WA News Feature Articles Perils of Place and Politics
Perils of Place and Politics
Written by Jan Hallam
Monday, 27 February 2017


Headlines over the past month issuing from Canberra around medical training and workforce distribution have given some cause for hope that these issues are being considered with some serious purpose, in contrast to the Government’s brutalist methodology of 2015.

The Assistant Health Minister Dr David Gillespie has continued to issue forth since we reported initiatives to create support hubs for doctors in rural areas. Now it has set aside a modest $10m a year for a program, dubbed by one media outlet as PGPPP Lite, with the same intention as that erstwhile and successful project but casting only a shadow of its former self.

The national Rural Junior Doctor Training Innovation Fund (RJDTIF) will offer only 60 places annually for prevocational doctors to road-test rural practice but given WA Health was funding 20 full-time equivalent positions for its go-it-alone 2015 Community Residency Program, our share of 60 is going to look a little anaemic.

Still, it is a positive step and shows the intention of the Minister, himself a former regional GI consultant, that the Government has recognised that is the government is to address the maldistribution of the country’s GPs it needs mechanisms to make rural practice more attractive.

WA data ‘diabolical’

As reported last month, the deep concern for WA is that, despite it being a well-worn and thereby easily dismissed catchcry, our situation is unique – there is not simply a maldistribution of GPs here, there is also a serious shortage of doctors with the right scope of practice in the right areas.

Two reports are imminent from WA Health and WAPHA which we are told will reveal sobering figures on doctor numbers in some rural and remote areas of the state and that’s a concern for organisations responsible for training, attracting and retaining doctors to these places.

CEO of WAGPET Dr Janice Bell, who fought tooth and nail to save PGPPP for no better reason than it worked, was heartened that the government was “quite rightly” re-investing in the prevocational area.

“The government lost its line of sight in the prevocational space when they gave up on PGPPP. It was a real shame for WA, junior doctors and the professional because it really did create a pathway for junior doctors in an experiential way,” she said.

“I am not a fan of training pipelines, I believe in maps and a GPS and that’s what I like to say we give our junior doctors. We lost of lot of the map – the opportunities for junior doctors – when we lost PGPPP. I think this is the attempt to bring that line of sight back, slowly and affordably, in the prevocational area but it has a long way to go.”

That WA’s needs should be considered uniquely, she is in no doubt.

“The data around GP workforce are showing a diabolical shortfall in some places of the state and a ‘cookie cutter’ approach to policy will be disastrous. There are places in rural and urban WA that are oversupplied with GPs and there are plenty of urban and rural areas suffering from the lack of GPs.”

Numbers are people too

WAPHA’s report is said to be a WA version of the Grattan Institute’s Perils of Place which studied how health outcomes of Victorians and Queenslanders were shaped by where they lived. And when it comes down to it, patient outcomes must be the focus of all of these numbers games as must be the personal and professional welfare of young doctors who serve them.

Training junior doctors to be ‘match fit’ is of particularly concern to Janice. Last year, training places were unfilled because candidates were not considered ready to take on the rigours of GP training.

Speaking to Medical Forum she said the current challenging climate was giving rise to more creative thinking about training in general.

“Students are not getting the same clinical exposure as in the past, or the same clinical experience in the pre-vocational years, which means they are often just not ready for a career in general practice. I’m delighted that WA Health has taken this seriously and is looking at how they can ensure that any doctor going into a generalist career – be it practitioner, physician, surgeon or whatever – will have those generalist rotations in those prevocational years.”

“That to me will make one of the biggest differences to WAGPET in placing registrars in some of those more challenging areas because right now some applicants are simply not able to practise safely and provide quality care.”

New training ideas

“New education and training models are being studied which would make better use of existing rotations to give students a map of what they need to learn and what they need to demonstrate they have learnt while in that rotation before moving on to another.”

“It will give students a better idea of where they’re going but it does put the responsibility of their education and learning back on the junior doctor. It won’t be compulsory but it is hoped the program will be recognised by the AMC and that the generalist specialist colleges – RACGP, ACRRM, RACP and RACS – will consider it as part of entry into their vocational training.”

“The pros are that students are much more likely to get diversity and a taste of a range of vocations they need for any generalist careers and they will know they are safe and competent to move on to the next stage of their education and training rather than just hoping they are.”

“The downside is it is more work for students but in return we hope to be able to give them a recogniseable qualification for that next step.”

Challenge to change

“This is all think-tank ideas and it’s a long way from fruition but in the absence of suitable funding, it’s about working with what you’ve got in a smarter way to improve the quality of education and ultimately the quality of care.”

While many argue it’s the perfect time for creative thinking, change is always a challenge.

“The health system has shown to be one of the least flexible and adaptable organisations in human history. The biggest challenge is to help those who support prevocational doctors recognise their responsibilities to training, support, employment and risk management of these young doctors. If that were taken on board seriously by employers it would make a huge difference.”

“If we want to grow our own workforce safely and competently from the three universities we have invested in, that pillar in the whole process would make the rest so much easier.”

By Jan Hallam