Australia’s healthcare system is often heralded as world class, and just last year held the highest ranking among OECD nations for its healthcare outcomes and pulled in third behind Norway and the Netherlands for its overall standard of healthcare.

But ask people living in regional Australia whether they think their healthcare is world class, and you get a very different response.

Coolah is a small farming town in Central West New South Wales, three and-a-half hours inland from Newcastle. Like many regional and rural towns across Australia, the town has been struck by fire, flood, pandemic and drought over the past five years. In 2017, the St Ivan fires decimated 55,000 hectares of farmland in Cassilis, Coolah and Dunedoo, killing thousands of cattle and destroying 35 houses. In the aftermath of the fire, the local communities were left shaken and devastated.

Greg Piper, a sheep farmer in Coolah, lost 4,000 acres of his property and close to 1,500 sheep in the fire. The stress on Mr Piper was only compounded by years of successive drought, flooding, and the COVID-19 pandemic. As the extenuating pressures began to take a toll on his mental health, Mr Piper decided to seek medical advice.

After failing to secure an appointment with the only GP in his town, Mr Piper needed to wait two months before he could see a GP in Mudgee, an hour and-a-half drive from Coolah. When he finally received a referral to see a psychologist, he was met with yet another waiting list, this time for five months.

“What sort of health system do we run? Are we a third world country?” Mr Piper wrote to the commission. “We hear about all this money and effort going into mental health but the reality is far short.

“What am I to do? Do I have to turn up at hospital emergency and threaten to shoot myself to see a psychologist?”

Graph of DALY rate by disease in Australia

According to the Australian Institute of Health and Welfare’s survey of patient experiences, up to one in five Australians felt that they had waited longer than acceptable for an appointment with a GP. This number rose to as high as 40 per cent in the Western NSW Primary Health Network (PHN) and 30 per cent in the Murrumbidgee PHN.

President of the Royal Australian College of General Practitioners (RACGP), Adjunct Professor Karen Price, says Australia’s growing population has meant the supply and demand for GPs has been thrown out of balance.

“The Australian population is seeing an increased prevalence of chronic disease and co-morbidities, which requires more complex care at the primary care level and longer consults. This means that GPs often see fewer patients in a standard workday,” says Price.

“We need a greater headcount of GPs to provide the same full-time equivalent workforce to ensure all Australians have access to quality health care.”

The World Health Organisation (WHO) currently recommends one doctor per 1,000 population as the minimum standard of healthcare needed in a community. According to data from the World Bank in 2018, Australia had 3.8 doctors per 1,000 population. However, national workforce data from the federal Department of Health reveals that some regional and rural populations fall below the WHO’s recommended ratio.

Map of Australia by GP to population ratio

Data from the federal Department of Health reveals as many as 28 regions across Australia do not currently meet that ratio. North West Victoria, the Murray region on the border of Victoria and New South Wales, and the New England region on the border of Queensland and NSW currently have the lowest number of GPs, with just 79 GPs servicing a population of over 115,000 in the Murray region.

“People living in rural and remote areas face multiple challenges, normally related to their geographic isolation, and often experience poorer health outcomes than people living in cities because of greater difficulty in accessing affordable health services,” says Price, the RACGP President.

“Before the pandemic, we were already facing a looming mental health crisis, rising rates of chronic disease and an ageing population. We urgently need to fix the cracks in our health system and ensure everyone can access the care they need.”

Shelley Piper has worked as a real estate agent in Coolah for over 15 years. In that time, she has seen the local medical centre persistently shrink. In 2018, the town lost its only GP, leaving its residents with no option but to travel long distances to nearby regional centres to seek medical care — and even then, they could still face week-long wait times.

“[My husband and I] are heading towards our 60s and we have sons that live here too. It’s important we have good medical care in our town,” says Piper.

“Telehealth is not that good, but better than nothing. But we need a good backup plan if something goes wrong for the short term.”

Graph of patients who experienced an excessive wait to see a GP in 2019-20

Coolah has since gained a new GP, whom Piper says has been working well with the community, yet the lack of a female doctor in town still means her medical options are limited.

“I dread being unwell,” says Piper. “If it’s a women’s problem, I’m even more nervous.

“I can book an appointment in Mudgee with a lovely woman doctor but I have to do it a few weeks in advance.”

Faced with long travel distances and extended wait times for GPs they may not be familiar with, let alone feel comfortable with, many rural Australians are opting not to visit a GP when they need to.

Data from the Australian Institute of Health and Welfare reveals that up to one in five Australians living in Western NSW, North Western Victoria, and Tasmania did not see a GP when they needed to in 2019-2020. Yet, research from the RACGP suggests that when patients have a consistent and meaningful relationship with their GP they are more likely to have better health outcomes, easing the cost of preventable hospital admissions by up to $4.5 billion.

“Regardless of their post code, all Australians must have access to GPs to maintain good health and manage preventable diseases,” says Price.

Graph of average hours worked by GPs by remoteness

As the Australian population continues to grow, GPs are beginning to face increasingly unmanageable workloads that are having a negative impact on their mental health. According to research by the RACGP, Australian GPs treat over 21.8 million patients each year, an average of 97 patients per week.

And, while COVID-19 has dropped out of the headlines there were over 36,000 new cases in Australia last week, down from a peak this year of over 150,000 in January.

“GPs are facing pressures from managing a global pandemic, supporting communities through natural disasters and a concerning influenza outbreak,” says Price.

“We are flat out caring for COVID-19 positive patients, delivering COVID-19 vaccines and boosters as well as influenza vaccines, as well as helping patients with mental health concerns exacerbated by the last two years of lockdowns and other pandemic-related stresses.”

Doctors in remote settings work almost double the average hours worked by GPs based in major cities with those practicing in very remote settings working an average of 45 hours a week. The increased workload has also had detrimental effects on the wellbeing of Australian doctors.

Graph of psychological distress in doctors compared to the general population

Beyond Blue’s national survey of the mental health of medical practitioners found that Australian doctors experienced higher rates of psychological distress when compared to the general population. These findings were supported by research conducted by the RACGP which found 53 per cent of Australian GPs reported at least one negative impact on their wellbeing as a result of the COVID-19 pandemic.

“If we don’t fix the problem now, these issues will only get worse,” says Price.

“Australia needs visionary reform and large-scale improvements to Medicare and general practice funding. We need to attract more GPs to the profession because we are the bedrock of any high-functioning health system.”

Prior to the federal election, the Labor Party announced a commitment to provide $750 million in funding to provide additional support for general practice chronic disease management, complex care, team-based care, and after-hours services.

The RACGP has stated that they are looking forward to working with the incoming Labor government on providing better access to healthcare services for regional and rural Australians.

Main image by Thirdman/Pexels.

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