ausdoc . com . au 8 NOVEMBER 2024

Carmel Sparke DR Michael Veal was watching his son play country footy on a wintry afternoon last year when one of the players copped a broken jaw .

He offered his medical help to the stricken player .

He knew there were no doctors left in the town of Avoca in Victoria ’ s Central Highlands since the Tristar Medical Group , the much-maligned rural bulk-billing corporate , collapsed in May 2022 .

Later , Dr Veal decided the situation was so bleak he would open a clinic there two days a week .

Now , he does a regular 140km round trip from his Ballarat and Creswick practices to see patients .

“ I am older , and I have paid off most of my mortgage , and I can afford to do it . The young doctors , they are not going to do it ,” Dr Veal tells Australian Doctor .

But he says it can only be a stopgap measure to ease the dire state of rural medical services .

“ When Tristar Medical went broke over two years ago , 29 medical centres closed , and at least 15 of those were in western Victoria , but it barely raised a concern ,” Dr Veal says .

“ I was working in the next town up the road , and we had literally dozens of panicked phone calls that week : ‘ But I need my insulin , but I need my blood pressure medication .’

“ And we had to say , ‘ We are not taking new patients . We are already overwhelmed .’ These people were desperate .

“ So a lot of those patients have been making the return trip to Ballarat , driving 100km each direction to find simple medical care .

“ A lot of other people just stopped getting medical care ; they are the ones I am now diagnosing with advanced conditions .”

By the time Dr Veal started treating patients in Avoca , the consequences of residents not being able to see a GP on a regular basis were evident in ways that statistics on workforce shortages are not .

Chronic conditions were presenting severely , with some patients who were diagnosed with diabetes three years previously who had done nothing about it over that time .

“ I am seeing a number of people who are walking in with enormous skin

cancers that are just dogs ’ balls obvious . They are not subtle things ,” Dr Veal said .

“ I have had people walking in who have had haemoptysis for a couple of years but had no doctors to see .

“ And guess what ? They have got lung cancer .

“ This was not just a problem of the country town having no GPs but also the impact of everyone being told during COVID-19 not to go to their GPs .”

Is pharmacist prescribing a fix for this ? Or urgent care centres ? Or patient registration schemes ?

The experience in Avoca underscores Dr Veal ’ s deep fears for the future of his profession and what it means if it is left to wither , particularly in rural communities .

He pointed to a recent RACGP survey showing that 29 % of GPs planned to stop work in the next five years and figures that slightly more than 1000 GP registrars started training this year despite there being 1500 places on offer .

“ General practice is fundamentally broken ,” he said .

‘ The young doctors , they are not going to do it .’

Dr Michael Veal .

“ I think we have driven off the cliff . There is no coming back from where we are now .

“ It feels like there has been a conscious decision just to abandon rural areas .”

He said the decline had been fuelled by long-term general practice funding cuts ; “ duplicitous and dishonest ” policies , such as the tripling of bulk-billing incentives ; and the changes to the Modified Monash Model .

Rural hospitals with overwhelmed EDs were just the tip of the iceberg , he said .

“ The common thing they write on the letters is ‘ GP FU ’. Well , that can mean something different to follow-up .

“ What are they going to do when they have no GPs to follow up patients ?”

At the age of 51 and with a “ mob ” of kids looking to finish high school in the next 4-5 years , Dr Veal said he would not be in the country forever .

“ I do not think that your average person spending a weekend away in the country from Melbourne or Sydney realises that there are no medical services left anymore .”

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