GP ratios worsen for the suburbs

This an Australian story, for anyone who clicked a link thinking it was their country.

The Sydney Morning Herald is reporting that GP-to-patient ratios are worse in several suburbs than in rural areas (where, conventional wisdom has accepted long ago, such ratios are fairly shit).

…doctor-patient ratios are worse in many Sydney suburbs than in country towns. GPs are searching for up to two years to recruit a doctor to help in their practices.

Fifteen of the state’s 20 urban divisions of general practice have a higher patient-to-doctor ratio than the existing Federal Government benchmark of one GP for every 1100 patients, though the Government said it did not set targets.

The worst regions are the Central Coast and Hawkesbury-Hills districts, which have one doctor for every 1800 patients (this rises to one in 5000 in some parts of the coast); the Blue Mountains (1:1700); and Sydney’s south-west (1:1600).

GPs in metropolitan Sydney are also feeling the strain as doctors age faster than graduates can replace them. Liverpool’s ratio is 1:1200, Macarthur’s 1:1478, and Manly Warringah 1:1154.

The more affluent divisions of Eastern and Northern Sydney are faring better, with GP patient ratios of 1:763 and 1:400 respectively. Central Sydney division, which covers the inner west and parts of South Sydney local government area, is closer to targets, with one doctor for every 1093 people. But traditional general practice hubs such as the North Shore, inner west and eastern suburbs are having difficulty finding GPs.

In the Hunter Urban division, one GP services up to 4000 people in some areas such as the southern end of Lake Macquarie, where many GPs have closed their books and patients have to seek basic health services out of the area.

If the problem is systemic (ageing physicians not being replaced) then yes, there is indeed a problem. By contrast the UK, where ratios vary widely, the worst was one GP per 3,428 people. Sucks to live there. Our rural ratios do not reach that, although I believe they do push 3,000 in some areas. I suspect that last statistic is anomalous. Although it could well be that the southern end of Lake Macquarie is dead boring – one of the reasons why rural areas cannot recruit doctors.

The point is probably moot. Come winter, anything over 1,000 is going to cause some real trouble. What a shame we treated our last brown-skinned doctor the way we did – whoops.

Solutions? Few enough. Outside of monstrous expenditure on fading towns, to attract physicians (and, hell, other professionals), there isn’t much. Altering fee structures won’t work – increasing fees will not push the burden to the emergency ward, and not, ultimately, reward GPs. A British-style system, where GPs are funded according to the number of registered patients on their books, might not be a bad idea, if the GP is going to work purely publicly.

Here’s a solution. Australia’s immigrant cluster in one or two fairly dense urban areas – a product of bugger-all done by state or federal governments to help immigrants push further out to take advantage of more opportunities outside the immediate confines of their language skills. Not to promote self-segregation, but people from those cultures have doctors, too – who just might head out to expanding multicultural communities as well, along with their kids – re-establishing communities, community groups, community economies, schools, etc.

Right now Australia is in a fairly vicious cycle of oceanfront urbanisation, heading to the fringes of the continent and looking ever-outward – to what, one wonders. I’ve said for a long time that a lot of Australian communities face slow deaths from pushing too far into too dry a continent, but slow deaths starting much further away from now, surely (hopefully? If not, the whole problem is probably moot, now).

The problem is likely, therefore, two-fold: not enough doctors (or not enough practising as GPs), and not enough in certain areas. For the former, I’m not sure what else can be done – GPs make a fair amount of money (ABS statistics of a few years ago have practices running operating profit margins of 25% or so), but less than specialists (those same statistics: an average of AUD100,000 for GPs, as opposed to AUD180,000 for specialists) although you’d never convince them of that.

A change in funding – possibly something like an NHS list, possibly something else – might help. It’d also cost the taxpayers a bundle, though, and we might not be too disposed towards the idea. A change in funding to increase the fees GPs could charge would never work – GPs are scarce in exactly the areas where people cannot afford gap fees (a difference between what the doctor charges you for something, and how much the government will contribute. The whole point of public health in our Medicare system is that there is not a gap).

For the latter, the problem is not how to move GPs to certain areas, but how you can move many elements of a community to areas that used to have them, making them communities again. Not something for which Australia’s governments – at any level – will ever be famous. Something will have to be done – Howard has already, apparently, lost his battle for the battlers.

Americans, here is a lesson to learn from us or the Brits: when you fund health care from general taxation, it becomes political fodder for a sitting government. Equity, levels of service, etc. If you’re a taxpayer, you get the right to expect health care (including GPs). And you get the right to dump the government that can’t give it to you.

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