The average Australian would consider $30,000 an expensive outlay for a three-week holiday, but Narooma GP Gundi Muller-Grotjan will be paying that before she even walks out the door of her practice for a well-earned break.
Dr Muller-Grotjan owns Bermagui Medical Centre and Narooma Lighthouse Surgery in idyllic coastal towns 25 minutes apart on the far south coast of NSW.
But regardless of how picturesque these locations are, staff numbers at the clinics are dwindling and she has been working “eight days a week” to plug the gaps to continue serving the community.
Soon, she will be paying the hefty price tag of $10,000 a week for a locum GP to replace her while she takes a three-week break.
“I’m working very, very hard but a locum is only just a bandaid solution,” Dr Muller-Grotjan said.
“Locums are really expensive; in essence they are so expensive we can’t afford them — it’s not actually helping us with our workforce.”
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Royal Australian College of General Practitioners (RACGP) president Nicole Higgins understands this issue on a personal level.
Dr Higgins is also a GP and owns a medical centre in North Queensland.
“I can’t compete with the state health system, not just for doctors but for nurses and administrative staff too,” Dr Higgins said.
How did the system become so reliant on locums?
State governments do not have any oversight of subsidies or Medicare rebates for GPs.
However, they do have a responsibility for locum health staff in public hospitals, which Dr Higgins said was where the issue started.
“[In the past], workforce shortages and solutions have been put in place and as the state hospital and state governments try to fill those gaps, those rates of pay continue to increase because it is increasingly competitive,” the RACGP president said.
“What has happened is the local community GPs can’t afford to compete with the government and the state health systems for locum staff.”
Work less, for way more
Dr Higgins said it was far more lucrative to work one week of the month as a locum doctor than to stay and work full-time in a community.
She said an “artificial market” had been created where the prices were so high that general practices could not compete with the prices that the state government offered hospital locums.
Are politicians across this?
It’s a well-known fact that Australia is facing a nationwide shortage of GPs.
Over the past six months, the federal government has announced attractive offers to encourage people to study and become rural and regional GPs such as offering subsidised university fees for rural-trained medical students.
However, Dr Higgins said more short-term help, such as a subsidy to help GPs like Dr Muller-Grotjan employ locum staff so they could have a break, should be on offer.
“What’s happening in Bermagui and Narooma is that these doctors have done it really hard through COVID and natural disasters,” Dr Higgins said.
“They’re really tired and, just like everyone, they deserve a holiday.”
A spokesperson for the Department of Health and Aged Care said the government could not limit the amount that locum doctors charged practices for their services.
“These are private businesses operating in a competitive market,” they said.
While the National Medical Workforce Strategy 2021–2031 — a report that aimed to restructure and support the health workforce — identified that locums in some cases were helpful, it also acknowledged the flaws the service created within the health system.
“Locums play an important role in the system, providing relief to the existing medical workforce,” the strategy report stated.
“However, concerns have been raised that locums have become an overly accessible solution to ongoing supply issues … locums pose risks to continuity and quality of care, cultural appropriateness of care, and longer-term workforce sustainability.
Grassroots community action
Long-time Narooma locals Peter and Barbara McCabe have spent countless hours campaigning outside the Bermagui and Narooma clinics.
The pair have since collected more than 300 signatures on a petition to pass on to federal politicians, in a bid to help Dr Muller-Grotjan “bring more doctors to the area”.
For the past seven years, Ms McCabe has lived with lung cancer, which has since spread to other parts of her body.
Because of her health complications, she regularly visited her local medical centre — Narooma Lighthouse Surgery.
“Because of my health conditions, it’s nice to know when I go and see my GP he knows my medical history and I don’t have to keep explaining it to a new doctor,” Ms McCabe said.
The couple both fear for Dr Muller-Grotjan and her staff.
“If they continue the working hours they’re doing, they’re going to get burnt out and they won’t be well enough to come to work and look after the rest of the patients,” Ms McCabe said.
“And that is a real problem.”
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