SCOTT LEVI:
And joining us on the line, the Minister for Regional Health, Dr David Gillespie. Good morning. Thanks for having a chat.
MINISTER GILLESPIE:
Great to be with you Scott. And hearing your dulcet tones over the radio there, I recall you might have been on the radio up here in Port Macquarie many moons ago.
SCOTT LEVI:
I was for a long time, Dr Gillespie. Yes, my first child was born at Port Macquarie Hospital and I worked at 2MC there and lived just near Flynns Beach for many years. Yeah, great part of the world.
MINISTER GILLESPIE:
Well, it’s good to see you become a legend on the Central Coast after doing it- cutting your teeth on the Mid North Coast.
SCOTT LEVI:
Well, they haven’t run me out of town yet so, we’ll see how we go. [Laughs]
MINISTER GILLESPIE:
Right.
SCOTT LEVI:
You’re attending a GP and pharmacy virtual roundtable on the Central Coast today. The big issue for our region and many around the country is the doctor shortage. Here’s what a local GP doctor, Ian Charlton, had to say, and he’s a fourth generation GP in the family. This is what he had to say about the future.
SCOTT LEVI:
Are the alarm bells ringing for you? That seems to point to a serious problem in the future. Your response there, Dr Gillespie?
MINISTER GILLESPIE:
Well, look, having practiced for 33 years as a doctor including as a general practitioner for part of it in my training, I’m a third generation medico, but now I’m in parliament with Lucy Wicks; we both came in together. But Dr Ian Charlton has actually not belled the cat, but yeah, there is a problem. There is a maldistribution. We’ve got- like the old saying: water, water everywhere, and not a drop to drink. We’ve got med students and doctors in hospitals everywhere, but you can’t get a GP in many areas, or you wait weeks to get into a general practice, or the books are closed.
So I thoroughly acknowledge, yes, there is a problem. That’s why we’re working. And I’ve been working since I was put back in the health ministry as Minister for Regional Health to try and fix this workforce dilemma of maldistribution. Too many doctors have gone down the specialist rabbit hole and hang out in hospitals for way too long rather than going into the primary care space, which- you know, my dad practiced for 49 years. The practice was in the front two rooms of our big house, so I’ve literally grown up in a general practice. And yeah, we have got a lot of things in place. Now, Lucy has realised this too. As I said, Lucy Wicks and I went- internees into parliament in 2013, and together we've worked on this. Lucy, in my most recent role, is part of the reason we have got this review of the DPA system, which has disrupted a lot of workforce movements on the Central Coast and in other areas.
SCOTT LEVI:
Tell us about DPA. What does that mean?
MINISTER GILLESPIE:
Distribution Priority Area’s rating looks at data over many years to measure the access people get to primary care services. Now, it's thrown up some unusual results, seem to be different from what the lived experience is on the ground. So at Lucy's behest, I've started an exceptional circumstance review of that process. So, with the help of the Rural Workforce Agency, which- headquarters is in Newcastle just up the road from you, can do a review and try and document what is happening now. Because in the DPA system, it relies on a lot of data over a five-year period. But if we have a lot of people who finished their training or their moratorium, or old doctors retire, all of a sudden what looks like over the last five years, plenty of service, you can have a situation where it's hard to get in to see a GP. So, look, we're trying to make it more contemporaneous and see if we can tweak it as a better indicator of what is needed. But the overall situation? Yeah, we are- we have got many other policies in place.
You know, Lucy also understands medical training, it's not just a three or four-year degree, and then you go into a general practice. You do your uni degrees. Some people do a biomedical science degree before they get into their med degree. And then when you're an intern and a resident, that just entitles you to then go into another degree to study to be a GP or a surgeon. And that second degree is run by colleges. Everyone has heard about the Royal Australian College of General Practitioners or the College of Surgeons. Well, they run the second degree, but you don't go into a uni for it. You do it while you're working in a hospital or in general practice in there.
So that's why there's a long gestation. Now, Lucy, she realised this from the get go and that's why she said to me and to Tony Abbott and to Malcolm Turnbull and to Scott Morrison, we need a training institution here on the Central Coast, so thank you, Lucy. She gets it. She is a politician second to none. You've got to have a great background and get things done, and I really tip my lid to the work she's done. But, look, we’re back on the case. I am doing a roundtable today with general practitioners, yeah.
SCOTT LEVI:
Alright. We’ll get to that in a moment. We’re speaking with the Minister for Regional Health, Dr David Gillespie. ABC Central Coast, it’s 8:45. Federal ALP Member on the Central Coast, Emma McBride, who also worked in the health system, she was a pharmacist…
MINISTER GILLESPIE:
[Talks over] Yep.
SCOTT LEVI:
…at Wyong Hospital, told us that many areas of the Central Coast aren’t being given the priority classification. She’s hoping a senate inquiry into the lack of doctors across regional and rural Australia will examine the model used to classify regions like ours.
EMMA MCBRIDE:
There’s some places like Cherry Hill that are a priority area where places like Toukley and Gorokan aren’t. So what I think the Senate inquiry will be able to do will to be get to the bottom of this. What is the formula? How is it applied, and why are regions like ours overlooked and missing out?
SCOTT LEVI:
Your thoughts about that? I mean, we’ve- sometimes we’re lumped as metropolitan, others, regional, rural, you know, it just seems to be inconsistent for the Central Coast.
MINISTER GILLESPIE:
Well, look, thanks Emma. I too have worked with Emma for quite a while in parliamentary committees and, yeah, that’s why I have initiated this review and the exceptional circumstances review. But there is a broader review of the DPA system that is being worked on. We are just about to launch that, but you got a sneak peek of that information on your show, Scott. So there you go. Breaking news.
SCOTT LEVI:
Thanks for the scoop. Hey, what about that growing gap between the wages of general practitioners and specialists? They come out of uni, they've got a big HECS debt and they see that they're going to make so much more as a specialist. But surely the specialists will have no one to refer patients onto them if we don't have the GPs.
MINISTER GILLESPIE:
Exactly. That's what I was referring to before. There are some specialities where they have huge numbers of people in training, or already trained, some with not enough. But the overall maldistribution is in two ways. It's metropolitan centric. The closer you get to big metro, CBD centres, the ratio of doctors to population rises exponentially. The second thing is we've got too many people choosing down the speciality route rather than coming in to the prince of specialities, and that is primary care, because that is the bedrock of the Australian health system. Getting a good GP in our town or a suburb or some of these more rural and remote areas is a really critical pillar. And we have got a lot in train already. We've got workforce incentive programs to get doctors into more regional areas. We have got a whole rural health multi-disciplinary training program that trains, not just med students in regional areas like the Central Coast, but in the north western areas, we've got an expanded Murray-Darling Medical Schools network, which has got the full med degree happening in places like Wagga, Orange, Bendigo, Mildura, Dubbo, Shepparton, and on the Central Coast, you have got a Central Coast Medical School. So…
SCOTT LEVI:
Great stuff. Yeah, and if you train them there, they might stay. That's the philosophy, isn't it? We'll go to a local GP, Dennis, who had a few thoughts. Good morning, Dennis.
CALLER:
Morning, Scott. I think it's about time we started looking at, first, financial income if you’re a GP. The current reward system from Medicare does not keep up with CPI. It’s half of CPI and the disparity between what I earn as a GP and what a specialist earns hour for hour is huge. Second, let's stop the bureaucrats interfering with how we practice as GPs. I mean, we are having, for instance, the payment for me doing an ECG, the electrocardiogram, has been significantly reduced. My practicing methods are under scrutiny all the time, which is fair enough. The amount of paperwork and bureaucracy, forget it. People see a GP now because of previous Labor government pushing, you’re all entitled to Medicare. [Indistinct] somebody who will just push a pen, [indistinct]…, give a script. I've had that often. I would not recommend to anybody going into medicine today to be a GP because the hours are long. The state- well, the Federal Government, both Labor and, just see us as a drain on the budget. Let's keep the costs down. Medicare was never meant to be a universal health system; it was meant to aid. So what did the Government do when they brought in the Labor government? They stopped the health funds from being able to pay the gap. So what are we stuck with? If I want to give proper care, I'm not being paid time per hour as much as my motor mechanic. If I charge, you know, if I want to charge a declassification(*), the highest possible, I've got to have reams of notes and justify it. You can forget the paperwork and all the rest of it. The impost on a GP are huge. We’re not treated with respect by government.
SCOTT LEVI:
We'll put it to the Minister. Thanks for your time. We're speaking to the Federal Minister for Regional Health, Dr David Gillespie, who practiced for 30 years as a GP in Port Macquarie. Dennis, there at the coalface. David, you know what- what are your thoughts?
MINISTER GILLESPIE:
Yeah. Well, the facts of the matter are that we have re-indexed Medicare rates for many items, including general practice items. That's the first thing that has been a bugbear. And there has been a bulk billing incentive increase, which is graduated to increase the more remote you go. I acknowledge that there is a discrepancy between what the general practitioner who’s had to do similar lengthy training. As I said, it's not just a med degree, internship and you hang your shingle up. There's a second degree and a lot of examination studying that you've got to do to be a good GP and cover a multitude of areas rather than just, say, the left ankle or the right kidney. You are looking after the whole body, plus the mental health of the whole body. You know, looking after family members from when they're born to geriatrics when they're needing to go into aged care.
SCOTT LEVI:
[nterrupts] And that's a bit of a problem, isn't it? We're chasing our tail with an ageing population right across the system.
MINISTER GILLESPIE:
Yeah. Look, I- he's preaching to the converted. We are trying to increase the, not only just the quality of training and exposing junior doctors. You know, doctor who started your interview, Dr Charlton. The figures that he was quoting, I've read them too and there is a problem. We don't have enough people going into general practice. So we're trying to increase the status, the financial reward, and the sustainability of general practice. They're all on my radar.
SCOTT LEVI:
Good luck with that. Thank you so much for spending some time with us.
MINISTER GILLESPIE:
Okay, thank you.
SCOTT LEVI:
Minister for Regional Health, Dr David Gillespie, there. He'll be attending a GP and Pharmacy Virtual Roundtable, as well as a meeting of the Youth Suicide Committee, with Lucy Wicks, the Member for Robertson today, to find bespoke solutions around suicide prevention and GP shortages here on the Central Coast.