Getting the levers right: a way forward for rural medicine

To the Editor: We agree with the points raised by Kamerman in his erudite article.1 There are, however, two things that should be mentioned.

The first is that Townsville and Gundagai do not have the same Australian Standard Geographical Classification — Remoteness Area (ASGC-RA) classification: Townsville is categorised as RA3 (outer regional Australia), whereas Gundagai receives the less remote classification of RA2 (inner regional Australia). This magnifies the absurdity of the current classification situation even further.

The second is that not only would the general practitioner copayment policy have led to practices deciding against taking on registrars, but it would also have had an even greater potential for practices to decide against accepting medical students. Although the proposed Medicare rebate freeze will not have the immediate impact on undergraduate and vocational training that the copayment would have had, the net effect will ultimately be very similar.

Placement in rural general practices forms a key part of our medical student training and is a major factor in the success that we have had to date in our graduates choosing both generalist and rural career pathways. An unintended consequence of the copayment policy could have been to derail these positive outcomes with a stroke of the pen. We predict that, as the impacts of the Medicare rebate freeze take effect, enough practices will eventually decide to withdraw from training to have a significant negative impact on training programs and, ultimately, the primary health care workforce.