on a bus, you’re driving hundreds of kilometres.”
Earlier this year Senate estimates figures revealed the number of international doctors moving away from rural and remote areas increased by more than 50% in the year since DPA reclassifications were introduced, according to the RACGP.
An independent report produced for the Department of Health in 2021 found that while overall, DPA classifications were appropriate: “The DPA calculation methodology may be disproportionally unfavourable to outer-metropolitan and regional catchments.”
The department is conducting a review of the DPA program, expected to be complete by the end of 2024.
The health minister, Mark Butler, told Guardian Australia: “The government funds a range of programs and incentives to encourage GPs to relocate, in addition to DPA.”
