In part 2 of our special series 'Restricted Practice' we explore the widening gap between city and country specialists, and the "mercenary" system forcing rural hospital networks to fork out fortunes for city-based doctors to fly in and out of the region.
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![Resident Brian Kelly has noticed a stark difference between the healthcare he received in Brisbane and what is available in Quirindi. Picture by Gareth Gardner Resident Brian Kelly has noticed a stark difference between the healthcare he received in Brisbane and what is available in Quirindi. Picture by Gareth Gardner](/images/transform/v1/crop/frm/164349425/79b1ceb9-607d-4042-94fb-9367830aaadd.jpg/r0_0_3685_2547_w1200_h678_fmax.jpg)
Stuck in limbo
BRIAN Kelly struggles to breathe.
"I couldn't walk more than say 50m, and then my breath runs out. The hip flays up, and my knees give way," he said.
Mr Kelly moved from Brisbane to Quirindi in pursuit of country life, a small agricultural town about an hour out of Tamworth.
On his last visit to Tamworth hospital with chest pain, he said he waited five or six hours and was discharged without transport to get home.
"The only way I could get there was to walk from the hospital down to [the town centre], and get the bus back to Quirindi," he said.
He used to be able to visit the Royal Brisbane Hospital, be seen immediately and then sent on to specialists.
In order to see a specialist in Quirindi, he said he basically needs to be coughing something up. As an old age pensioner, "money is really tight".
No stranger to hospital visits, Mr Kelly was transferred to Tamworth in 2019 suffering stomach pains.
Ultrasounds were done, and the surgeon said his gallbladder needed to be removed. He's had pain and felt nauseous "24 hours a day ever since".
He said his GP saw the report and told him the decision was "nonsense" and that his gallbladder appeared normal.
"I'm not very happy with the hospital here at all," he said.
Mr Kelly has nodules on his thyroid and is meant to get six-monthly ultrasounds, but hasn't seen anyone since the move.
He used to get things burnt off his skin "left, right and centre".
The elderly man needs to see a respiratory physician, but none are available.
He needs to see an endocrinologist, "but they charge the Earth".
Those things really worry him, but he isn't actively looking for treatment anymore.
"I'm stuck in limbo," Mr Kelly said.
The cost of care disproportionately impacts the health of those who need it most, according to 2020-21 patient experience data from the Australian Bureau of Statistics.
These groups are more likely to require care and delay care generally, but there is a clear disproportion in delays due to cost.
Outside the boxes
![Samantha Pitkin said she and her family, Matilda, 7, Mitchell, 3, and husband Kirk, need extra help. Picture by Peter Hardin Samantha Pitkin said she and her family, Matilda, 7, Mitchell, 3, and husband Kirk, need extra help. Picture by Peter Hardin](/images/transform/v1/crop/frm/164349425/577d5b93-70a7-4154-af74-8e15d5fc5b52.jpg/r0_0_6880_4587_w1200_h678_fmax.jpg)
Samantha Vina Pitkin fell through the cracks until she became a heroin addict.
Ms Pitkin spent a decade using heroin in Sydney, leaving Tamworth without her children to score in Cabramatta and eventually Kings Cross, where she took up sex work.
She fell pregnant, decided she wasn't going to lose another child, and moved home to Quirindi in the New England North West.
"The country saved my life, but I'm terribly, critically ill," the 47-year-old said.
Ms Pitkin suffers from what she describes as a vascular ulcer. It comes from a varicose vein under pressure, which explodes, coupled with lymphedema, she ends up with an ulcer.
Lymphedema causes enlarged limbs and is typically seen in people who have breasts removed, or who have been in car accidents.
But she believes her condition is genetic, and that anomaly is just part of the reason she claims doctors won't help her.
Although she said she hasn't used drugs in more than 15 years, she's sure that health professionals assume otherwise.
"I can't imagine why else they treat me the way they do," she said.
Ms Pitkin said she goes to Quirindi hospital and said they give her excuses, get her on waiting lists, tell her there aren't counsellors available and to ring back.
The Hunter New England Health district was contacted for comment on Ms Pitkin's case, but due to patient confidentiality a spokesperson said they could not talk about specific patients and their care.
Ms Pitkin admits she doesn't always turn up to the appointments she's booked.
"I thought that's what community health was for, for us losers that can't keep appointments?" she said.
Working in the country 'shouldn't feel like charity'
![Regional specialists manager and emergency clinician Mian Bi brings private specialists into Tamworth through a fly in, fly out model. Picture by Gareth Gardner Regional specialists manager and emergency clinician Mian Bi brings private specialists into Tamworth through a fly in, fly out model. Picture by Gareth Gardner](/images/transform/v1/crop/frm/164349425/1fcf139b-10cd-4d6e-ae81-e8ed1ff57432.jpg/r0_0_4990_3302_w1200_h678_fmax.jpg)
PATIENTS who fail to attend appointments are causing big issues in public hospitals - just ask Regional Specialists Tamworth managing director Dr Mian Bi.
He's also an emergency clinician at Westmead Hospital, and said often people don't turn up because it's free and there are little consequences for no-shows.
"Whereas for a private clinic, we can - and we do - charge if you don't show up," he said.
The Sydney-based doctor started Regional Specialists Tamworth to address doctor shortages.
If the public system was working, he wouldn't have a business model, he said, arguing it's too much to ask a new doctor to pack their bags and work as the only specialist of their kind in Tamworth.
He offers doctors work for three days of the month, with clinicians on hand to support them.
"The main thing is that you don't want the clinician to feel that coming to the country is charity," Dr Bi said.
"I want it to be that working in the country and working in the city is the same for you."
Dr Bi first set foot in Tamworth because the city needed emergency doctors and he was willing to travel.
He has honed his skills at metropolitan, regional and rural hospitals across the state.
Rural and regional doctors need to do a lot more, and the job demands a wider range of skills, Dr Bi said, with less resources, specialists and access to primary health care.
Life in the country isn't for everyone, and Dr Bi said a desire for work-life balance is contributing to the doctor shortage.
He said in the country, you're isolated from your peers and there's fewer opportunities to choose from when it comes to schooling for children.
"In the country, you can't service the 'just to be safe' people, you service the people who really need the help," he said.
"For some clinicians, that's very rewarding, because they come out here three days, they see more interesting cases, and they help more patients, in their own minds, than they would in Sydney.
"The sell that I tell them, is 'come to the country, see patients who have a good range of pathology, and a lot of them are actually crying out for help'."
Rural health's 'mercenary' culture
IN A CLASS of 70 University of New England Rural School of Medicine graduates, Northern Tablelands MP Adam Marshall didn't find "a single one" that was going to become a rural GP west of the Great Dividing Range.
They told him they were planning to continue studying and specialise in paediatrics, geriatrics, or surgical "because that's where they can build a solid business".
It's led to a "mercenary" culture where health districts compete and bid against each other for travelling doctors, he said.
There are significant challenges securing clinicians in rural and regional areas, not just for the Hunter and New England regions, but across Australia, a spokesperson for the Hunter New England Local Health District said.
Sometimes there are gaps in medical coverage that cannot be filled, despite making every possible attempt to secure a doctor, the spokesperson said.
Locums - doctors that temporarily fill vacant positions - get paid "exorbitant" wages for one shift, minister for regional health Bronnie Taylor said.
"I can't put a cap on that, which would be the responsible thing to do as the minister, because if I put a cap on that, they just go to Queensland or Victoria or Darwin, where they're prepared to pay that money," she said.
Read part one of Restricted Practice.
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