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The Zone - Kim Webber

Michael Short talks with Kim Webber, CEO of Rural Health Workforce Australia about the shortage of healthcare workers in rural areas.

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THERE IS no ''them''. There is only us. The nebulous, omnipotent force from whom so many demand solutions - as in ''they really must do something to fix the problem'' - doesn't exist. Nor should it. Our governments work for us to provide decent legal and logistic frameworks, but most of the time the best innovation and solutions come from the community.

Dr Kim Webber is us. The chief executive of Rural Health Workforce Australia is in The Zone to explain why the chronic shortage of healthcare in the remote parts of our nation will not be solved by big government; indeed, why it cannot be totally solved at all, but how it can be ameliorated by local action.

It might seem paradoxical, even defeatist, that the head of the non-profit organisation charged with finding ways to recruit and retain the healthcare workforce of rural and remote Australia believes the problem cannot be fully solved. But it's not; it's just honest and informed. She's seeking progress, not votes.

{WHO] Dr Kim Webber, hunter and gatherer of rural healthcare workers
[WHAT] We have a chronic shortage of doctors in the bush
[HOW] Locals must be creative in wooing and keeping doctors

[WHO] Dr Kim Webber, hunter and gatherer of rural healthcare workers


[HOW] Locals must be creative in wooing and keeping doctors
Photo: Simon Schluter

''I like to think of it as a chronic disease - you can't cure chronic disease, but you can certainly stop it getting worse and certainly improve quality of life and improve the symptoms. Intractable is not the word I would use, but we will definitely need to focus on this, as far as I'm concerned, forever.''

The issue is complex, which is one reason why ''they'' can't merely throw our money at it and declare it fixed. It is not just that there are fewer doctors per head in the bush - the shortfall varies across the land and thus cannot be readily captured in simple figures. It's not just about doctor-patient ratios; it is about distribution, too.

The traditional reckoning in Australia has been that there ought to be one doctor for every 1000 citizens. At present, that's the national situation on average, but the ratio is far higher in cities, far lower in many rural and remote areas.

''Health workforce is a bit of an immature science, if I can put it that way. We don't know how many is enough, and we as a country don't have a target or we've never published 'this is what you should expect'. I really think it's something I would love to see us do as a country, but the problem is that if you set the target, people expect you to meet the target and I think that might frighten governments off. So, we don't actually know what we're aiming for.''

That means scoping and treating the problem depends on talking to people in rural communities. That's the demand side. On the supply side, it means recruiting from the medical schools, a devilishly difficult task.

''We know we've got a problem because of what we actually hear from communities, and that we know that there are lots of communities without a doctor in that town or without a practice in that town so they don't have access to health workers in that town. They have to travel outside of their town. There's lack of public transport in rural communities, which means you're very much relying on getting yourself to a health professional.''

It involves so much more than the number of doctors. As important is the amount of time it might take to access healthcare - in terms of waiting times as well as travelling times. It's also about the availability of transport and other services that support healthcare.

But, above all, it is about the attractiveness of life in the regions, which brings us back to the recruitment and retention conundrum. The recent devastating hardships - fatal floods that came after a decade of drought - have hardly highlighted the joys of rural life.

People in the bush generally cherish the lifestyle. And it's not lost on others - witness the many thousands who've left the cities to make a sea change or a tree change. But often those people are leaving the city at the end of their full-time working lives, rather than shifting in the early years of their careers. That flow has added to the demand for healthcare in the regions, adding to Webber's woes.

Incidentally, a further indicator of Webber's difficulties is the incipient ebb in that sea-change flow. Only a matter of weeks ago, the Council on the Ageing warned that some people are moving back to the cities precisely because they can't get sufficient healthcare elsewhere.

As many as 7 million people live in coastal areas outside major cities. Coastal population growth is estimated by the National Sea Change Taskforce to be 60 per cent higher than the national average. The healthcare shortage is even more acute in remote inland areas.

Webber peppers her interview with the word ''challenge'' (see the full transcript and an edited audio/slideshow at Her greatest struggle is to make people understand there is no simple, target-driven national fix that can be funded. There's no policy box for Canberra to tick.

People just don't want to hear such truths. ''They think that their part of what they do - be it education, be it recruitment - is the answer and so I think being the lone voice [is the hardest thing I face].

''A lot of what I'm talking about is the hearts and minds and you almost feel like you're sounding irrational and fluffy and so trying to explain that and trying to be the lone voice for real change I find quite a challenge, particularly when I'm around very smart people.

''They want an answer and they want to be out of the media and they want it to not be a problem so they can go do something else.''

Kim Webber is determined, not daunted. She's passionate, not emotional. And she is achieving change, town by town, placement by placement.

As many as 70 per cent of the doctors who go into rural and remote communities come from offshore, the most common source being Britain. The rest are recruited from cities. Government-funded relocation allowances of up to $120,000 certainly help (yes, ''they'' can have a limited role), but it's about so much more than money.

''What we're talking about here is asking people to relocate their lives, their families, to another area. And that's where it's almost not about the work. It's about the lifestyle that community will offer.''

It's from the community that some of the most creative solutions are coming. Webber cites the efforts one South Australian town went to in welcoming their doctor, who had been recruited from India. The school had an India day and brought the doctor's wife in to teach others how to wear a sari. The schoolchildren were taught about Indian culture. ''Those kinds of things are so powerful, so powerful. You can't put that into policy or make people do that. That comes from the heart, the heart of a community. They're saying we want to bring this person in and make them feel close and overcome the difference.''

Another community, this one in Victoria, found out what their incoming GP liked to do. They had a town meeting and matched up local skills to those likes, and someone was assigned to take the doctor fishing, another to invite him around to play chess.

Webber's getting there. There are actually more doctors today in rural and remote communities than there were 10 years ago, but the population being served has grown so much that the shortage remains. Webber wants medical school entrance criteria adjusted to allow more non-city students in. She wants support services to take the administrative load off GPs, so they can be focused on medicine rather than, in effect, running a small business.

Above all, she wants more communities to embrace the responsibility of welcoming and retaining doctors.

What motivates her? ''Some people's lives are pretty awful, and so if you actually just provide a bit of support to make their life a little bit better and for them to be able to tolerate the things they have to deal with, that kind of makes me happy.

''My life is pretty good actually and always has been, but I recognise that other people's are not as good, so being able to just take a little bit of a load off is something I would love to see.''

Little by little, things are changing. Under arrangements at present, doctors who take the financial incentive to relocate can leave after five to 10 years, depending on the circumstances.

''I have heard stories where the [doctor's] family says 'We're not leaving here, this is our home now'. And for someone to call their community their home, that's a real success story.''

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