As a longtime doctor in the bush, Ai-Vee Chua is smitten by the doctor-patient relationships she has made over the years.
It's been more than two decades since the diminutive hardworking GP and her husband, also a GP, moved to Dubbo leaving the cushy comforts of Sydney where they both grew up.
"We chose to become rural GPs not only as a result of the positive experiences that we both had as medical students in our rural placements but also we felt it was important to provide our services to communities in need," Dr Chua said.
As a university lecturer, she often coaxed medical students and registrars to follow their steps and become bush doctors for good.
"I used to say to them I may be a little biased but rural GP is the best specialty in medicine," she said.
But why are doctors hard to find in many rural towns since then? By 2032, the entire health workforce is projected to be 11,392 devoid of doctors in cities and regions, a Cornerstone Health and Deloitte Economics study has found.
The services GP provides in small rural and remote towns, in particular, have seen a sharp decline despite the posting of homegrown and overseas doctors training for their Australian qualifications while serving in these towns.
To be a qualified GP in Australia accredited by the Royal Australian College of General Practitioners requires over six years of medical studies, two years of post-graduate hospital training, and another three years of the supervised GP practice training.
Every year, the federal department of health allocates and funds 1,500 trainee doctors but last year, the program ran short with only 1,434 trainees, and the year before that, only 1,329 graduates enlisted in the program.
The shortfalls in attracting trainee doctors were attributed to dropping outs mainly due to widespread dissatisfaction over salary, employment terms and working conditions, according to the study.
The Skilled Medical job board recently required locums or temporary staff such as a senior GP for Central West NSW service offering $3,600 per day salary to work for the month of July. Two registrars were also needed at $160 per hour so the salaries seem attractive.
Locums come and go in rural health services yet these services are still experiencing shortfalls which indicate recurring shortages being felt across the profession that Dr Chua has described as a "precipice of crisis" that loomed over time and overlooked at a bigger scale.
"Fast forward three years to 2022 and include the impact of the pandemic, we have seen GP practice closures in Dubbo and in a number of our more remote towns over these past two years," she said.
"There have been increasing challenges especially for rural GPs in recent years, with an increased amount of red tape that is time-consuming to navigate and that detracts us from direct patient care."
The dilemma to fill increased patient care services versus staff availability was exacerbated by COVID-19 that beleaguered doctors like Dr Chua faced while trying their best to meet increasing workloads.
"The pandemic has brought with it additional challenges, the need to adapt to different models of care, wearing of personal protective equipment, an increase in mental health presentations, and an unrelenting increase in workload associated with the provision of vaccinations and also care for people with COVID," she said.
"We have seen patients feeling the strain with the pandemic take out their angst on GPs and practice staff."
Dr Chua said she and her fellow rural doctors have met difficulties accessing specialists and allied health services in cardiology, neurology, gynecology, endocrinology, dermatology, psychiatry and psychology services addressing widespread mental health cases.
"These resulted in our GP teams working extra hard to help our patients navigate these access issues in our wider healthcare system.
"Throughout the state, our GP workforce are exhausted and in some instances, these have brought on early retirement and resulted in doctors leaving to work in other fields instead."
At her own Family Doctors clinic on Boundary Road, there is no sign Dr Chua is ever giving up as a bush doctor.
"We get to form very special doctor-patient relationships over many many years with the people we provide care to.
"Often we have the privilege of looking after several generations of their families over time, and we have such an opportunity to make a significant difference to the well-being of the people under our care."
Based on her own experience, Dr Chua believes giving kids who grew up in small country towns the opportunities to become their town's doctors seems a perfect idea.
"We need to give our country kids an opportunity to study medicine and to do this as a [source of] long-term placements as well as providing them post-graduate training in rural areas...the solutions are there and we need a coordinated effort."
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