News Parliament

FEDERATION CHAMBER - GRIEVANCE DEBATE - RURAL AND REGIONAL HEALTH SERVICES

There is inequality between the city and the country, and nowhere is this seen more than in the chronic shortage of doctors in country Australia. This is something that country people have been very concerned about for many years, and it's time something was done about it. Access to medical professionals and the services they provide is something city people take for granted. Country people, however, know all too well what it's like to go without them, and we've had enough of it. Charles Sturt University aims to help solve this long-running problem by training doctors in the bush for practice in the bush through the Murray-Darling medical school. This country university has put forward an evidence based case for a rural medical school as a better solution to rural doctor shortages, based on a comprehensive analysis of independent evidence from Australia and overseas.

CSU invested in a comprehensive economic analysis that found that a rural medical school will not only fix rural doctor shortages but deliver over $2 billion in flow-on jobs and economic activity in the regions. They have answered every claim and every counterclaim from the city lobbyists with independent, measured and objective evidence. When city lobbyists said there were not enough clinical training places, or training capacity, in the regions to support a new rural medical school, CSU did the hard work to obtain an independent analysis of current and future capacity. The final report was a devastating indictment of the lobbyists' claims, and, to date, the city lobbyists have not provided any evidence, facts or data to show how their programs are better placed to solve rural doctor shortages. For its trouble, CSU has been the target of a lobbying and advertising campaign commissioned in the faraway offices of the lobbying departments of big city universities and other medical elites. Not only are the city lobbyists unable to show us the evidence for city medical programs; they have refused to let rural people access the data they have that would show the exact number of city medical graduates who have gone bush. The last thing the big city universities want to talk about is their own performance.

So let's have a look at some of the city lobbyists' claims. For a start, they've said that the current system is going well; it just needs a little bit more time and they'll be able to nail it. There is a chronic shortage of doctors in country Australia, and our country communities know it. All of the lobbying and the spin can't hide the fact that many in the bush wait weeks or months to see a doctor, let alone get one to practice medicine in their town, village or, even, city. Less than 10 per cent of graduates from the big city universities end up practising medicine in the bush. In fact, I believe the figure to be about eight per cent, with as few as five per cent choosing to work in remote general practice in Queensland. Using doctor-patient ratios, rural and regional areas continue to be under-serviced by medical practitioners, with 452.6 medical practitioners per 100,000 people in major cities compared to 282.6 in inner regional areas, 258 in outer regional areas and 256 in remote and very remote areas. I must say that when I met with one of the city universities, after I was elected to be the member for Calare, I asked them to tell me how their graduates ended up practising in the country. 'How many?' I asked, and I'm still waiting.

The bush has had enough. Country communities know they are getting a dud deal, because they see the shortage of doctors firsthand, and, despite the ever-increasing investment in rural medical workforce strategies, there is no evidence of improvement in graduate relocation over the past 20 years. Take, for example, the Bonded Medical Places Scheme. This scheme entails the federal government subsidising a certain amount of medical training places at the big city universities on the condition that the students work in the bush for a certain number of years when they graduate. This is called the 'return of service obligation'. On any objective view, that scheme has failed, and it has failed very badly.

A large proportion of the students that the urban universities have enrolled are foreign students. They pay full fees and then leave Australia when they graduate. I get the impression that a lot of vested interests don't want the likes of CSU upsetting the business model by decentralising training places to country students. In fact, Australia continues to be one of the nations that are the most heavily dependent on overseas doctors. According to the Australian Bureau of Statistics, in 2011, overseas-trained doctors represented 51 per cent of GPs in outer regional areas, 47 per cent of GPs in remote areas and 44 per cent of doctors in inner regional areas. Around 20 per cent of medical practitioners arrived in Australia in the last five years. We should be training our own. That's what we should be doing in this country, and that's what Charles Sturt University wants to do. We shouldn't have to rely on foreign doctors to come out to our regional communities. We should be training our own in a country university for country students, and I note that Charles Sturt University wants to quarantine 80 per cent of its places for country students.

One of the other claims that the lobbyists make is that there hasn't been enough consultation. Well, Charles Sturt University has been consulting on the Murray-Darling medical school for almost 10 years. Perhaps, if you were living on the International Space Station, you'd have an excuse for not knowing that, but otherwise there has been ample opportunity for input. In July 2016 I consulted with the people of Calare when I told them that, if I were elected, I would be fighting for the Murray-Darling medical school. It's also a National Party policy that has been endorsed by various conferences and branches for many years.

The vice-chancellors and councils of the big city universities might not like it. Organisations such as the Australian Medical Association and the various student bodies who tend to do its bidding may not like it. But the reality is that there is a mandate for this, and that's called democracy. It may be that a lot of those city lobbyists don't think rural people are qualified or smart enough to have a say, and that's been one of the other problems with this debate. There has been a condescending and—I would say—patronising attitude to country people who oppose what these city lobbyists are saying and doing. But, as I said, the proof is in the waiting rooms of country Australia. The proof is in the towns and villages where they can't get doctors to set up their practices or replace doctors when they leave. The reality is that these city lobbyists and this closed shop haven't been able to lay a glove on the analysis of Charles Sturt University.

We're told that there's a problem with postgraduate training places. It's going to be years before the Murray-Darling medical school starts, once it gets the green light. There's plenty of time for the postgraduate system to adjust. I think that one of the biggest problems with the postgraduate system is that there aren't enough country kids who want to practise in the country actually filling those positions. That's the problem with it. It is great that lots of doctors from the city want to spend their hospital internship in places like Orange. Who wouldn't want to come out there? There's great food. There's great wine. I've welcomed probably hundreds of them myself over the years. And then I often see them when they come back for FOOD Week, for example, or for some of our great regional events. They're not staying here. They all love to come out, and it's great that the places are oversubscribed, but the cold, hard truth is that they are not staying in the country to practise in the country.

So I'm fully supportive of increasing the capacity for postgraduate training and giving priority for postgraduate training places to country graduates. It should be country first. If we want them to stay in the country, we've got to do everything we can to keep them practising in the country. As I said, it will be two years to get a medical school up and running from a green light, and then it will be a number of years after that before the first graduates start coming through the system. Mankind has been able to put a man on the moon, so beefing up and adapting a postgraduate training program for country students should be achievable in that amount of time.

Charles Sturt University has a very strong track record in delivering a modern country workforce: dentists, pharmacists and physiotherapists. For example, 70 per cent of inland accountants in New South Wales trained at Charles Sturt University. So we know that that system works. The question is not whether the Murray-Darling medical school will work. The evidence on this is conclusive. The real question is whether the multimillion-dollar programs run by the big city universities are working. With this still-chronic doctor shortage across rural Australia, the answer has to be no. The closed shop needs to be opened. We need equality between the city and the country in medical services. We know that the proposal put up by Charles Sturt University works. The time for the Murray-Darling medical school has come.