New model could be answer to doctor shortage

The Federal Government announced a new model of employment for Rural Generalist (RG) Trainees earlier this month called the ‘Single Employer Model’, which is set to be trialed in the Murrumbidgee Local Health District (MLHD).

The program was designed by the MLHD and the University of NSW (UNSW) as a medium-term solution to the crisis facing many rural and district hospitals across the state – a lack of on-call doctors.

The Rural Doctors Association of Australia (RDAA) is a strong supporter of the new model and worked closely with Dr Paul Mara from Gundagai, former RDAA President, to push for its funding.

RDAA President Dr John Hall said that if the pilot program works, it would be “a massive win for the bush.”

“Currently, junior doctors are employed by the state hospital system while they are undertaking their early training years, and they receive all the usual benefits you get working as an employee,” he said.

The benefits available to junior doctors as hospital staff include the following entitlements and their accrual, sick leave, holiday pay, workers compensation and maternity leave.

However, once junior doctors finish this part of their training they are faced with a difficult choice.

“If they want to become a General Practitioner (GP) or RG, they need to leave the hospital and become essentially self-employed, working out of a private General Practice within the community, even though they are still required to train and be supervised, losing their accrued benefits,” Dr Hall said.

“However if they train in another specialty, which are largely hospital based, they can keep the benefits, and continue building on them, during their training years.

“This has been a huge barrier in enticing junior doctors to choose GP or RG as a career option.”

That’s where the new Single Employer Model steps in.

Under the new model, the MLHD will remain as the employer of RG trainees in the district. This means that junior doctors finishing as a hospital trainee can keep their employment benefits and entitlements if they chose to complete RG training.

“This model would provide significant incentive for young doctors to chose RG as a career, with this employment advantage available to them, but not in other GP training pathways,” Dr Hall said.

“A model like this could be a major part of the National Rural Generalist Training Pathway, and give a level of support for doctors choosing rural generalist practice, which will provide a supported training and career pathway to develop the doctors needed in the bush.”

The issue of doctor availability at Tumut Hospital has been a hot topic for a long time. There is a frequent issue of having no doctor on call at the hospital, because the system works on a volunteer basis – doctors at GP practices need to sign-on to work at the hospital, and there is a shortage of doctors putting their hand up for the task.

This means that patients are regularly transferred to Wagga Wagga for emergencies and after hours treatment when there is no doctor available in Tumut.

Last year a Tumut paramedic revealed that he was forced to work 24-hour shifts because of the shortage of doctors at Tumut hospital.

Member for Wagga Wagga Dr Joe McGirr ‘breathed a sigh of relief’ when the new employment model was announced, seeing it as a long-awaited solution to the critical doctor shortage.

At a rally held in Wagga Wagga last year, Dr McGirr said the lack of appropriate medical services in rural areas like Tumut was unacceptable and was placing strain on the current health services and the local economies.

 Dr McGirr took his concerns to parliament, urging the government to consider the MLHD and UNSW proposal as a practical and achievable medium-term resolution.

 He said the only barrier to its implementation was red tape, with discrepancies identified between the federal and state health policies. 

 Following several discussions with Minister for Heath Brad Hazzard, Dr McGirr later joined Member for Albury Justin Clancy and Member for Cootamundra Steph Cooke in a joint request for the Federal Health Minister’s support of the training package proposal.

 Minister Hazzard later convened the first Bilateral Regional Health Forum in Wagga Wagga to tackle the issue.

 Dr McGirr said he believed the official announcement of the training program trial was a key outcome of December’s bilateral roundtable and ultimately, a win for both the electorate and the state.

“I think this is a great first step towards addressing the critical doctor shortage in regional and remote hospitals in the medium-term. It will provide a direct boost to the medical workforce in these areas,” he said.

The Tumut Community Association (TCA) believes that while the model is a positive step in the right direction, it doesn’t address the core of the problem.

“We applaud that they’re doing training which will [be] aimed at getting more GPs out to rural areas. We think that’s a positive step,” TCA Secretary Christine Webb said.

“However, we don’t think it addresses the hospital’s need for doctors. Basically they’re still expecting GPs to be not only qualified and educated in all that they need to be for primary healthcare … [but] then be a specialist in a field as well.”

Mrs Webb also said that the model doesn’t address the cause of GP burnout, which is “being on call, and the workload.”

“While they might increase the number of doctors taking up the role of a GP in a rural area, they’re not addressing the burnout,” she said.

“They’re not addressing the fact that these doctors then have to be on call 24 hours a day and in a lot of communities it’s quite a number of days in a year that they have to be on call.”

Mrs Webb is worried that even if these GPs and RGs do complete their training and sign up to be on call at the hospital, they will become burnt out from the workload and decide to seek employment elsewhere and leave regional hospitals.

“Why should we expect that, for example, somebody who trains in one field then has to go and take on another role and not only on top of that, be on call 24 hours a day for quite a few days in a week?”

The TCA have been lobbying for two full-time doctors to be employed by Tumut hospital for almost one year now. They launched a petition last May, which is nearing 10,000 signatures.

“We’ve had wonderful support from not only our local community but the surrounding region, and very strongly from Wagga,” Mrs Webb said.

She said that the TCA has been convening with Shadow Health Minister Ryan Park about the cost of employing full-time doctors.

“We have it on good authority that it actually costs a lot more money to be paying doctors to be on call than it does to have specialist doctors employed at the hospital.”

Mrs Webb said that the TCA is continuing to investigate the issue and will have more information in the coming weeks.