ABC Mildura – Swan Hill
16th December 2021

JAMES FINDLAY:              Now, we’re heading into an election year. The announcements are coming thick and fast. Recently, it’s been announced that doctors and nurse practitioners working in rural areas will be eligible to have their university debts wiped from next month. That’s if they move out to regional areas. A couple of weeks ago, you heard the Member for Mallee, Dr Anne Webster, say that the devil was in the details in regards to the policy. Well, the Minister for Regional Health, Dr David Gillespie, might have the answer on that. He joins you now in the studio along with the Member for Mallee, Dr Anne Webster. Good morning to you both.

MINISTER GILLESPIE:      Good morning.

ANNE WEBSTER:             Good morning.

JAMES FINDLAY:              Let’s start with you, Minister. You’ve worked as a gastroenterologist.

MINISTER GILLESPIE:      Yes.

JAMES FINDLAY:              You know what it’s like working in the field, working regional- out regionally, as a health professional. Do you think this policy will help fill the gaps in rural Australia?

MINISTER GILLESPIE:      It will certainly shift the dial. It is a really generous incentive.

But the reality is we have three times more doctors in metropolitan Australia per head of population than we do in regional so it’s there for a reason. You know, many graduates- because to get a fully minted, certified, standalone GP specialist, or a non-GP specialist, it takes about 10 or 12 years. When I graduated, like Anne’s husband, you know, you did your internship and residence, and you could go and do cardio thoracic surgery or neurosurgery. Like, you just did a uni degree, but now you do two. You do your uni degree, you do your licencing, your registration, and a second training program to become a member of a college. So a lot of people end up in metro-land by the time they finish. And this is a big cash incentive for people who’ve done their licencing year and a couple of years so they’re experienced. They’re not going out green to the country. They’re in their post-graduate fourth year after med school, and they will- year for year, they have to do a minimum of two years. But if they’ve done a five-year degree to get the full relief, they need to do five years. If they go very remote or into the remote regions, they get two for one bonus. It applies to nurse practitioners as well, because we need them in regional Australia as well. They’re doing increasing roles and making medical practice and care deliver to a much wider audience. And I think it will.

Because we’ve just announced it now going into MYEFO, unfortunately a lot of people have got next year’s commitments already lined up. But there will be a certain slice of people who are training and living and working here already that were maybe here on a six month or a twelve-month rotation, who think: whacko-the-diddle-oh. Bye bye HECS, I’m staying in Mildura. Or they’re going to Swan Hill, or they’re going somewhere. It will move the dial, and then next year you will see a bigger uptake, because everyone’s talking about it and the HECS debt can be upwards of $100,000.

JAMES FINDLAY:              This morning, you brought up nurses as well, because it’s not just doctors, it’s nurses. And this morning we heard-

MINISTER GILLESPIE:      Nurse practitioners.

JAMES FINDLAY:              Nurse practitioners. Now, hopefully have the answer to this, but I haven’t been able to find it, but the Australian Nursing and Midwifery Federation Secretary of the Victorian Branch this morning told us- Lisa Fitzpatrick, she told us that she’d like to see midwives included into this scheme. We were- this morning we heard about the midwife shortages in Swan Hill. Are midwives included in this? Or is that part of the scope?

MINISTER GILLESPIE:      Well, the brief is nurse practitioners, which means, first of all, the nursing degree, then a master’s degree. And so it’s about a four-year process. It’s almost the length of a med degree. And they do take added responsibilities. And they’re the- you know, we need all health professionals. It’s hard getting pharmacists, you know, it’s hard getting dentists. There are too many jobs snobs is my idea. But look, they fall for the bright lights. And also there’s this- an issue of, as I said, they’re much older now when they graduate, and so they have a partner with a partner career. And sometimes there’s partner resistance to going and staying rural. So there’s many levers that we are trying to influence. We’ve got amazing- Anne’s been part of the push for a med school, end to end here with Monash and with Latrobe, and we want to try and grow that space as well. We’ve got the radiation bunker that Anne and the former member campaigned on back in 2017, and it’s finally coming to fruition. There’s so many good things, and we’re meeting with the local health district about their plans to talk- turn this region into a academic medical centre. All courtesy of Anne, my good colleague, who’s made a big splash down in Canberra.

JAMES FINDLAY:              Yeah, Dr Webster, you did say a couple of weeks ago that, you know, you hadn’t seen all the details of this, devils in the detail, don’t know if it’s- you know, you couldn’t comment a lot on it at the time. Have you been able to take a deeper look at it, and are there things missing?

ANNE WEBSTER:             No, I haven’t seen the detail at this point in time. What often happens is that we have the announcement, and those with the power see the detail, and those of us who are, you know, coming along second, then we’ll get the detail as time rolls on. I think the important thing is that people can access it. The fact that it’s actually coming into play January 1, 2022, is a really good step. And as Dr David Gillespie has said, people who are already here may decide they’ll stay because they’re going to lose a significant part of their debt. One of the things that I did say to you on the day too is that it is one of the tools in the toolbox to increase workforce capacity in our regional communities. I maintain that. And one of the others, as David has just said, is the undergrad biomed course, which I’ve fought for since stepping into office two and a half years ago, and worked with Latrobe. We’re still pushing that hard, is all I can say. I’m taking the Minister over to Latrobe today and to Monash and to meet with the grassroots and hear some stories of local doctors who are training and those who would be as well.

JAMES FINDLAY:              Yeah. Dr Webster, you have talked about how it’s important to get people into the regions so they study here, more chance of them staying here as professionals.

ANNE WEBSTER: Yes, yes.

JAMES FINDLAY: Dr Gillespie, the policy is great for getting young doctors out to the regions, which will get like people with less experience out here. But what is the Government doing to get more experienced doctors and nurses out here?

MINISTER GILLESPIE:      Well, partly, the (formerly HECS) HELP relief, as I said, it kicks in. If you start rural as an intern or resident, the policy that I put through the ERC and Cabinet was that the indexation freezes, but the relief happens in your fourth postgraduate year. We have many levers already in place to distribute half the registrar’s training in general practice around non-metro areas. So we have those levers being pulled in their junior years.

But this mid-level experienced doctor, having worked for a full three years going to their fourth year, if they stay, we are not getting a green intern. We’re getting capable, young doctors who are halfway through their registrarship to become a member of a college. If they stay, they get one-for-one. A minimum two years – can’t just be a sampler, three-month rotation, bingo, I want my HECS let go.

JAMES FINDLAY: Yeah, no.

MINISTER GILLESPIE: They have to do a minimum of two years, and it’s one year for one year. Unless you go really remote to Modified Monash six and seven regions, like the Kimberley or Northern Territory or some remote island, they get two-for-one.

JAMES FINDLAY:              Yeah. It’s just I’m hearing that the incentives for experienced doctors to supervise junior doctors have been eroded over the past few years; that the incentives just aren’t there like they were before.

MINISTER GILLESPIE:      Yeah look, there’s so much detail in MYEFO, that is another issue we’ve addressed, and we’re working on policies to increase the amount of rural supervision. There are so many things. This is the big message, but there’s all these added extras, a bit of, you know, salt and pepper on it. Anne?

ANNE WEBSTER:             Yeah, I think one of the, one of the keys here in Mildura is that if we can develop a tristate tertiary training hospital – which is a big dream, but I think that it, it has broad support – if we can make that happen here you automatically bring in those highly skilled, highly trained, because you’ve got the momentum and the numbers. So I think Mildura is situated, and others, you know, we’ve – this has been a conversation that we have been having – agree that Mildura is situated so far away from Bendigo, so far away from Melbourne. We have a really unique situation here where. as a tristate training centre, we connect with the academic – Latrobe, Monash, whoever else wants to step in – and the hospitals to actually form, effectively, a, a very active training and supportive environment – not just for doctors, but also for our allied health and nurses. So look, it’s a big dream, and it’s got- all the construction of that dream needs to come together, but I think that we have significant support locally for that.

JAMES FINDLAY:              It’d need a lot of Government funding though?

ANNE WEBSTER:             Oh yes, it would. Funny about that – needs dollars. And it also needs state commitment to that. And at the moment what I’m seeing is a more centralised approach down to Melbourne, Ballarat. If you look at the consolidation of many of our healthcare and hospitals down south of Mallee, it’s been centred to Ballarat – that is the last thing Mildura needs. We need to develop and we need the state government to commit as well to this. So there- look there are conversations that need to take place. I’m very passionate about this; I think that our healthcare is like the key issue for all of us. And the radiation bunker that we’re visiting today is a sign of the Australian Government’s commitment to Mildura, and that people can get their radiotherapy here in Mildura soon – very soon.

JAMES FINDLAY:              This announcement would be- has been very welcomed by med students quite broadly. But just before we move on, the rural doctor’s network say- of New South Wales say there are 41 small towns in western and far western New South Wales that are at risk at not having a practicing GP in 10 years, at all.

MINISTER GILLESPIE:      Yeah.

JAMES FINDLAY:              Nine of those are short to medium-term risk. You’ve been in Government for eight years now. Why now?

MINISTER GILLESPIE: Look, there is a, a retirement issue. A lot of skilled doctors, GP obstetricians GP anaesthetists, the multi-skilled general practitioner. We have put a lot of money into rural generalist training, dedicated spots in the general practice training program. We’ve got other initiatives that have been added to it. But the gestation of a fully minted doctor, as I’ve pointed out, is 10 to 12 years. I entered Parliament, in 2013; if I was enrolling in a med school 2013, I’d still have two or three years to go. So you don’t replace things quickly – these workforce issues take time.

But the big bang that we announced the other day with the HECS-HELP debt relief is a dial shifter. It will- Because we don’t have to wait for someone to go through six or eight years of two med degrees, or a med degree, a pre-med degree and a college certification and membership. We have got people who are in the system now, and it affects them now. That’s why it’s so important that every junior graduated doctor is hearing this live on ABC. Go west, young woman or young man, out to Mildura and the mighty Mallee. We have got a place for you.

We are trying to recreate this multi-skilled general practitioner model. Queensland started it, they call it rural generalism – that’s the flavour. The medical beast that we need in country Australia is the doctor who works in their practice, who works at the hospital. Part of that formula depends on the state government. Its universal, it seems, across the whole Federation. Whenever there’s a problem, even though it’s within the constitutional rights and powers of the states, everyone comes to Canberra to solve a problem that the states have responsibility for. Message to local health districts around Australia, please appoint more junior doctors in regional towns.

JAMES FINDLAY:              Yeah, that’s funny – we were just speaking to a young doctor on Monday. There, there was a- the group of nine young doctors being taken to Swan Hill, they were checking out all the, the facilities there. And these young doctors, as you mentioned before, they specialise in different areas as well. They have to do extra training for working out in the regions, because they do have to do a lot more…

MINISTER GILLESPIE:      Yeah.

JAMES FINDLAY:              … out here.

MINISTER GILLESPIE:      Yeah.

JAMES FINDLAY:              But- Yeah. They were- They’re very keen to move out here, we just need more of them.

MINISTER GILLESPIE: Well that’s the missing link. We need more junior, early graduation doctors appointed in these regional centres. Because if they get sucked back into the vortex of metropolitan Australia, sometimes that linkage is lost, and they, they find a partner, then life gets complicated. But I’ve done it, Anne’s lived it – her husband, they came out when you were…

ANNE WEBSTER:             44 years ago.

JAMES FINDLAY:              Oh, wow.

ANNE WEBSTER:             For one year, one year.

JAMES WEBSTER:            One year.

ANNE WEBSTER:             And here we are.

JAMES FINDLAY:              Such a long one year.

ANNE WEBSTER:             I know. It is such a long one year.

MINISTER GILLESPIE:      That’s scary, my dad did the same thing. He was the country GP, went for one year before he saved money and went to Scotland to become a surgeon. But 49 years later, he retired in a country town called Queanbeyan.

JAMES FINDLAY:              It does happen.

JAMES FINDLAY:              Dr David Gillespie the Minister for Regional Health is with you, so is Dr Anne Webster, the member for Mallee. You’re on ABC radio, ABC Mildura-Swan Hill, James Findlay with you. It is 8.50am.

Just before you go, a lot of people talking about this today. Yesterday, the Victorian Chief Health Officer, Brett Sutton, said that more than 400,000 Victorian’s are overdue with their COVID vaccine booster, while more than 700 are eligible for their third shot. Anthony Tassone, the President of the Victorian Branch of the Pharmacy Guild, I told Nicole Chvastek, on Drive yesterday, that half the amount of pharmacies were opting in to give third vaccines – that was half the amount of them were giving first and second vaccines. He said the GPS and doctors were being paid less to give the third vaccine, and pharmacists needed more funding from the Federal Government.

[Excerpt]

ANTHONY TASSONE:      It’s real- It’s the Federal Government’s program, and they need to fund it properly. Pharmacies cannot be expected to subsidise the Australian Government’s COVID-19 vaccination program. I can say, from a Pharmacy Guild perspective, we’ve had multiple discussions with the Federal Government about this; we’ve put forward a number of proposals of what we need to do to make this sustainable. They haven’t budged.

[End of excerpt]

JAMES FINDLAY: Omicron is here. There’s a, a push to get people their third vaccine. Is the Government aware of, of this problem?

MINISTER GILLESPIE: Yeah. Both the Omicron issue and the, and the payments for the vaccine boosters. Yeah. Look, it’s a logical, rational argument, and I have supported that. And it’s a work-in-progress; I’ll keep advocating for that.

JAMES FINDLAY: So will the Government raise the, the funds for pharmacists?

JAMES GILLESPIE: I wish I could give you a solid answer for that, James, but I’m not in ERC; and Minister Hunt has carried through the vaccine program. But I certainly follow the argument, and the reality that a lot of people are withdrawing from the vaccine pro- you know, vaccine administrators, both pharmacies and GP’s.

JAMES FINDLAY: Yeah. Yeah. Yeah.

MINISTER GILLESPIE: And it will need to be readdressed.

JAMES FINDLAY: Thank you for your time this morning, Dr David Gillespie.

MINISTER GILLESPIE: Thanks.

JAMES FINDLAY: And Dr Anne Webster.

ANNE WEBSTER: Thank you, James.

JAMES FINDLAY: And both of you have a Merry Christmas too.

ANNE WEBSTER: And you too.

JAMES FINDLAY: Thank you.