Call for more doctors

Tumut is in the midst of a health crisis.

There is no issue with the health professionals that currently work here. By all accounts, our General Practitioners, nursing staff, and other health workers do a marvellous job. But there is a crisis nonetheless, and it is one of quantity, not quality.

“It’s a very sad situation,” said owner of the Connection Medical Centre, Hansie Armour.

“We have doctors who want to come here, who have doctors who are waiting to come here, but we can’t have them.”

Most readers will probably be surprised to learn that getting new doctors for the town is not as easy as simply finding doctors we want to move here. There are complicated rules dictating where professionals at different levels can work.

The most relevant part of what is a tortuously complex system for Tumut is a classification given to certain areas called ‘District of Workforce Shortage.’ This benign sounding bureaucratic term is the primary culprit behind Tumut’s current woes when it comes to attracting and retaining medical professionals. It’s the kind of doublespeak government term that makes your brain immediately switch off, but bear with me – it’s crucially important to the standard of health services in this town.

So what is it? Well, the bulk of the rural medical workforce is currently drawn from trained migrants from overseas. Like most other professions, Australian-trained doctors flock to the coastal cities, and there’s not much the small towns of the interior can do to prevent this.

When a doctor migrates from overseas, however, part of the package is that they have to spend their first ten years in a rural area. These doctors have a strict moratorium on working in any area that has not been stamped by the Federal Government with ‘District of Workforce Shortage.’ Tumut has benefitted from this system in the past: wonderful doctors like Dr Osman Darwiche originally moved to the town as part of the program. But in 2014 it was stripped away from us, with no clear explanation as to why.

The full decision-making process of the Department of Health is not made public knowledge. Nevertheless, since then, any doctor who has moved from overseas is not legally allowed to practice in Tumut for the first ten years of their time in Australia.

This change is having severe consequences for our health services. Doctors retire or leave town with no viable method of replacing them, and the number of practicing doctors is reduced with no reduction in the workload. Those remaining are working themselves to the bone to make up the difference, and the hospital is left without procedural GPs to staff it.

“We burn our doctors out,” said Hansie Armour.

“Spit them out and end up with none. This isn’t a money issue, it’s an issue of the rules. The rules don’t meet the need.”

“It’s really frustrating,” said Tumut Family Medical Centre Practice Manager Janette Wilson.

“I’m not even just talking about from our practice’s point of view, I’m talking about from the community’s point of view. In rural areas, overseas doctors are our staple, and we can’t get them.”

In the region, Tumut stands out for not having this DWS classification. Wagga also doesn’t have it – which seems fair enough – but Gundagai, Cootamundra, Young, Tumbarumba, Holbrook, and Temora do. Yass and Cooma, two towns with almost identical population sizes to Tumut, both have over double the number of doctors that we do. They are classified as DWS.

It even has ramifications for the new hospital. Country areas like Tumut rely on GPs with procedural training, such as obstetrics and anaesthetists, rather than separate specialists to perform these roles. Currently, Dr Darwiche is our only doctor with obstetrics qualifications, and our only GP anaesthetist, Dr John Curnow, recently retired. There are nine fulltime-equivalent doctors in town currently, with eight sharing the workload at the hospital, but this is in a constant state of flux.

With a ‘District of Workforce Shortage’ classification, the pool of possible hires would widen enormously – and without it, it’s proving basically impossible to bring more of these procedural GPs to the town. This means that Tumut is looking at being in the almost amusingly absurd situation of possessing a brand new hospital with surgical capabilities, but without any doctors living here capable of performing surgery.

“If we’re going to be a maternity hospital, we need to have an anaesthetist in case there are any complications, to ensure a healthy mum and a healthy bub,” said Janette Wilson.

“If there is a trauma – and with the ski fields, the logging industry, the water skiing on the dam in summer, it happens – we need to have an anaesthetist available for our community. That’s what our fight is about, to replace Dr Curnow and get a GP anaesthetist back in town. And we can’t get one!”

Having a medical workforce stretched thin doesn’t only have consequences for the community. It has consequences for the current workforce. In a town like Tumut, the only doctors available for the hospital are the GPs, something the DWS does not take into account, and they are working overtime to fit everyone in.

Janette Wilson explains what a typical day for an on-call doctor looks like:

“Our doctors are generally at the hospital at about eight o’clock each morning for rounds,” she said.

“They come down to the practice at around 9.30am, depending on how many patients they have up at the hospital. They start consulting at 10am, so before they start consulting they have to check yesterday’s results, make sure there’s no urgent recalls, do any reports or letters, prescription requests, that sort of thing. Then they see their patients til 5.30 – 6.00, depending on how busy they are. After that they often have to go back to the hospital, and if they’re on call they could get called out three, four, five times a night.

“If they’re on call and there’s an emergency at the hospital during the day that takes up three or four hours then all of those patients they’ve booked in have to be rescheduled for another time. That has a flow-on effect for the next week, because you’re double-booking ahead for the next week – and that’s stress on them, because they know that they need to be at the hospital for that emergency, and that that patient needs their care, but that their next week will be so busy because they have to double-book.”

It is, in a word, “exhausting.”

Insiders like Janette Wilson and Hansie Armour are confident that this ‘District of Workforce Shortage’ classification being changed is the key to making our strained health services significantly healthier.

But can anything be done?

“It can only be solved, I’ve come to feel, by political lobbying,” said Ms Armour.

Local health professionals have been trying their hearts out to have this classification changed – or, at the very least, to get a straight answer for why Tumut isn’t considered eligible for it – for years, without any luck. The best bet now is with the community: you.

Fortunately, the Shadow Minister for Health, Catherine King, will be in Tumut on Monday for a public meeting regarding local health issues. Representatives from the industry, like the Connection and the Family Medical Centre, will be speaking with her privately beforehand, but they are desperately hoping as many community members as possible show up to voice their support and make it clear how vital this issue is to the town.

The meeting will be held at Club Tumut, Monday August 28, from 2pm – 3pm.

On the other side of the fence, the Federal Health Minister, Greg Hunt, can be contacted at [email protected], (02) 6277 7220, or Shop 4, 184 Salmon Street, Hastings, VIC, 3915.