Why do we have a problem in recruiting General Practitioners and how can we overcome the shortage? The answer – to quote Aneurin Bevan, the Health Minister in the Post World War II Labour Government: ‘By stuffing their mouth with Gold’.
In 2001 the Author Chaired a Review of the Australian Medical Workforce Advisory Committee (AMWAC), the principal body to oversee medical workforce planning and to provide information on how to optimally match the supply and expertise of medical practitioners with community demands in Australia. The report –Tomorrow’s Doctors-review of the Australian Medical Workforce Advisory Committee, was presented in late 2002 Catalogue Records and the Reviewers also published the findings in the Medical Journal of Australia.
The important issues raised included
- The Australian medical workforce, like those of most developed countries, is increasingly “feminised” and exposed to the global market for doctors
- Demand for health services is increasing.
- Concern in relation to doctor shortages is increasing particularly in rural areas
- There should be more flexibility for entry of overseas trained doctors
- There is an urgent need to increase medical student numbers
- Issues of workforce practice, including role/ task substitution should be explored
Well little has changed except on the recommendation to increase Medical School enrolments, which has resulted in an increase (Domestic students) from 1,699 in 2004 to 3,533 in 2021 Medical Deans while lip service has been given to most of the other issues.
So while we have doubled the number of doctors we are graduating at the same time the number of final year Medical students indicating they will train in General Practice has fallen from around 55% in 2004 to less than 20% in 2021. So why do we have a problem in recruiting to General Practitioner, and, if they are not training as GPs, what are they doing? It seems that many are going into Specialist training which offers lifestyle (working part time) and certainly financial benefits but does little to address community needs for a medical workforce. Surely the reasons for these career choices need exploration given the dire situation we find ourselves in with General Practice.
If this is so then perhaps we need a much broader review of the role that the health workforce plays in the community, remembering that less than 50% of diseases are social and life style factors (obesity, lack of exercise, health and general literacy, education, employment) which rarely can be solved with prescription or a diagnostic test. This is not to belittle the role of health professionals but does illustrate our health system emphasis on the Medical model rather than a more holistic approach.
The recent Grattan report on Primary Health Care proffers some insights and potential solutions. The report summarises many of the issues that likely work against General Practice as a career choice when it remains one of the best ways for anyone to practice the ‘healing role’. I have been a specialist all my life but when I look back at my early career when I used to do GP locums at weekends and vacation times it remains without a doubt one of the highlights. I know it is different now but I know many GPs who still enjoy their busy lives and the satisfaction they have from their interactions with the patients they care for.
The Grattan Report does recognises that payment is a key issue – What they get paid and how.
We travel around the world ‘espousing’ the benefits of the Australian Health System – a system that works because we have this wonderful cohort of GPs who act as a filter to Specialists and guess what! – we pay them about a half of what we pay the Specialists! Across OECD countries the renumeration of doctors (both GPs and Specialists) is significantly higher than the average wage of all workers. While in Australia self-employed specialists earned at least twice as much as self-employed GPs.
The pay gap in Australia between Specialists and GPs remains one of the highest in the world despite efforts to reduce out of pocket expenses which continue to disadvantage patients, particularly at the specialist level. A small co-payment at a GP level is probably essential. At present the thousands of dollars added to specialist bills remains a blight on the health professionals who charge these fees.
The Grattan report makes compelling reading, exposing the deficiencies of our current health system. We still have a very hospital centric system if exemplified by our politicians who at every election bombard the community with promises to build a new hospital or clinic in every local area! Most of us don’t spend much time in hospitals – or at least shouldn’t. But we do need services in those communities that prevent us from attending Hospitals – and of course they have blossomed during Covid as health professions embraced Digital based solutions – Telehealth and the like – and these must continue to be appropriately funded Northern Health emergency department
The Grattan Report also points out that since the inception of Medicare the health care profile in Australia has also altered with chronic disease taking up much more of the health care budget and subsequently health professionals’ time. Doctors in particular, but all health professionals, need to ask what needs to be done by them and what could be done by another member of the health care team. Programs for these conditions need to focussed on prevention at every level. Why do we continue to see how obesity drives so many chronic diseases yet we baulk at getting serious about bringing in taxes on sugar content of food and drinks while the world every year gets ‘heavier’?
Whilst the Grattan report proffers a number of solutions for a “New Primary Care” model I think we may be underestimating the financial and lifestyle pull of part time specialist practice on those seeking to join the medical profession. If so then costings will be significantly higher and Minister Butler may need to look at history and the oft quoted response from Aneurin Bevan the Health Minister in the Post World War II Labour Government when asked how he was going to persuade the Doctors to join his National Health Scheme and he replied ‘By stuffing their mouth with Gold’.
And so he did.