A proposal considered to have the potential to provide much-needed and long sought-after support for rural GPs working in country hospitals has been knocked back, with the rejection having been labelled as "unacceptable" and "an absolute catastrophe" by doctors' representatives.
In March, the Australian Medical Association SA and Rural Doctors Association of SA submitted a joint proposal to the Department for Health and Wellbeing's Rural Support Services, outlining a need for remuneration and professional development support for rural GPs frequently delivering after-hours care in hospitals on top of their already-large GP commitments.
The proposal was rejected last week, leaving the AMASA and RDASA reeling.
"We have provided a solution to the rural workforce crisis, unfortunately our proposal has been rejected by the local health networks and RSS, and it's very unclear as to why that decision has been made," RDASA president Peter Rischbieth said.
The proposal followed the expiry of the previous three-year GP agreement on November 30 last year, and AMASA president Michelle Atchison said the rejection of the new proposal was a "slap in the face".
"What we saw from the response last week was a rerun of the contract from last year, without any thought about updating that to bring into it acknowledgement of what GPs do in country hospitals," Dr Atchison said.
"In the recent state budget, there was a commitment for equipment for, and retention of, GPs in country areas.
"So on one hand, the state government is saying recruiting and keeping GPs in the country is an important part of their budget and focus, but on the other hand they're rejecting a package that would allow GPs to remain and work in their rural hospitals."
The minister has been aware of problems in the rural health sector ever since he came to office, and we're very keen to work with him to get the solutions out there for our rural communities.
- PETER RISCHBIETH
Dr Atchison said it was important to realise the proposed remuneration in the joint agreement was specifically to recognise the large amount of work carried out by GPs in country hospitals.
"We're not asking for a package of money for GPs to work in the country, the support and remuneration is specifically for the extra work that GPs do in hospitals," she said.
"GPs will finish their day's work (in their GP practice), then go to the hospital and deliver a baby, or give potentially lifesaving treatment to someone who has been in a motor vehicle accident, or come in at 3am in the morning to operate on a burst appendix - those kind of things absolutely need to be acknowledged."
In response to Stock Journal questions, a statement from RSS clinical advisor Hendrika Meyer said RSS remained "committed to supporting GPs".
"We acknowledge the concerns raised by the AMASA and RDASA and will continue to work directly with them to address their concerns with the aim of finalising the new agreement to benefit rural GPs and the towns in which they provide such valuable services," the statement from Dr Meyer said.
But the statement failed to address specific questions about the exact reasoning behind the rejection of the AMASA and RDASA proposal.
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Dr Rischbieth said Health Minister Stephen Wade needed to "step up and take ownership of a decision".
"The minister has been aware of problems in the rural health sector ever since he came to office, and we're very keen to work with him to get the solutions out there for our rural communities," Dr Rischbieth said.
He said without adequate support and remuneration to acknowledge the work of GPs in country hospitals, the already shrinking rural doctor workforce - 72 GP registrars in SA 2021, down to just 26 enrolled for rural placements in 2022 - would continue to dwindle.
"Being a rural GP is a great career choice, I've been doing it for 35 years, and I know how important it is. We want young doctors to come and join us, but those numbers have dropped to less than half of what they were four years ago," Dr Rischbieth said.
"Many practices are crying out for more GPs to support their primary care clinics and to also provide services to their local hospitals, but we won't get the young doctors out to rural areas if working conditions in those locations aren't attractive," he said.
"There are some challenges working a rural environment no matter what industry you are in, but you can build systems to support that, so you've got people who want to come and do that type of work and career in rural areas.
This response is a slap in the face, for rural doctors and their communities.
- PETER RISCHBIETH
"This is about building the environment to attract our junior doctors to come and join us, and being able to say we will look after and support them, but we need to have our LHNs and our local health units making those opportunities viable."
Dr Rischbieth said GPs had been working on a day-to-day basis at rural hospitals since their hospital contracts expired in November.
"GPs have done this expecting their continued willingness to work tirelessly for their patients and communities - despite not having a new deal in place - would eventually be recognised by RSS," he said.
"This response is a slap in the face, for rural doctors and their communities."
Opposition health spokesperson Chris Picton was critical of the rejection of the proposal.
"The Liberals were elected promising they would improve regional health, but over three years later we now have doctors warning that under their watch regional communities will 'wither and die'," Mr Picton said.
Mr Wade was contacted for comment.
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