Why can’t we get permanent general practitioners for our country town?

To the Editor: A rural general practitioner’s workload is significantly larger than that of his or her urban colleagues, and this is attributable to work activities in rural public hospitals.1 A GP who provides after-hours on-call service to the community through the local hospital or emergency department is not only valued, but also more likely to be retained in the rural workforce.2 However, on-call commitments and the unrelenting nature of after-hours care can negatively affect professional and personal wellbeing, family life and opportunities to enjoy the rural location.3

I currently work in the city, but did much of my training in rural and regional areas. Doing GP locums allows me to stay in touch with rural and regional practice. However, working as a locum has highlighted to me how arduous on-call commitments can be. When you are working as the solo town doctor, or one of two, there is not much opportunity to share the on-call roster as recommended by the Rural Doctors Association of Australia.4

In my experience, some hospitals have restrictive service contracts, which further contribute to the GP’s burden. For example, the doctor is mandated to be within 10–15 minutes away from the hospital at all times while on-call, and must attend, when requested, within the times specified in the contract. These times are the same as those expected in large urban hospitals.

In large urban tertiary teaching hospitals with on-site doctors, the median time taken for a doctor to attend patients whose condition has deteriorated unexpectedly is 13 minutes. One in five episodes had a recorded response time longer than 30 minutes.5 By requiring on-call GPs to meet or better the expected response times of urban tertiary hospitals, “on-call” in effect becomes “on duty”.

An on-call weekend results in being confined to home from 8 am Friday to 8 am Monday. I empathise with GPs working permanently in a country town and having to cope with such restrictions.

Given what we know about the negative impact of onerous on-call and after-hours commitments on doctors, including GPs, and the subsequent negative effect on workforce retention in rural and remote Australia,2 why are we still setting ourselves up for continuing failure?