The World Health Organisation (WHO) Global Code of Practice states that member countries should become self sufficient in their healthcare human resources. Australia is a Member State, but in the last few decades has failed to develop self sufficiency, and continues to reply upon overseas trained doctors. Up to one third of its medical workforce is overseas trained.
This is particularly the case in the rural areas, often called "the bush", where there are fewer doctors per head of population than in the urban areas. Australian medical graduates are reluctant to leave the urban centres to practice in remote areas where facilities are more basic and the skills required may be more diverse. Emergency Medicine skills are sought after in the bush.
Patients in the rural areas wait longer to see their GPs and lack good access to Emergency care. Over 29% of patients have to wait more than 24 hours for basic primary care appointments. 40% of doctors working in the bush are overseas trained, mostly from Europe, Asia and the Indian subcontinent. However after these physicians have completed their obligatory time in the bush, they too wish to move to the medical jobs in the metropolitan areas.
Rural medical practices, particularly in New South Wales, Western Australia and Queensland have severe difficulties in recruiting doctors.
A recent study from the Melbourne Institute found that financial remuneration of A$ 270 K per annum would be required to attract sufficient numbers of GPs to work in the bush. However the MABEL Survey of Australian GPs identified 6 key factors which influence doctors' decisions :
- On Call Duties
- Working Hours
- Time Off
- Spouse Employment Opportunities
- School quality
- Public Hospitals
In essence, financial incentives alone are not sufficient. Working conditions play a major part in attracting people to these jobs as these have a major effect on quality of life. Rural medical practice can be isolated, stressful and challenging and opportunities for good schooling and spouse employment limited. However some doctors do relish these challenges and the independence of practice which they offer as well as the opportunity to diversify skills and manage a more complex range of conditions.
Australian medical schools have increased the numbers of their students, aiming to meet the WHO code of practice for self sufficiency in doctors. But it remains to be seen whether they will be able to close the gap between rural and city medicine and there may be a continued need for overseas GPs.