ISOLATED, burned out and "chronically underfunded" - being a doctor in regional NSW is tough, but it's not stopping Dr Robin Williams in his quest to "futureproof" the sector in the Central West.
A General Practitioner and Chairman of the Western NSW Primary Health Network, Dr Williams says while his small town practice, Molong HealthOne, is luckier than other clinics the state's shortage of regionally-based GPs is an issue that is very real.
"We are very fortunate in Molong, but I would think that we're probably unusual compared with other small towns, because there is a shortage [of GPs] everywhere - rurally and across NSW," Dr Williams said.
"I think we are better placed than communities further north and further west, in as much as we're able to access registrars and they seem to enjoy working with us, so, they come back."
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Dr Williams, along with two other fully-qualified GPs - Dr Alex Hoyle and Dr Jodie Wheatley - work at the Molong practice either full-time or part-time.
GP staffing also includes one full-time registrar - with another come August, and another returning from maternity leave in 2023 - along with one university student, who is currently on placement from Orange's Charles Sturt University campus.
While registrars are senior doctors, who are on the home stretch of their formal studies, their role still requires supervision under a 'fellow', meaning a full-fledged GP.
Essentially, having no GP or limited fellows at a practice, ultimately means zero to scarce new, emerging doctors.
"In smaller towns, sometimes you've only got one doctor who can do that [supervise a registrar] and if they leave, then you can't get registrars in and the whole service could potentially collapse - that's why I think it's so important for us to try to futureproof [the industry now]," Dr Williams said.
Amidst meetings of the western region's Primary Health Network, Dr Williams said its team had recently pinned dozens of towns as being in danger of clinics folding in the near future.
"We've identified about 37 to 40 to towns where there's a real risk of there not being practice services in the next five years, because of either retirements or burnout or people just leaving," he said.
"Once you look outside of the Dubbo, Bathurst and Orange cities, you've also got procedural towns - which are Mudgee, Cowra, Forbes and Parkes - and they have significant issues with recruitment, especially because they need procedural GPs.
"But then all of the other towns, I think in the footprint, are potentially at risk and I think there's also at least 37 of towns within those communities that have got very small hospitals - or NPS' as they're called now - and we just can't recruit the younger generation of doctors to come into those towns."
These doctor enlistment and retention issues, Dr Williams says, could be largely attributed to factors such as professional isolation, unattractive industry salaries and cost-of-living, to name a few.
"I think there's only 15 per cent of new graduates who are choosing to go into General Practice and when I started my career in the UK, well over 50 per cent of all graduates became GPs," he said.
"Now, if we're down to 15 per cent, then there's a huge shortfall in primary care [and] that's the issue that all governments really need to address - that it's becoming less popular, it's being chronically underfunded and it's just not attractive for the new generations of doctors."
Highlighting the role as a "specialty of choice" for emerging professionals is a big part of the solution as well, the Molong doctor says.
With the increase of many students opting to go into specialist medical roles, the rate of GP wages don't seem to be cutting it, particularly with consideration to the current cost-of-living.
"I think there's a combination of factors and a part of it is remuneration, but both the state and federal governments really need to start looking at making general practice and primary care, the specialty of choice for new graduates," Dr Williams said.
"When you come out of medical school and you've got big HECS debt, you become a lot more aware of the need to earn money, so I think [making that choice] has an effect on it.
"I also feel that if you come and work in a rural area, it's a possibility that you may feel more isolated than if you were in a big centre, so they may be voting with their feet in order to feel more a part of collegial approach."
Building a shared work environment is the goal for Dr Williams, who says it won't be long until he will also head down the road of professional retirement.
"That's what we're trying to build in Molong, is to have that collegiality around our practice so that we all support each other in keeping things going," he said.
"We do also have the CSU campus in Orange which is taking a lot of undergraduate students from rural areas, so we're more likely - or hopefully - able to retain those people to work in the smaller communities and I think that's a positive thing.
"So, that's part of the historical planning for when I retire, which will be in the not too distant future, and the point of what we're trying to do - to transition the new guys [registrars] in, so that they can take up the mantle and move things forward for the next 25 years."
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