Michael McCormack (Riverina, National Party) Share this | Hansard source

The first recommendation by the House of Representatives Standing Committee on Health and Ageing Lost in the labyrinth report on the inquiry into registration processes and support for overseas trained doctors goes to the very core of this most important issue. The seven-member committee firstly recommended that the Australian Medical Council, in consultation with the Medical Board of Australia and international medical graduates, take steps to assist IMGs having problems and delays with primary source verification. This would include continuing to help IMGs who have passed all requirements of a pathway towards registration as a medical practitioner, excepting primary source of verification; liaising with the Educational Commission for Foreign Medical Graduates to ascertain and address any obstacles to gaining timely primary source verification; and giving IMGs the latest information relevant to their application including the anticipated time frame for response based on their application, or options as to how they could speed up the process such as contacting the institution directly. This was one of 45 recommendations by a committee which wants the best outcomes for rural and regional health.

I know and appreciate the commitment of the committee to the promotion and welfare of country health. Two of the committee's representatives in particular have a deep sense of purpose and passion for and on behalf of those who live beyond the coastal fringe and who expect, and rightly deserve, the same health delivery as people in metropolitan areas. I refer to my coalition colleagues the members for Hasluck and Parkes, who both for many years have campaigned for improved access to medical services for the regions. Their actions are admirable.

Prior to entering parliament, the member for Hasluck served as a senior public servant in the fields of Aboriginal health and education in New South Wales and Western Australia. The member for Parkes represents almost a third of the land mass of New South Wales, a huge area with many hospitals, many multipurpose health facilities, and many challenges. For the member for Parkes, the sheer distance between health outposts is understandably a major factor. Getting specialists, general practitioners and allied health professionals to the far-flung parts of the state's far north is something for which Mark Coulton has continually and loudly lobbied, both in his capacity as Mayor of Gwydir Shire Council for three years and, since 2007, as local federal member. So I commend the members for Hasluck and Parkes and the other five on this lower house standing committee for their efforts to improve regional health. It needs all the help it can get. As experienced rural GP and obstetrician Dr Maxine Percival observed only recently at a function in this very building:

If rural practice was a patient, I would say that its condition would be critical.

The situation is critical and it is fair to say that, but for IMGs, it would be far worse for regional areas.

I would like to quote from an article in last week's The Land in a supplement entitled Rural Health 2012. Dr Paul Mara has for almost 28 years run a busy practice with his wife in Gundagai in my electorate of Riverina. He and his wife, Virginia Wrice, have also been founders of the Rural Doctors Association of Australia, an organisation of which Dr Mara is the president. In the article he said:

There are not enough doctors in the bush. Basically what a lot of communities have done is taken on the idea that it's about having a doctor. Any doctor.

And the headline on this article was 'A doctor, any doctor won't fix GP crisis', and that is so true. Dr Mara went on:

Whereas, at the association level what we are looking at is how we can improve the quality of service delivery through improved training for doctors to better meet the needs of communities.

And that is regional communities. He continued:

And there is no doubt in my mind that federal government policy has put us in this situation.

We have got a lot of doctors from overseas, many of whom are not fully qualified and many of whom don't really want to be in the bush. And we see that as being a key problem.

He is right, of course. Dr Mara went on:

So at the association level we have looked at a training program which we hope will be rolled out nationally to provide doctors from Australia or overseas with the skills and expertise they need to practise in the bush.

That program would be modelled on the Queensland Rural Generalist Pathway and would be aimed at ensuring all GPs working in the bush, whether trained locally or overseas, have the wide range of skills and knowledge needed to provide high-quality service, the best-quality service, to rural communities, communities which need and deserve that sort of quality health care. Quoting Dr Mara again:

You can't have it both ways, you can't say we can just get a doctor from overseas and plug him into a country town and, on the other hand, say we want to have high-quality care.

To be a rural doctor you need to do 10 years of training. You can do a six- or four-year medical degree in Australia.

The four-year medical degree involves undergraduate degrees as well.

And then we (RDAA) are saying you probably need (another) three to five years (training) after that is to have the skills to meet the special needs of (rural) communities.

And rural communities do have special health needs. They are different in some ways to metropolitan areas. We do not have the same sort of wide range of specialists available—obstetrics is not available in many areas. So they are special areas and they are certainly challenging places.

Those extra skills short cover areas such as obstetrics, anaesthetics, surgery, emergency medicine, advanced training in paediatrics, indigenous health, acute mental health, geriatrics and palliative care, Dr Mara says.

"All of those things require a higher level of training (in the bush) than what you might necessarily need if you are a metropolitan GP."

Dr Mara also gave evidence to the inquiry which produced this report, Lost in the labyrinth. On 31 May he gave evidence at a public hearing here in Canberra, in which he said:

I think the key thing to state is that there is an ongoing medical workforce crisis in the country. The policy of importation of overseas-trained doctors is not really solving that problem. When I first did the research I alluded to, we said that there were about 1,000 doctors needed in the bush. Since then, we have imported from overseas literally hundreds of doctors, yet the situation is still much the same at the present time. So the policy of importing overseas-trained doctors is not solving the situation, but that does not mean we are opposed to having doctors from overseas working in the country so long as those doctors have access to the highest quality education, training, support and supervision if they need it and they and their families are not discriminated against. The association is clearly opposed to the moratorium (1) because we believe it does not work and (2) it imposes hardship on those doctors out there and makes them prone to manipulation and exploitation by different groups.

… … …

In regard to the issue [of] assessing these doctors, we have a position that, in their variety, the colleges should be ensuring that these doctors have the same capacity, skills and qualifications as Australian trained doctors; however, there needs to be some flexibility around assessment procedures, particularly for doctors who have been working in the bush for a number of years and have clearly been performing adequately, but are at risk now of deregistration.

Finally, in Wagga Wagga, there are concerted moves afoot at the moment to bring about a rural medical school for the city. Money—$20 million—has been provided for building such a facility in Port Macquarie, which, like Wagga, has a rural clinical school. That would be an ideal fit for New South Wales. If we had a rural medical school in Port Macquarie and also one in Wagga Wagga, we would have one in the north and one in the south.

As the member for Wannon just proclaimed loudly and passionately: we need more Australian trained doctors, particularly Australian trained doctors gaining their skills in the bush, in regional areas. That is the desirable outcome. A very hard-working group of clinicians, former member for Riverina Kay Hull, state member for Wagga Wagga Daryl Maguire and myself are working hard at achieving that very outcome. Hopefully, with federal government support in the future, that will become a reality, because it would be a great thing for Wagga to have a rural medical school to take that additional step from the rural clinical school that it has now. Working in conjunction with the University of New South Wales and possibly Charles Sturt University, both of which have very good form on the board as far as these sorts of things are concerned, it would be a desirable outcome and would certainly provide well-trained medical professionals in the bush, because let me tell you, Madam Deputy Speaker, that is exactly what we need to meet many of the challenges that regional health is confronted with.

Debate adjourned.

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