On Wednesday afternoon the two GPs at Dorrigo in northern NSW went on strike, closing their surgery in desperation and frustration at the bureaucratic barriers that have stopped them from recruiting help.
Dr Horst Herb, who has worked in Dorrigo for six years, explains how it came to this:
Dorrigo is a small rural community, semi-isolated from the nearest urban centre Coffs Harbour because of a steep mountain road in appalling condition. I am the only full time doctor there, looking after some 3,800 patients together with a female part time colleague.
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When I took over the practice, the town had been without a doctor for six months. Because of the tyranny of the distance, people all too often did not attend medical services far away but rather accepted neglect of their chronic and sometimes acute illness. As a consequence, people with diabetes, asthma, chronic kidney disease, or cardiovascular disease had catastrophic health problems, and we were swamped with the consequences in the emergency department and with emergency admissions.
I believe we managed to restore the public health situation to a state comparable with the average urban population, if not better. Emergency admissions or consultations for derailed chronic disease are now very rare, and even progress of such disease has become uncommon.
However, this was achieved at the cost of the doctors’ private lives and health. Last month alone for example, I logged 378 hours on call, and rarely get home before 8pm, and often only much later. Many days we don’t get a lunch break before 2pm.
The few moments that may appear as time off to outsiders are in reality spent with tackling the tons of paperwork we are burdened with. We cannot continue like that forever. I should have realised when I could not attend my mother’s funeral overseas because I could not find a locum in time. Our marriages suffer, we neglect our children, and worrying about this distracts us from our medical work where any distraction or lack of mental focus could result in loss of life or limb.
In February we managed to recruit a most competent doctor prepared to move to our town with his family — after trying for nearly six years. Doctors with the right mix of skills and willingness to move to a small country town are extremely rare.
It took two months until this rare gem could be assessed by the Medical Board which confirmed that his knowledge and skills including communication skills were adequate for the position. This came as no surprise since he had been working in the Australian hospital system for more than six years, and performed very well according to his supervisors. So why is he not working yet?
He was trained overseas. No matter that he has been Australian citizen for six years, no matter that he performed well for six years in major Australian hospitals (he became “registrar of the year” in a major Sydney teaching hospital!), no matter that the Medical Board assessed his professional and communication skills as satisfactory — the bureaucracy responsible for registration insists he has to pass an
English test first with marks that many Australian HSC students would not be able to achieve (A minimum of band seven (out of 9) in each of all four subtests).
These bureaucrats basically state that if this most competent doctor commits a few spelling errors in an English test he cannot practise in our community (but can continue practising in the hospital system in critical care where he works now). They deem it more important to stick to poorly thought through rules to the letter than putting my whole community at risk of losing medical services — and this they will.
When we appealed that requirement we were told that they will discuss an exemption on the 18th of June, so we waited some more, all of us getting desperate. So what was the decision? To procrastinate some more, and wait again until the 2nd of July. And no guarantees that a decision will be made then.
And even if he got the exemption, the insane bureaucratic process of getting a Medicare provider number for an overseas trained doctor would have barely started – we would be looking at least another two months of piles of paperwork and procrastinating bureaucrats who seem to have no other purpose in life than to delay progress and make our lives difficult.
Both my part time colleague and I have decided that we cannot sustain our current pace without help any more. Six years of working far beyond our duty and possibly beyond human capability are enough. Sacrificing our personal life for the need of the community at large is only fair enough as long as there is genuine need — but if this situation is created artificially by a cruel, inefficient, and inflexible bureaucracy we can’t see the point any more. We will now do as the bureaucrats do — work five days a week, nine to five, with regular lunch breaks and even holidays.
Emergencies nine to five only, please. However, we still feel like human beings and will not display the same callous disregard for the needs of others as the bureaucracy does — if we happen to be in town we will still attend life threatening emergencies regardless of time of day or personal commitments.
Since writing this cry for help, Dr Herb and his colleague have shut their surgery. They plan to strike until getting a written guarantee that their new recruit will be allowed to join them.