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Rural health in retrospect

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BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

As the second Chair of AMACRD, I feel that despite being a relatively new group within the AMA, we have much to be proud of. So, as 2017 turns into 2018, I look at the circumstances that surrounded us, and am glad to note that we have worked hard, we have little victories we can take credit for.

So, Rural Doctors, I invite you to commemorate all our work in the year 2017, but also to note the challenges that lay ahead.

First off, I want to address the slow internet in the Outback. We are getting attention concerning this slowly (but steadily) and have advocated consistently for improvements.

  • NBN Co attended an AMACRD meeting at the time of the rollout of Skymuster II and had a good opportunity to hear our stories.  We advocated to end the data drought by increasing bandwidth, reducing the cost per gb to make our data needs more affordable.  We know that NBNCo has now announced larger satellite data allowances and intends giving medical practice ‘public interest premises’ status, which should improve data allowances and speed even further.
  • We made a submission to the Productivity Commission for the Telecommunications Universal Service Obligation, some of which we were pleased to see was included in their Final Report
  • Council members appeared before the Joint Standing Committee on the NBN, making a case for improved access to superfast broadband by describing in vivid stories what internet is like for us.  I am told the stories were received with amazement.

 Workforce Distribution continues to be an issue. Despite the influx of new medical graduates, there are still unfilled workforce needs in rural Australia. The concept of maldistribution is on the minds of everyone who is trying to solve this problem.

  • AMA has been invited to the Distribution Workforce Working Group.  This group will meet frequently to advise the Minister of Health and the Rural Stakeholders Forum with recommendations.
  • We have also updated the AMA Rural Workforce Initiatives Position Statement to reflect the current state of our workforce and to offer solutions: new wet behind the ears medical graduates, bewildered overworked International Medical Graduates (IMGs) feeling unappreciated, rural health still far behind but eager to catch up.
  • The Government has provided funding of up to $93.8 million from 2015-16 to 2018-19 to implement three components to support the rural pipeline that included: Regional Hubs; Rural Junior Doctor Training Fund; and Specialist Training Programme.

Infrastructure is an area where we have had some wins, but we cannot afford to relax on this front. Hospital, clinics and toilets all need walls, doors and privacy. 

  • Following AMA advocacy, the Government, as part of the 2016/17 Federal Budget, announced a redesign of the Rural and Remote Teaching Infrastructure Grants (RRTIGP) to create a more streamlined Rural General Practice Grants Program (RGPGP) which intends to improve uptake. AMACRD provided input to inform the Department of Health revision of the RRTIGP. The AMA will push for continued infrastructure grant funding.
  • Closure of services in hospitals, especially maternity services is the trend. However there are some “wins” in Queensland with their Rural Generalist program bolstering rural obstetrics.

In the past, Rural Health has been pushed into the background, but we are beginning to see it given some attention by the Government.

  • Recently at an international rural medical conference I was eavesdropping on North American attendees.  They were impressed with the focus that Australia has on rural health.  To quote, “They think rural health is so important they have a Federal Minister for Rural Health!”
  • Now we have even gone a bigger step forward.  We have a National Rural Health Commissioner, Professor Paul Worley.  That should impress the International Rural community.  It took an act of parliament to create this arms-length Commissioner separate from the governing bodies and he is one of us.  We will have an advocate, speaking on our behalf.  He will be rolling out a national Rural Generalist program and the AMA is keen to work with him.

 The vexed issue of Bonded Placements has yet to be resolved, but we are seeing some developments here.   

  • The Government is looking at potentially reforming Return of Service (RoS) obligations on doctors working in bonded placements.  This issue will continue to be developed into the new year as well.  AMA is in discussions concerning this.
  • We need to care for our young, as they are the next generation of doctors. If they are treated like prisoners they will rarely return voluntarily to their former jail cells.

Regarding 2018, AMACRD has additional areas it will be vigilant on including (but certainly not limited to) the following:

  • Support for IMGs and doctors who are struggling with Australian Medical Council and Fellowship exams
  • Monitor the development of the National Rural Generalist Pathway
  • Provide input to Health care Homes, Practice Incentives Program redesign, and Medicare Benefits Schedule Reforms
  • Invigilate the application of the Modified Monash Model for Rural Workforce Incentive programs
  • Support our new Rural Health Commissioner
  • Rural Aged Care
  • Foster team work amongst Rural health care providers both medical and allied health
  • Monitor the new Rural Junior Doctor Innovation Fund (a tweak on the former Prevocational GP Placement Program (PGPPP)) to see 60 Full time equivalents by 2019.

 Although some of these discussions may be uncomfortable, it is essential that we keep rural health in the spotlight. I look forward to continuing to make advancements and am optimistic about AMACRD achieving more victories in 2018.

@drshirowatari

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