The most amazing thing about Laura's article, is how she sees inequalities in health outcomes in purely that of an unequal distribution of resources, and thinks that this could be remedied by "telemedicine."

There is an unequal allocation of resources in rural areas, and I can assure you that our productive farmers who are denied the sort of healthcare common to city dwellers, get mad when they see a busload of government doctors, dentists, and nurses arrive in town, set up shop outside of the local aboriginal affairs office, and begin treating patients on a racial basis.

Could I submit something here? Smart people exercise, smart people watch what they eat, and smart people do not smoke cigarettes, sniff petrol, drink alcohol while pregnant, or engage is stupid risk taking behaviour. Smart people are an asset which needs to be protected. Dumb people are the opposite. Dumb people are a pain in the khyber, and dumb people are costing our community an arm and a leg.

Whereas it could be viewed as noble that we try to have some equity in our health system, it is utterly ridiculous when we spend so much time and money remedying the self inflicted health problems of the dumbest members of our society, while at the same time giving our smart productive people the finger.

My premise, is that it would be a lot more cost effective if we paid dysfunctional, welfare dependent, dumb people of any race not to breed, and gave financial benefits to productive smart people of any race to procreate. Unfortunately for our civilization, we now seem to have embraced some sort of Eugenics in reverse.

An interesting piece, but somewhat univectorial. Having lived in rural areas for some considerable part of my life, including some of the most remote, like 200km East of Norseman in WA at the Western edge of the Nullabor, I know that rural people are excellent practical physicians and often pretty good at minor surgical procedures as well, informed by no more than a couple of books, sometimes not even that. The health issues that they cannot deal with alone include heart health, depression, ob/gyn and others which require access to well-equipped facilities or diagnosis beyond their own competence. In other words, they need a doctor and a medical clinic.

The problem they face is that doctors don't want to live in places like Balladonia or Burketown, especially women doctors. The medical profession attracts some of our most competent students and has the highest entry standards of any academic offering and those students, not unreasonably, expect that they will enjoy a high income and social standing commensurate with their high level of ability. That means they need a city around them, not 50 houses, a pub and 400km of emptiness in every direction.

Adding to the problem is that 50% of our trainee medicos are women, who will often marry professional colleagues and after 10 or so years of practise will choose to have kids, which will take them out of the labour pool for some years and if they return it will very frequently be part-time. Women doctors choose general practise at significantly higher rates than their male peers, exacerbating the problem and because they partner with other practitioners, two potential bush doctors are removed from the pool.

http://www.racgp.org.au/afp/2012/june/general-practice-research/

"The demographics, working practices and demands of the Australian general practice workforce continue to evolve with a shift to larger practice sizes, feminisation of the workforce and part time practitioners.17,18 Feminisation influences practice demographics, type of consultation and working hours."
[cont]

So the issue is one of willingness to serve on the part of GPs, which is somewhat related to the feminisation of the medical workforce. There is a shortage of GPs across the country, including in cities, because the GP workforce is increasingly composed of part-time female practitioners. Male practitioners disproportionately choose to specialise and some specialisations are also undersubscribed while there are potential medical students who cannot get places at uni or to do internships because the places have been taken. In the 20-34 demographic there are nearly 12000 women registered as doctors and only 10000 men, but all the men are employed, while around 2000 of the women are not. A similar but not quite as dramatic pattern is seen in the 36-44 demographic.

http://www.aph.gov.au/binaries/library/pubs/bn/sp/medicalpractitioner.pdf

http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129542629

Some efforts have been made to compel service outside cities by offering bonded places, but these have not been successful for the reasons described in my first post.

The solution we are presented with here is for GPs to act like an on-line diagnosis tool for those in remote areas, facilitated by the wonders of the NBN. I'm not sure why the GP's even required, if that's the case, since many GPs already rely heavily on expert systems for diagnosis in their own practise. Why not just install such systems and diagnostic instruments in each community with simple instructions for their use? If the patient is to remain responsible for their own care anyway, what role does the practitioner have? To me this sounds like an employment scheme for part-time female GPs to allow them to remain in the cities, where they have saturated the market, especially in women's health services.

I'm in favour of a more sensible approach.
[cont]

1. Stop the stupid prioritisation of female medical training. Not only do women have a shorter working life, when they do work they work fewer hours and they choose locations close to cities rather than in outer metropolitan, regional and remote areas. They also take more and longer holidays and many of them don't ever practise after training, moving into admin and other non-clinical roles. Screen female applicants for genuine commitment to medicine as a vocation. Impose a mandatory commitment to a minimum time in practise after internship.

2. Create a program to encourage our best and brightest boys to choose medicine, streaming them into specialisations.

3. General practice today is not the arduous intellectual endeavour it once was. While a good knowledge of anatomy, etc is important, I doubt that being able to name all of the bones, tendons, ligaments, muscles and identify their attachment points is a skill many practising GPs possess. Create a program designed to encourage boys (and girls who are committed) of the second rank intellectually to study for a degree that qualifies them as GPs, but which they must upgrade in order to specialise. Nurses already have this.

4. Make education free and provide cheap funding to establish practices for those who are willing to commit to practise in the bush.

5. Roll out the diagnostic stations I: described above.

6. Cancel the NBN, or replace it with a cheaper FTTN system and use the money saved to fund the programs above.