Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Hansard source

From Coffs Harbour to Orange, Gladstone, Bunbury, Rockingham, Burnie, Armidale in New England, Katherine, Darwin, Geelong and Warrnambool, my medical degree served as a ticket to travel and experience the joys of working and living in regional Australia. I loved my time in these communities. People were genuine and so grateful to have a doctor, often travelling long distances to seek help. The medicine was great. It sharpened my skills because, with limited diagnostics or specialist support, diagnosis came down to your smarts. I learned to study faces, bodies or the quiver of a voice for clues. Was that tinge of yellow a liver problem, the ruddiness of the face a problem with drinking or a lung cancer, listlessness the sign of an underactive thyroid or the fluid around ankles a sign of protein loss through the kidneys? Could a loss of sensation in the legs be due to spinal cord compression? A chronic cough with weight loss in an elderly person with X-ray changes might have been reactivating tuberculosis or swollen glands under the armpits a sign of lymphoma. Young farmers with dislocated shoulders or arms swollen from a fracture sat stoically, waiting to be seen after having sometimes driven themselves miles to get to hospital.

Perhaps most fulfilling was the continuity of care. My mentors in these places got to know their patients over years and decades. They were wedded to them. Aside from the patients, there was an unmistakable sense of community. As junior doctors, we were invited to colleagues' homes for barbecues. The practice nurses looked out for me, like procuring a bike to help me get around town. Everyone knew who I was. The anonymity of a big city was replaced with the warmth of care. Importantly, I never felt unsupported. Specialist help from a city hospital was always only a phone call away.

Despite all these attributes, I ended up, like so many graduates, back in the big smoke. It is an enduring regret that I was not more deliberative in my choice of practice. My internship was at a big city hospital, and once I got on that treadmill I never got off. I also incurred a big HECS debt which took around a decade to pay off.

My story is, sadly, the norm rather than the exception and partly explains the unequal distribution of clinicians, with an excess seen in metropolitan areas compared to a scarcity in the regions. Analysis by the Australian Institute of Health and Welfare in 2020 showed that there were more than 386,000 full-time-equivalent clinicians working in major cities, compared to 132,000 in all other regional and remote areas combined. The Medical Deans Australia and New Zealand survey of 2021 found that among final year students just under a third considered working outside of a capital city. I despaired that at a major hospital I worked at I could count on one hand, over my 13 years there, the number of junior doctors who ended up in general practice.

It is heartening, then, that we are at least doing something about this. Our amendments to the Higher Education Support Act will reduce or waive HELP debt for rural doctors and nurse practitioners to encourage them to live and work in the regions. Eligibility commences from 1 January this year, retrospective, with applicants required to work at least 24 hours per week. In order to have 100 per cent of the relevant HELP debt forgiven, those in remote and very remote communities are required to work for half the length of the course. Those in small, medium or large rural towns are required to work for the full length of the course. So, Dr Sheridan, who is three years or more post graduation, will be eligible for 100 per cent of HELP debt forgiveness if he works three years—that is, for half of his six-year medical degree—in a remote community like Cloncurry. If he works in a small, medium or large town, like Wangaratta, forgiveness of his HELP debt would occur after working for a minimum of six years or the equivalent of his degree.

The classification of rural and remote locations is based on the Modified Monash Model. It is expected to help around 850 doctors per year. HELP forgiveness could equate to a benefit of approximately $46,000 to $68,000 for students who studied medicine and around $8,000 for nurse practitioners, based on 2022 student contribution amounts. This bill will also waive indexation on HELP debts for the time spent working in a regional or remote area. Refunds will occur through the taxation system after the 50 per cent or 100 per cent work milestones have been met. In 2018-19, those who studied medicine were estimated to take, on average, 10.5 years to repay their HELP debt—much like I did. It's the longest repayment time of any field. Those who studied nursing repaid their debt in an average of 7.7 years.

Outside the remit of this bill are other initiatives to support the regional health workforce. We know that financial incentives are often not enough, which is why we are investing in a mentorship program. We are expanding the prevocational doctor training program to 1,000 places by 2026 through a $5.6 million investment so that more junior doctors have an opportunity to experience rural primary care at an early stage of their career. This is part of the $185 million workforce package to attract more doctors, nurses and allied health professionals into the regions. We all need good mentors—wise heads with grey hair who have seen it all before and are generous with their time—and there is no shortage of them in regional communities.

When it comes to correcting the maldistribution of health professionals, every little nudge helps. When cost-of-living pressures are biting, it makes a real difference for doctors and nurses to consider moving to the country. I wish I had joined the docs all those years ago. My advice to juniors is: don't be seduced by the city when wide-open spaces with a great lifestyle and a fulfilling career beckon. I commend this bill to the House.

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