The difficulties attracting young doctors to the regions and communication challenges between doctors and the hospitals rose to the fore as the first regional hearings of an inquiry into state and healthcare funding kicked off in Wagga on Monday.
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Temora GP and Rural Doctors Association president Rachel Christmas told commissioner Richard Beasley of the Special Commission of Inquiry into Healthcare Funding that doctors in Temora are being forced to rely on remote services in the town's hospital emergency department due to the sheer demand.
"We're having to use remote services more often because the demand is too great," Dr Christmas said.
She said when patients come into emergency they are assessed and instead of calling a local doctor, they speak with an on-call doctor from a remote location who manages admittance of patients to the hospital.
"This is a way of managing our fatigue," Dr Christmas said.
The inquiry heard Temora doctors work not only in a doctor's GP practice, but also in the town hospital and aged care homes.
While noting communication between Temora doctors and their local hospital wasn't an issue, Dr Christmas said hospitals further afield did not communicate enough when dealing with patients.
"We [the GPs] know our patients really well ... we are a really good resource for bigger hospitals," she said.
The inquiry also heard the steady decline of graduate doctors from taking up a career in general practice.
"General practice has long been a poor cousin in the medical fraternity," Dr Christmas said.
"It's not remunerated as [much]."
Dr Christmas noted the downward trend was "long-term" and whereas in the past, GPs used to work a myriad of hours, now they are having to work harder as patient cases become "more complex".
She said it was now "snowballing" and noted the trend is happening beyond NSW as well.
Dr Christmas also weighed into the challenges of attracting GPs to regional and rural communities like Temora.
Launched in 2018, the Temora Quack Quest social media campaign to attract rural GPs to the town drew attention from far and wide.
And while it did prove somewhat successful, Dr Christmas said it has been hard attracting GPs to the community, noting that they lost two doctors.
"Both were overseas trained, a different culture... [and] fitting into a small community was challenging... [and ultimately] family and community called them away," she said.
The possibility of more locum doctors was raised, but Dr Christmas said a downside of such support was there is no long-term relationship with patients.
"The advantage of being a GP in a town like mine is I know the people and they know me," she said.
Dr Christmas also weighed into the possibility of the state government funding doctors to provide primary health care through the hospital.
She raised concerns this could lead to resentment if those workers didn't live in the town and didn't share responsibilities such as hospital and aged care work.
Meanwhile, Wagga's Dr Ayman Shenouda - a past president of the Royal Australian College of GPs - raised issues over the lack of adequate communication between the state hospital system and doctors.
Dr Shenouda said hospital patient discharge summaries can take up to two weeks to return to GPs, and when they do arrive, he said they don't always contain enough detail.
Raising another issue, he said a few years back, a patient of his, a 90-year-old lady with shortness of breath presented to his practice while he was away.
He said a locum assessed her but couldn't find the cause and send her to hospital where they conducted scans and even called in a cardiologist, who also couldn't locate the cause of the problem.
"The first day I returned, she was in my rooms ... [and] she was very frustrated and anxious about what happened to her," Dr Shenouda said.
"I noticed her body language... [she] was stressed more than anything else."
She went on to say a priest had told her to make contact with her abusive ex-husband and Dr Shenouda realised she was suffering from anxiety.
"No one would have picked that, because no one asked her," he said.
He said a key difference was the relational nature of general practice.
He echoed Dr Christmas' concerns that general practice is struggling to attract new recruits.
"Ten years ago, 50 per cent of [graduate] doctors were choosing to do general practice, now it's down to 17 per cent," Dr Shenouda said.
He said this decline could see major problems in the future, including putting increased pressure on hospital emergency departments.
Dr Shenouda said it costs $400 to assess a patient in emergency, whereas it is only about 10 per cent that cost for a GP to see them.
He has also previously raised concerns about the rising cost pressures facing GPs as the state government considers plans to introduce a GP payroll tax, despite the fact doctors are already taxed by the federal government.
The week of Wagga hearings will feature a long list of prominent health officials including MPHN interim CEO of policy, strategy and innovation Narelle Mills on Tuesday, UNSW associate dean of rural health Tara Mackenzie on Wednesday, MLHD primary care director Alam Yoosuff and Wagga Base GM Lenert Bruce on Thursday and MLHD CEO Jill Ludford on Friday.
Local government representatives will also attend as witnesses, including Coolamon Shire mayor David McCann on Wednesday, while Berrigan Shire mayor and CEO Julie McKean attended on Monday.