Healthcare staff working in rural New South Wales hospitals say disillusionment, rising costs and burnout are driving them from a system let down by state and federal buckpassing.
Dr Ian Spencer, who runs a GP practice at Wellington in the western slopes region, says he resigned from his position as a visiting medical officer in the local hospital because of the pressure of the locum (visiting doctor) system, which he describes as “chaotic”.
“I found that I either had to dramatically cut back what I did [at my GP practice] to being at the hospital more, or the other way around,” he says.
“I’ve got registrars [at my GP practice] who I’m supervising, and to me that is more important.”
Dr Karen O’Brien lives in regional Victoria and locums across NSW, Queensland, Victoria and South Australia. She says word gets around quickly among the locums who work as “fly-in, fly-out doctors” about which rural hospitals to avoid.
“There’s a couple there that if they asked me to go to I would say no because of the experiences of other doctors who I’ve spoken to,” she says of hospitals in the central and far west regions of NSW.
“The problem as a locum is you come in almost as an independent contractor … if you don’t have a good supportive, quality team around you, then mistakes get made and then your career is the one that’s no good.
“So I think that’s one of the reasons that doctors will stay away from those kinds of places.”
According to O’Brian, it’s not that locum doctors don’t like a challenge; rather, “it’s like … how much of a challenge do you want to take on?” she says.
O’Brien is taking a break from locum work in the central and far west region for now because she says she was asked to be on call every day.
“I struggled to make that decision because I enjoy working in Walgett, the staff are wonderful and I enjoyed working with that community,” she says.
Medicare obstacles
Mark Burdack, the chief executive of Rural & Remote Medical Services – a charity operating in the region – says part of the issue is government policies that “do not reflect the reality of how rural health systems work”.
He said the decision by the federal Labor government to introduce a Medicare freeze in 2013, continued under the Coalition until 2017, resulted in GP incomes falling below inflation, “forcing many GPs to close up shop”.
Dr Indra Karalasingham runs a general practice in Cobar and says it’s going backwards financially, as costs to run it have jumped by 20% to 30% due to rising expenses and the Medicare rebate hasn’t kept up.
“Bulk billing is becoming increasingly unrealistic as time goes by,” he says, adding that there’s a huge need to maintain this service in his community for people who otherwise couldn’t afford healthcare.
Burdack says the issue was compounded by the state government’s renegotiation of pay for rural GPs working as visiting medical officers, causing many to leave.
“It exacerbated the strain on rural practices when the state should have been supporting resident rural GPs,” he says.
“We now have millions of dollars in rural health money going to fund city and overseas-based GPs to deliver care as locums or via telehealth, stripping money and jobs out of rural towns.
“This situation had nothing to do with rural doctor shortages.”
‘Becoming dangerous’
According to the western primary health network, 41 small towns in the central and far west region are at risk of having no GP in the next 10 to 15 years.
A spokesperson for the federal health minister, Greg Hunt, said the commonwealth now pays more than 61% of total health funding across Medicare, hospitals and mental health, even though these are state responsibilities.
“We would be delighted if the states would like to match our total health expenditure or the increase in commonwealth funding since 2012-13,” the spokesperson said.
A western NSW local health district spokesperson said the rural medical workforce across NSW had increased by 47.6% since June 2012, adding that the federal government was responsible for ensuring patients have access to primary care and GPs.
“In some rural areas, it is difficult to sustain 24/7 coverage of the local hospital as there are not enough GPs or doctors willing to undertake work as a visiting medical officers to provide a safe roster with no gaps,” the spokesperson said.
“When GP visiting medical officers are unavailable, an alternative is for a locum doctor to provide services for the hospital.
“Locums and visiting medical officers can be difficult to source, even with generous remuneration arrangements in place.”
A scathing report handed to the NSW government in early May, after the state inquiry into healthcare in regional, rural and remote regions, found healthcare staff are being pushed to breaking point by unsustainable working hours, poor recruitment and retention strategies, a lack of resources, poor remuneration, threats to safety and a culture of fear.
Dr Aneillo Iannuzzi, a doctor at Coonabarabran hospital, says the hospital is struggling to get staff not because there are none, but because healthcare workers are “so disillusioned” with the state and federal government’s management of the rural health system “that they’d just rather be unemployed or look for work outside of the sector”.
He tells Guardian Australia he is now considering his future working at the hospital.
“These places are so much set up for failure that it’s becoming dangerous,” he says.
