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Rural Victoria: Your Hospitals – Your Doctors.

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The RDAV warns that there is a major crisis in progress in rural Victoria. This will affect hospital of all sizes. It will be felt much more over the next 5-10 years.

• Obstetrics is steadily retracting to just a few centres.

• Rural Hospitals are increasingly going on to bypass, sharing on call with other sometimes distant hospitals, or using unsafe rosters because of shortages.

• Rural Hospitals continue to lose services and downgrade in the direction of outpatient and aged-care facilities.

• Except for State-funded EDs in a few locations, neither State nor Commonwealth appear to accept full responsibility for rural casualty.

• Shortages affect all rural hospitals from the largest downwards.

• Australian trained specialists and procedurally competent GPs are in increasingly short supply.

• Incoming doctors are progressively less assured of supervision, assistance and training.

• Rural Medical School and GP Registrar training are threatened by the growing shortage of experienced teachers.

• The Queensland “Bundaberg” crisis related to deskilling over the whole rural sector, which is affecting all States including Victoria.

• Towns are losing resident doctors. Conditions are also particularly difficult for GPs in towns without hospitals caring for acutely ill patients.

• Larger practices are under threat of closure or take-over by corporates.

• Australian trained nurses, especially midwives, are in seriously short supply and there are major shortages of other ancillary staff.

• Lack of appropriate early diagnosis and management means increased morbidity and mortality, as well as many unnecessary transfers.

• A 2009 reclassification will probably lead many Victorian rural towns to be regarded as inner regional and ineligible for Federal grants they now receive which are vitally supporting rural medical services.


Services could be maintained by adequate numbers of properly trained doctors and nurses. However:

• The cadre of trained and experienced rural GPs is ageing into retirement, with an average age over 50.

• Doctors are working into retirement years and remaining on-call at advanced ages.

• Australian trained doctors are not entering rural in significant numbers except recently in Queensland because of new programs there.

• Present conditions do not encourage recruitment from Victorian Regional GP Training Programs.

• Victorian policy relies on overseas recruitment. It is driven by fiscal rather than clinical policy. Overseas recruits generally move on to capital city zones as soon as their immigration status allows.

• Indications are the nursing workforce is moving in a parallel direction.

• Rural Doctors require 5 years of assisted practice to acquire the experience and necessary skills to truly benefit their patients.

• Measures adopted by other States to train and retain a rural generalist workforce are not being considered in Victoria. (Follow links below)

The RDAV calls on interested parties to lobby for a proper solution to the problem and for all concerned rural doctors to register their support by joining RDAV and playing an active part in the future of the rural medical movement. Despite its smaller size, Victoria shares, with other Australian States, distance and capability problems that seriously threaten the health and well-being of its rural residents if effective local health services are not provided. Victoria has relied on ad-hoc recruitment and laissez-faire management for far too long and is paying the price in terms of loss of rural medical services.

Starting absolutely as soon as possible, the State should begin to cultivate and train a rural medical generalist workforce, providing appropriate industrial conditions. Whilst this will not avert further closures before things bottom out, it will allow redevelopment of rural hospitals in future years. Impedimenta of separate Commonwealth and State responsibilities must be overcome through appropriate joint approaches and cooperation. Appropriate inducement for doctors and nurses to work in rural must be maintained.

Links

Queensland: ‘Rural Generalist Training Pathway.’ The Queensland Government has concluded that rural clinical standards will be improved by a four year postgraduate general medical training program including one year’s training in one of the specialties of Anaesthetics, Obstetrics, Surgery, Medicine or Emergency Medicine. Hospital staff specialist posts will be available to graduates of the Fellowship of the Australian College of Rural and Remote Medicine. The program aims to train 110 graduates annually. http://www.health.qld.gov.au/orh/ruralgeneralist/default.asp

West Australia: ‘Engaging Rural Doctors’ Final Report 2007. WA is currently exploring ways of progressing the training and placement of rural generalists. www.ruralhealthwest.com.au/download.cfm?DownloadFile=B85BE343-145E-2880-29818B7A96900750

South Australia: ‘Recognising the past. Rewriting the future. A new partnership for rural doctors.’ 2006. Acknowledging worsening depletion of its rural workforce and the need to restore confidence in a rural career, SA introduced a comprehensive workforce package. www.countryhealthsa.sa.gov.au/LinkClick.aspx?link=rural_health.pdf&mid=342&PortalID=0

NSW: ‘VMOs in Rural Doctors' Settlement Package Hospitals Indexation of Fees from 1 August 2008’. This package, won in the industrial court in 1987, has done much to keep the workforce stable. However there is growing realization that more needs to be done. http://www.health.nsw.gov.au/policies/pd/2008/PD2008_068.html

Rural Medical services: 2008 Snapshot: status and loss of services: Selected Indices.

Maternity Services loss: maps and projections.

Victorian Rurality indices present and from 1.7.09.