What’s the issue?
Living in the country rather than the city means you are more likely to get sick or injured but you are less likely to find adequate healthcare. And if there is a vacancy for a medical professional in your town, expect it to take far longer to be filled.
The healthcare shortage in rural Australia is reaching extremes, as shown by the experience of one country town which pledged a $500,000 incentive to help attract a doctor! In 2007, Temora (a town in south-west NSW) lacked a physician with experience in anesthesia and obstetrics. As the town’s population of 29,000 waited, a local surgery posted the hefty incentive to gain a doctor with the right skills. Temora is typical of rural and remote Australia, where a visit to the doctor can be as common as a shower of rain.
What are the main differences between the country and the city?
A decreased quality of life is the likelihood for those affected by healthcare supply problems in our country towns.
In urban Australia, there are approximately 326 doctors for every 100 000 people. Sound lean? In country Australia, the number of doctors falls to 130 per 100 000 people living in areas that are hundreds of kilometres wide. This can result in extra pressure for doctors, who are often the only medical professionals available.
A similar story exists with dentists and nurses. Major cities have the services of roughly 58 dentists per every 100 000 people, but this number is decreased to just over 18 in the country. There are an equal number of nurses in urban and country areas, yet nurses in rural and remote Australia work longer hours than those in the city.
Medical people are not the only resource concentrated in the city. More hospitals and hospital beds are available in urban and regional areas. Small country hospitals have to rely on patient transfers to larger city hospitals for particular procedures. Sounds like a pain for the hospital as well as for the patient.
While patients in both city and country areas can suffer insane waiting lists for healthcare, country patients have the added stress of higher fuel and food prices. It may be more expensive to eat a proper meal than it is to grab fish and chips for the family, which in turn may lead to poorer health. And count your five hour round trip to the doctor out when fuel prices start to sky rocket. While rural and remote patients can get travel assistance, many claim it is insufficient.
People living in country areas are already more likely to be unemployed, earn less after tax, smoke, drink excessively, take illicit drugs and be overweight. Insufficient access to healthcare means that they are also more likely to be disabled, have bad teeth, suffer from depression and miss work due to injury or illness. It’s a pretty heavy price to pay for being able to see the stars at night.
Why do these differences exist?
Some medical graduates argue that it is important to be working in the city, ‘where the action is’, especially when they’re just starting out. They also believe that good support bases may be lacking in some country positions. Then there is the obvious allure of a choice of hundreds of city pubs and clubs over the weekend, rather than the local RSL. A lack of infrastructure as banks and quality telecommunications in rural communities can also be a major disincentive.
Also, country doctors are often required to work much longer hours than city doctors. Some rural doctors are the only health professionals in their area and have no one to rely on if they themselves need to call in sick.
Then what needs to be done?
Rural access to health care can primarily be viewed as a state responsibility. State governments are allocated money by the federal government to supply equal and adequate healthcare access.
The Howard government spent over $4 billion in office on rural health initiatives, including the Rural Medical Infrastructure Fund in 2005 which provided more than $7.6 million for thirty five projects. It gave nearly $275 million for rural healthcare in the 2007 budget. Then Kevin Rudd’s turn came around.
In May 2008 Prime Minister Rudd allocated $275.2 million in the federal budget to spend on 31 rural GP (General Practitioner) Super Clinics over 5 years. The Ministry for Health and Aging announced that this means that ‘working families will receive health care where and when they need it, no matter where they choose to live’. The Rural Doctors Association of Australia (RDAA) seemed to think this declaration was a huge overstatement. In fact RDAA President Dr Peter Rischbeith expressed extreme disappointment that rural health had received the same poor treatment as it did under the Howard regime.
Before the budget announcement, the RDAA had called for government support to convince an extra 16 000 health professionals, 1000 of whom should be doctors, to take up country positions. Along with the Australian Medical Association (AMA), the RDAA formulated the ‘Rural Rescue Package’ which would make sure that rural doctors were valued and given incentives to practice in more remote areas. This project was not given funding.
Rural Health Workforce Australia (RHWA) argues that graduates with country backgrounds, or who study at rural universities, are more likely to work in rural areas. The RHWA is calling for a stronger effort to be made to attract medical students from rural areas. Most Australian universities have a compulsory rural placement component to undergraduate medical studies, however funnily enough this practice seems to deter more graduates than it attracts.
The National Rural Health Alliance (NRHA) argues that the gap between rural and metropolitan health can be closed with a 30 per cent allocation of resources to the 30 per cent of the population who live in country Australia.
This page was updated by kate elise
How do I know this?
Abbott, W, ‘World study of rural health best practices’,
www.e-bility.com/
Australian Department of Health and Aging, ‘Health Budget 2007-2008’
www.health.gov.au/
Australian Government Department of Health and Aging, ‘Health Budget 2008-2009: Delivering Healthcare to all Australians’ (13 May 2008)
www.health.gov.au/
Australian Medical Association, ‘AMA/RDAA Rural Workforce Rescue Package Factsheet’ (18 October 2007)
www.ama.com.au
Cootamundra Herald www.cootamundra.yourguide.com.au/
‘Healthier Rural Communities – New Clinics’,
The Coalition Government: Election 2007 Policy www.liberal.org.au
Milgate, S, ‘Shortage of Rural Doctors in Australia (and what can we do about it, if anything?)’,
Australian Doctors Fund (August 1999)
www.adf.com.au/
Parnell, S. & Cresswell, A, ‘Doctor crisis leaves 12m short of care’,
The Australian (November 19 2007)
www.theaustralian.news.com.au
Rural Doctors Association of Australia, ‘Rural doctors welcome Rudd commitment to country Australia’ [Media Release] (November 27 2007)
www.rdaa.com.au
Rural Doctors Association of Australia, ‘Different Piper, same tune: rural health ignored in Rudd Budget’ [Media Release] (13 May 2008)
www.nrha.ruralhealth.org.au
‘Rural health workforce Australia: Strategic Plan 2007-2010’
www.rhwa.org.au/
Simmons, D, ‘Rural Primary Health Care in Australia: What Can We Learn?’,
New Doctor, Issue 74 (Summer 2000-2001)
www.drs.org.au
Stark, J, ‘Doctor shortage looms as GPs head for retirement’,
The Age (January 17 2007)
www.theage.com.au/
