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Scheme offers a solution to rural doctor crisis

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An innovative scheme that has boosted the recruitment and retention of doctors in remote communities in far western NSW, delivering significant improvements in health, should be rolled out nationally, according to the AMA.

The AMA said the Easy Entry, Gracious Exit scheme developed by the NSW Rural Doctors Network (RDN) has been a major success in attracting and retaining doctors in four communities – Walgett, Lightning Ridge, Brewarrina and Collarenebri – that have historically struggled with inadequate medical services and high practitioner turnover.

Under the program, Rural and Remote Medical Services (RaRMS) – a not-for-profit company set up by the RDN – takes responsibility for the administration of the practices, enabling medical practitioners to concentrate on their clinical duties.

One of the early beneficiaries was Dr Vlad Matic, who was the sole private GP and Visiting Medical Officer in Walgett in the late 1990s.

At the time his practice workload was onerous.

According to an appraisal by RDN, it was not unusual for Dr Matic to see 40 patients at his Walgett Doctors Surgery practice and then find a further 15 waiting to see him when he arrived at Walgett District Hospital at 6pm.

In an interview with Australian Doctor in 2009, Dr Matic said the heavy workload meant he had no time for preventive care.

“I realised that I would never be able to fix the health outcomes in the town,” he told Australian Doctor. We needed to entice more health workers, especially doctors, to come and work here.”

In 2002, RaRMS assumed responsibility to operate Walgett Doctors Surgery and engaged Dr Matic. By early 2003, Walgett’s medical workforce had been expanded to two resident GP/VMOs engaged by RaRMS (supported by a fly-in GP/VMO for two months a year) and a resident GP at Walgett Aboriginal Medical Services, freeing up Dr Matic to undertake public health work.

This experience has been replicated in the other communities where RaRMS has assumed responsibility for practice administration work such as securing locums, ensuring the continuity and security of medical records, employing staff, securing surgery space, managing the purchase and maintenance of IT, medical equipment and consumables, engaging and paying utilities.

In return, doctors pay a service fee to the managing entity.

Relieved of these administrative tasks, doctors have been able to concentrate on treating patients and working to improve health outcomes, improving job satisfaction and reducing burnout, with the result that the doctor retention rate in these towns has risen to an average of five years – a vast improvement on experiences such as that in Brewarrina where, in a 20-month period a succession of 22 locums went through the town.

In its appraisal, RaRMS said the Easy Entry, Gracious Exit model had resulted in “greater reliability of general practice and VMO services, and less community anxiety about whether medical attention will be available when required”.

In addition, the scheme boosted local employment, particularly for practice nurses in Walgett, Lightning Ridge and Brewarrina.

AMA President Associate Professor Brian Owler said the Easy Entry, Gracious Exit model had the potential to ease the doctor shortage in many rural and remote communities across the country.

“It involves adopting a ‘walk-in, walk-out’ approach that enables GPs to work as clinicians without having to become small business owners and managers,” A/Professor Owler said.

“This model removes many of the obstacles that prevent doctors from establishing or maintaining a country practice for the long term. It allows them to stick to their core business – looking after patients.”

 A/Professor Owler said the model ensured a far better experience for practitioners, boosting the chances they would stay.

“Once the doctors arrive in these towns they often find that, while free to leave at any time, the support, financial arrangements, and the interesting medicine is so attractive that they readily remain for a reasonable period,” he said.

In a Position Statement on the model, the AMA said experience in had shown it ensured continuity of patient medical records and practice management independent of doctor turnover, fostered stability in the professional and clinical working environment, improved relations with the local Area Health Service, encouraged a significant expansion in Medicare services, and eliminated the regular crises caused when doctors were ill or took leave.

 “The key objective is to ensure the continuity of the practice or practice management structure, rather than the continuity of the individual doctor,” the Position Statement said.

The AMA Position Statement on the “Easy Entry, Gracious Exit” Model for Provision of Medical Services in Small Rural and Remote Towns can be viewed at position-statement/easy-entry-gracious-exit-model-provision-medical-services-small-rural-and-remote

 Adrian Rollins