The number of junior doctors enrolling in general practitioner (GP) training in Australia peaked at around 1450 in 2017 and subsequently declined by around 20 per cent in 2020. In the Northern Territory (NT), from a peak of 74 new enrolments in 2016, numbers have plummeted by 80 per cent, with only 14 new enrolments in 2023. This decline is greatly eroding primary healthcare services in NT and is occurring alongside an unprecedented contraction in availability of other types of remote health professionals.
Over the past few years, many remote NT clinics have closed because of lack of staff and many positions remain vacant, especially in Central Australia. The collapse of primary health care is evident every day in NT hospitals and emergency departments, and in stark statistics such as the 20 per cent relative increase in chronic kidney disease observed in NT in the past two years. Some, who have lived and worked in NT’s health sector for many decades, observe that the remote primary healthcare workforce crisis is the worst they’ve seen.
Urgent actions are needed – and we know what these are. We interviewed more than 50 medical students, junior doctors, GPs in training, GPs and representatives from a range of key stakeholder bodies, both within NT and more broadly across Australia, to identify and prioritise solutions to the decline in junior doctors enrolling in GP training in NT. There was consensus that foremost in importance was to ensure many more junior doctors have rotations in primary care than has been occurring since the 2015 demise of the Prevocational General Practice Placement Program (PGPPP) and its 2018 replacement with the four-fold scaled-down Rural Junior Doctors Training Innovation Fund (which is only available for interns).
As with many other complex problems, no single silver bullet will reverse the decline. Instead, multifaceted strategies are required that target each stage of the GP training pathway. During vocational training, portability of employment benefits is a high priority. Currently GP registrars lose entitlements when they leave the hospital system and when they change rotations. This could be addressed through mechanisms such as a national entitlement fund or the single-employer model which New South Wales (NSW) Health is now extending across rural NSW (and which is being trialled in Tasmania). Without a comparable arrangement in NT, doctors interested in becoming GPs will train elsewhere.
Also important is offering flexibility during vocational training, so that the training is a better fit with GP registrars’ life circumstances (for example, enabling training to be completed in a timeframe that allows other interests to be pursued), and ensuring that high-quality, bespoke training experiences continue to be provided with the transition to college-led training.
NT is currently the only Australian jurisdiction without its own medical school and remains heavily reliant on recruiting medical graduates from interstate. More NT remote and primary healthcare experiences are needed for more NT-based medical students and this will require better infrastructure in remote communities to accommodate and support learning teams. ‘Flipping the model’ so that most teaching of NT-based medical students occurs in remote or very remote settings, with rotations into urban hospitals (rather than the reverse), could support NT’s future primary healthcare medical workforce.
It is also key that GPs and remote generalists have prominent leadership and mentoring roles during all stages of the medical training pathway, something which is absent in many Australian universities and hospitals.
Last, but by no means least, a broader range of funding levers are needed to better remunerate GPs (and GP registrars), thereby reducing disparities in GPs’ earning potential with other specialists.
This article is based on work that was led by Professor John Wakerman, in collaboration with Dr Devaki Monani and Dr Priya Martin, and funded by the Northern Territory Primary Health Network.