Hospital pass: What value are new facilities without the doctors to run them?

Queensland regional centres are preparing for new medical facilities after the State Election, but the good news comes at a cost with GP numbers on the slide, providing a new headache for rural health policy makers. Brad Cooper investigates.

Oct 29, 2020, updated Oct 29, 2020
The new Roma Hospital due to be officially opened after the State election. (Photo: Supplied).

The new Roma Hospital due to be officially opened after the State election. (Photo: Supplied).

Whoever takes on the role of Health Minister after the October 31 poll better come equipped with a sharp pair of scissors for all the grand openings of new hospitals and medical facilities planned next month.

The pinnacle will be the official opening of the new Roma Hospital, which was completed last month at a cost of $112.6. million.

The 24-bed, three-level hospital represents one of the largest government health infrastructure investments in the south west region in decades, creating 97 full time equivalent jobs during construction.

In the state’s central west, residents of Blackall will see their new hospital opened on November 25, replacing the run-down hospital built in 1938 at a cost of $20.11 million.

While the upgrades spell good news for bringing first-class treatment facilities closer to regional populations, the more sophisticated medical care being offered is contributing to a decline in general practitioner numbers.

Roma GP Dr Rosie Geraghty says she is observing the trend in her community, where doctors are gravitating to the higher salaries and better conditions in hospitals as employees of Queensland Health.

“The new hospital is fantastic but at the end of the day it’s just a building – effective patient care comes down to the trained doctors, nurses and allied health staff being available when and where they are needed,” Geraghty says.

Why is this significant?

At its simplest, GP shortages create longer wait times to see a doctor.

The ramifications go well beyond being a frustrating inconvenience for patients.

Difficulties accessing consultations with a GP may deter some people from medical treatment altogether, meaning conditions go undiagnosed or the continuous management of chronic conditions becomes sporadic.

In rural communities where rates of obesity, diabetes and Australia’s biggest killer, cardio-vascular disease, are higher than in the city, and health outcomes are generally poorer, the problem becomes even more critical.

It means that when patients finally see a doctor, they are sicker than they would have been had they seen a doctor earlier.

Their complications may require specialist care, which for a lot of people in the bush will require regular long-distance travel to larger cities on the coast, Brisbane, in most cases.

Hospitals also suffer. The accumulating health burden has the potential to spill over into emergency departments, which for stretched government health budgets is more expensive to deliver than primary care at the GP level.

With health taking some 30 per cent of government expenditure each year, that’s a cost all Queensland tax payers wear.

Pressured workloads also put doctors under strain, increasing fatigue and heightening the risks they will make mistakes.

A current shortage of locum doctors to provide relief for doctors who need to take leave is exacerbating the challenge.

Rural GPs also play a massive role in medical education, effectively training and supervising junior doctors on the job.

Stress erodes their availability to bring new professionals through the pipeline.

From there the dynamic is something of a self-perpetuating doom loop – the worse the situation gets, the less attractive a medical career in the bush becomes for new graduates, while difficulties increase retaining staff at risk of burn-out.

Rural communities vulnerable

As reported previously, Queensland rural communities are in a better position than almost anywhere else in Australia thanks to the rural generalist model, classified as a sub-speciality where doctors in the bush are essentially trained to be a jack or jill-of-all-trades, delivering babies, administering anaesthetic or performing some surgery among a suite of other clinical  services.

Queensland is unique in Australia as the State Government was the first to provide an identified funded training pathway.

Fittingly this was confirmed in Roma in 2005 in a deal struck between rural doctors and the Health Minister of the day, Labor’s Stephen Robertson, who became the model’s champion. To this day, the decision is known in health circles as the Roma Agreement.

Over time it has enjoyed bipartisan support, with LNP Health Minister Lawrence Springborg tasking it forward during the term of the Newman Government.

“Rural generalism has, without a doubt, saved many hospitals across rural Queensland,” Geraghty told InQueensland.

“Before then we had no hospital doctors – just GPs trying to cover both their clinics and hospital rounds.

“Over the last 10 years we’ve seen the fruits of that program, with doctors coming in that are well supported, with good skills with a year of anaesthetics, a year of obstetrics and a year of surgery under their belts that has kept our hospitals alive.

“However, there’s been a trade-off with a sharp reduction in GPs and now the challenge ahead is to increase the attractiveness for people who want to do primary care only without having to do hospital care.”

Roma GP Dr Rosie Geraghty. (Photo: Brad Cooper).

Bigger regional centres like Roma have been the main beneficiaries of the rural generalist model.

Small community hospitals, like general practice, have not had the same experience.

The signs of a system in distress was flagged at last week’s LGAQ conference on the Gold Coast, where the Central Highlands Regional Council demanded action on providing accommodation and rental assistance from State Government revenue to support their doctor workforce.

Queensland Health for many years have supported all public doctors that work in regional and remote Queensland with a housing subsidy.

The council understands the subsidy is under threat, not just for their region, but for greater Queensland, effectively leaving Queensland Health doctors homeless after December 31, unless they are able to secure new housing in communities like Emerald where rents are high and property supply tight.

“The impact of being unable to attract doctors to regional and remote areas will result in hospitals being unable to provide sufficient care to the community, returning hospitals to previous arrangements of having fly in fly out locum doctors on roster arrangements,” the council’s successful motion read.

Medicare rebate under fire

On paper, overall doctor numbers look strong, leading some to argue that the issue is not one of shortage, but equitable distribution that ensures patients have the best care available regardless of their post code.

At the end of last year, Queensland had 2602 medical practitioners working in areas classified as rural and remote, according to Health Workforce Queensland data. North Queensland had the largest rural medical workforce in the State.

Longreach based GP and the immediate past president of the Rural Doctors Association of Queensland, Dr Clare Walker, says the most significant factor is the disparate funding models of medical care.

As she explains, graduates of the rural generalist pathway are employed by Queensland Health, which offer attractive and competitive salaried positions for larger rural hospitals.

General practice by comparison relies on a subsidised user pay funding model that doesn’t offer the same compensation.

This strikes at the heart of the Medicare rebate paid to doctors. For example, a standard GP consultation will see Medicare pay $38.75 to the medical provider – with a further $10 paid if the patient is a child or elderly.

Sixty per cent will go directly to the doctor providing the service, with the remaining 40 per cent retained by the clinic to pay for administration and operating costs.

Like a restaurant that has to turn tables quicker to make a profit, doctors are effectively encouraged by the system to cycle through their patients quicker. Some doctors have the average consult time down to six minutes.

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The risk is critical diagnoses may be missed. The system is also susceptible to rorting.

These are big picture issues not only specific to rural areas.

But for doctors working in rural communities, where they have more sustained contact with patients managing chronic illness and accidents on places like farms and roads are more prevalent, demanding more of their skills, the Medicare rebate amounts to poorer compensation for their time.

“This is why you won’t hear the Australian Medical Association for example talking about Medicare rebates as an issue,” Walker says.

“For their city-based doctor members they are not as disadvantaged as rural doctors.”

As Walker further explains, RDAQ has advocated for integrated and shared workforce models between hospital based and primary care as one measure to address the discrepancy.

But her organisation also believes that a connected thread between primary care at the GP level and secondary care in the hospitals is a central principle of rural generalist medicine, offering remotely located communities responsive and flexible medical services.

For now, medical professionals like Walker and Geraghty are seeing the discrepancy hit home in a very real and tangible way for their communities.

Both Longreach and Roma operate with nine full time GPs.

The Longreach medical workforce services a region of about 12,000 people from the one clinic.

Roma has two medical clinics of four GPs each, plus one sole operator servicing a region of 10,000 people.

Another GP operates out of Mitchell, 88 km west, and there are two fly-in-fly-out doctors from New Zealand operating out of Injune, 90 km north.

Both workforces are operating on the cusp of the ideal doctor-patient ratio, although the aforementioned pressures on their time such as training, administration and their own professional development reduces the clinical hours they have available.

If they want to take a holiday, their colleagues either have to pick up the slack or they have to find and fund a locum to relieve out of their own pockets. If they lose a doctor permanently they go from ailing to critical.

“I can only describe it as a system under strain,” says Geraghty.











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