More GP vacancies filled, but rural health system remains stretched

But the health system in rural areas remains stretched, with on-call and locum work creating separate problems in need of attention.

In August last year, the number of SA vacancies advertised on the Rural Doctors Workforce Agency website sat at 62, whereas this month the number has almost halved to 35.

RDWA chief executive officer Lyn Poole said there had been great progress in the past year, partly as a result of initiatives to encourage the training of more rural GP registrars, while several registrars that might otherwise have left are staying, potentially because of the pandemic.

She said there had been creative thinking to find solutions, such as a restructure of the medical centre at Jamestown to also cover Peterborough and Orroroo, while other solutions had required patience, trying to move doctors across state borders, as was the case in Streaky Bay and Robe.

There are also plans to trial a new training method on the Eyre Peninsula, with the Streaky Bay and Mid Eyre practices hoping to use a new remote supervision method, which could help get an extra GP registrar into locations where there might not be the opportunity for on-site teaching.

Despite great recruitment progress in recent months, Ms Poole said the next few months would have new difficulties, with a reliance on the domestic workforce, as well as complications created by border restrictions.

She said some doctors were only part-time, but this often suited the smaller populations in these areas, and could even be a positive recruitment tool.

While the nature of part-time work could provide an incentive to help move GP graduates to rural areas, filling the void through locums and on-call doctors from other towns was not a "silver bullet" solution, according to Kimba GP Graham Fleming.

Dr Fleming has been the Kimba GP for nearly 12 months, taking the position because he sympathised with the town, which had been without a doctor for the preceding 18 months.

He works in Tumby Bay on Monday afternoons (where he previously worked full-time for 40 years), and in Kimba for three full days a week. On top of that, the 74-year-old is on-call for Kimba, Cleve, Cowell and Elliston for one day a week, and one weekend every month. Three other doctors in Cleve, Arno Bay and Elliston have the same on-call commitments.

"I can have 25 patients booked at Kimba, and be remotely treating eight critically-ill patients in other hospitals - a workload like that is unreasonable and downright dangerous," he said.

RELATED READING: New unit set to strengthen rural medical workforce in SA

Dr Fleming said on-call transition requirements between doctors also had its shortfalls.

"I'm having to countersign all of the orders that (the previous doctor on-call) has given, to fulfil the need of the auditors in Adelaide. But it's meaningless, because I don't know what transpired in the conversations between doctors, patients and nurses," he said.

Dr Fleming said while the Rural Generalist Pathway - an initiative to support the development of rural generalist and specialist skills in early-career health professionals - would address some of the issues of the health system in rural SA, a lack of specialist equipment in rural hospitals would reduce the effectiveness of the program.

"The program aims to train people in the city to go the country. But once they go to the country, facilities have been removed," he said.

Rural Doctors' Association of SA president Peter Rischbieth said the establishment of the Rural Generalist Coordination Unit earlier this month was an "important step" to help move GPs to rural areas through the pathway.

RGP training positions have been developed and advertised for the Upper Northern and Limestone Coast training networks, with others to follow.

But he said more government commitment was required to help doctors move through the program.

"Only two years of training are recognised in the program, we need one that will provide a five-year training program that will be funded by state and federal governments, and supported by the various training institutions in metropolitan and regional cities," he said.

Despite many vacancies being filled, Dr Rischbieth said the rural medical workforce was still "severely undermanned", with more permanent doctors required in each town to reduce the reliance on locums.

"Medical students love working in country areas, we need to give the junior doctors the same opportunity to work alongside (senior doctors), and hopefully that will translate into graduates being longer workforce participants in rural areas, to provide that continuity of care in each town," he said.

Health and Wellbeing Minister Stephen Wade acknowledged the "incredible commitment and hard work" of rural GPs, and said recruiting, training and developing health professionals to deliver country health services was a top priority.

"Locum doctors are only used when local GPs cannot fill the on-call roster. They are not a planned long-term solution, as outlined in the Rural Medical Workforce Plan 2019-24," Mr Wade said.

"The RMWP lays out a range of strategies aimed at supporting the high workload of rural GPs, including the potential to expand the use of the SA Virtual Emergency Service to provide back-up patient care after hours."

The RMWP is part of the state government's $20-million Rural Health Workforce Strategy, which also involves the Rural SA Ambulance Service Workforce Plan 2020-25, while nursing and midwifery, allied health and Aboriginal Health plans are also under development.

Start the day with all the big news in agriculture. Sign up here to receive our daily Stock Journal newsletter.