How do we get young GPs into regional practise?
GAYNDAH'S Dr Henry Ung, who in just over a week's time on February 2 will celebrate his 50th year of practice in the country town, is looking forward to his retirement.
But it's not so much a question of when but of who - as in, who will replace him? To that end, Dr Ung does not get to choose when he retires. He is dependant on a system that is currently struggling to produce enough bush GPs to replace those nearing the ends of their careers, importing 2000 foreign-trained doctors per year to keep abreast of the attrition rate.
In 2013, Dr Ung's partner in the practice departed for Bargara after receiving a second medical degree and has not been replaced. The effect was twofold. Professionally, it meant Dr Ung could no longer work with Gayndah Hospital, as he had no one else to look after his practice. Personally, it meant his already scarce holiday time became practically non-existent.
Dr Ung took a week's holiday over Christmas but said this was not an annual occurrence by any stretch.
His longest stretch sans break was three years, in the 1980s.
There's no incentive for young graduates to practise medicine in the bush, Dr Ung said during a rare window in his daily consultations.
"Most rural practices are bulk-billing, whereas in the big cities with the Medicare fee schedule they can charge $80-100 for a consultation. Here we are getting $36. So they are thinking why see three patients when I would only see one in the city?
"So the only way is to get doctors from overseas, because those doctors would get a month's wages, or probably six months, in rural Pakistan for instance, in a week.”
Even then, Dr Ung said, foreign-trained GPs only tend to spend a couple of years practising rurally, before "zoom!-back to the cities and the next mob come”.
Dr Ung said that in his time, he and Gayndah Hospital had helped train well over 100 medical students as part of their social and preventative medicine course requirements, but that he isn't aware of any who stayed.
"I think they use this as a stepping stone. None of them over the years turned to rural practice. None of them came to the country. They wanted to become famous heart surgeons.”
Dr Ung suggests a conditional scholarship where recipients are required to spend two years practising in the country as a way of attracting young doctors.
"They might like it, like me. Give it a chance.”
Wife Elaine, who manages the practice, thinks along similar lines.
She said universities had it back-to-front, that aspiring doctors should train mostly in the cities, before being required as part of their licence to work in the country.
Another factor, she believes, is that there are no jobs for doctors' spouses.
"Doctors don't marry nurses any more, they marry other professionals.
"If they are high-flying accountants or engineers or whatever, there aren't jobs for them.”
For wives, Mrs Ung said, it's no longer the case that they were willing to put their careers on hold.
A 2017 position paper from the Australian Medical Association titled Rural Workforce Incentives echoes many of the Ungs' concerns.
In a list of "fundamental reasons why rural areas are not getting their fair share of the medical workforce”, they include "inadequate remuneration” and "poor employment opportunities for other family members, particularly partners”.
According to the AMA, some steps which could be taken to encourage rural practise include motivating rural students to enrol in medical school, providing flexible working arrangements with locum relief, subsidising housing and/or providing tax relief, or introducing a rural loading to ensure competitive remuneration.
A 2016 journal article found that, in 2014, regional and rural doctors worked an average of three-and-a-half hours more than their urban counterparts.
"As you get older then you found the time was a lot more difficult, but I did my job,” Dr Ung said.
He speaks in the past tense, but he is still doing that job, day in, day out, unfailingly and unflinchingly.