The reference to "closing the books on new patients" is a disturbing development.

What is happening about nurse practitioners? These were the semi-doctors who were supposed to ease the load on the GP by attending to the more mundane examinations.

And - why do we tolerate a system in which holders of the MBBS (which is proably the toughest university course to get into and has a curriculum of huge complexity) end up in skin clinics doing work which, with practice, a real estate agent could do?

Yes indeed health watcher - many resources and clinical training is wasted in those fast buck "skin clinics' usually attended by the worried well - just like the new medicare rebate now avaialable for attending psychologists are being sucked up by the same group.

However the Cost of a GP consultation is a disincentive to seek treatment for many elderly and those with young families. What is it now $58/visit with a $28 rebate for a standard consultation?? Add to that the costof medication and people defer seeking treatment on a regualr basis adding to the burden of disease.

So, many punters go to ED departments for all manner of things - it is free.

There is also the misconception that in going to a major hospital ED you will get treated by some one who, by virtue of the fact they work in a "big Hospital" - actually knows what they are doing and can offer a decent service - a dangeros assumption indeed.

GP shortages are a major concern - it will take an imaginative combination of nurse practitioners, OTD's and local docs stepping back from the turf war on role delineation with other professionals before the community gets acccess to appropriate levels of treatment by the most appropriate professional.

GPs are no longer the self sacrificing altruistic mob they once used to be - nor in fact should they be - they are now making sensible choices about their life, their own health and that of their faimilies - reduced hours give rise to reduced services.

But much of what they do can be safely handballed to other practitioners - it happens in a defacto sense already - it is a practice that can and should be be easily accelerated.

http://www.onlineopinion.com.au/view.asp?article=4185&page=2

The idea of GPs closing their books was unthinkable once upon a time. That so many practices have done so, and that bulk billing rates have fallen significantly in many places, is surely evidence of a supply problem? There are many ways that the problem could be eased in the short-term while we all try desperately to think of ways to make general practice attractive to new graduates - and until we do that, the problem will never be solved.

I would like to say that the problems you outline are very real and have led to the situation being faced by many communities throughout Australia. Doctors are giving up / retiring or joining the big Corporate medical practice. But you seem focussed on simply putting the problem to the lack of doctor numbers. It is much more complex than that. The aspect of patient demand is never mentioned. Unless things change you will never have enough doctors to be general practitioners. There seems to be an unlimited need on the part of patients and this side of the equation is never spoken about. I am trying to explore / unravel what has gone wrong to cause the situation we see today.

I would like to ask why do you think it necessary to have the same GP on each time you want a doctor? There should not be any problems in ongoing management by different doctors if there is one set of of case notes / an agreed diagnosis and anagreed process of management of that problem.

What is needed is a definite diagnosis and a proper management protocol. What happens now is the whole process is tempered by a whole range of managements tempered by a patients response. An example of this would be how should a patient with osteoporosis be managed ?

Dr Trebor Chodrum
locumgp

Perhaps the medical dropout rates need to be looked at:
Excellent marks are required to enter which is understandable considering the course but leaves very few placements.
6 years for the medical degree and one year for intern after training is a long time and sorts out those that are not dedicated.
The university degree plus books required is very expensive and leaves many with a very large HECs debt.
The medical training is very demanding with little chance of any other life apart from dedicated study so a normal social life and/or self-funding with casual work is rarely an option.
Many students start another degree until they are sure they want to make the committment and get university-stale.
Some may have previously qualified for a degree and worked then have to lose that income.
Wages are still comparably very low when trained. Many compare their wage with other options such as a mechanic at a mine and find they could have made a fortune as an apprentice then a qualified mechanic in the time they spent at university. Women may opt to take time out after training to have a family so have little chance of earning wages or warranting the study until family is manageable with work.
Once trained, the private liability insurance required for a GP is price prohibitive and puts many off.
The options of working at a large city hospital with good backup service and equipment compared to working at as a country GP with little or no backup options, on-call 24hrs/day if alone, little equipment in the small hospital etc is an easy choice.
The problems are easy to identify but solutions are not so easy.

Retaining and training GP's
Non GM Farmer is right. There is a big problem because the costs (inc social costs) of training leave the doctor with a high debt and so not many go on and become GP's unless they are female with a partner who is the prime bread winner.

The rest become specialists to quickly recover costs.

So the attraction for any new GP's of no start up costs,no ongoing running costs and a good super all of which happen in a big medical centre. So with the influx of new graduates these centres will have no problems attracting medical staff. But the smaller 1-2 GP practices will find it difficult and will not get staff. Patients will have to adjust and travel long distances to these new / bigger centres. There is no other solution.

Rural Practices will not be able to attract anybody and this can be overcome by the Area Health Services setting up 2 year contracts with good wage / super and other good conditions. You will not be able to rely on GP's wanting to go to the rural areas without support

Trebor