BENDIGO will become a priority area to attract general practitioners, as health professionals warn the city is in the midst of a medical crisis.
Health professionals say Bendigo patients may be at risk as they struggle to make appointments at general practice clinics, waiting up to three weeks in some cases, due to a shortage of GPs.
Doctors say patients' chronic diseases may be getting worse, as they postpone urgent consultations, while other patients may not be getting the care they need on a short term basis.
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Many say Bendigo's general practice availability is approaching the state it was in 2004, and has been for about six months.
An aging population, population growth, long term funding cuts to general practice, growing specialisation among the medical profession were among the factors at work, health professionals said.
Many also pointed to a GP workforce approaching retirement age and a reluctance of student doctors to go into general practice.
Bendigo Community Health Services director of Primary Health Care Services Graem Kelly said people were being put "dramatically at risk" by a GP shortage.
Many of the individuals that we service are quite at risk of getting acutely ill quite quickly, or not having their chronic disease managed appropriately.- Graem Kelly
He said there was a "real medical crisis" on a number of fronts in Bendigo, putting pressure on bulk billing GP services.
Mr Kelly described the shortage as severe, saying BCHS got a high number of calls from patients who had not been able to access GP care, either on a regular or a short term basis.
He said patients were waiting up to three weeks to see a GP.
Mr Kelly said this meant people's conditions could worsen to the point where it became uncontrolled, in situations where a GP could have intervened before they needed to go to hospital.
It also meant doctors faced unrealistic expectations, as they tried to address an insurmountable demand, he said.
The crisis had become most severe in the last six months, he said.
Mr Kelly said a shortage of trainee GPs - known as registrars - had left positions vacant, meaning Bendigo was exposed.
He said the possible change in Bendigo's geographical classification, which could reduce bulk billing incentives, would also lead to pressure on general practitioners.
"We're one of the final points of call for the most disadvantaged," Mr Kelly said.
"Many of the individuals that we service are quite at risk of getting acutely ill quite quickly, or not having their chronic disease managed appropriately.
"We're feeling the sharp edge of patients coming in much quicker."
Bendigo Primary Care Centre chief executive Glen Careedy said there was an increased demand for health care, but he had stopped being able to find new doctors.
Mr Careedy said the clinic was booking out earlier and earlier each morning.
It had become very noticeable in the last cold and flu season, he said.
He has been advertising for a GP for about two years, with virtually no response.
Mr Careedy said growth and an aging population meant there was an increased demand for general practice services in Bendigo.
But it had become harder to find GPs willing to move to the city.
The practice only attracted three trainee GPs this year - a key way doctors' surgeries get GPs to stay in an area - where they could have taken six, Mr Careedy said.
Funding restrictions were also hitting hard on top of this, he said.
Mr Careedy said the situation was becoming like Bendigo's doctor shortage in 2004, when anyone who moved to town couldn't get a doctor, because most had closed books.
This affected patients in two ways, he said.
People with immediate medical issues, such as a cold, or flu, or asthma playing up, might not be able to see a doctor when they needed.
Those with ongoing or chronic conditions, who needed to see a doctor over a longer period, might not be able to access the continuing care they needed.
Existing conditions, such as diabetes, or heart conditions, could get worse in this situation, where a GP could have prevented problems.
"We've got a population that's far more heavily weighted in the 65 plus range now and those people carry a lot of chronic diseases, and often more than one, so good management by a regular GP is important," Mr Careedy said.
Smaller practices were also feeling the pinch.
Lowndes Street Clinic employs two doctors full time, and two part time.
Principle Heny Georgeos said patients were calling round multiple practices to find a GP, because their usual doctor was booked up for days.
Dr Georgeos said sick patients often had to wait a few days to see a GP.
We just don't know what to do. It's becoming very stressful for us and for our patients.- Heny Georgeos
He said the problem had gotten worse in the last six months.
"We have people ringing every day and asking if we're taking new patients and unfortunately we can't because we can't really cope with the load we have," Dr Georgeos said.
"A few doctors have actually retired as well in the last two to three years and they're not being replaced by anyone else."
Dr Georgeos said he had advertised in many places for a new doctor, but there didn't seem to be any interest in coming to Bendigo.
"There have been more and more people coming to Bendigo and less doctors staying which I think created a shortage," Dr Georgeos said.
"Over the past five years we've had five doctors coming and leaving within 12 months.
"There is no incentive from the government, and the other side of that is that we can't now get any overseas trained doctor who have done their exams to work here, because Bendigo is not considered a district workforce shortage area."
Dr Georgeos said chronic conditions were not being managed as they should be, because of the GP shortage. He said doctors were becoming burnt out by overwork.
"Patients are calling around, they can't find a GP, their usual GP is booked up for days, patients if they're sick they have to wait a few days or just ring around to find someone who is available," Dr Georgeos said.
"People postpone urgent things that need to be looked at, which may not be very good for their health. Some conditions may need to be looked at within a day or two, but they can't get to their doctor.
"We just don't know what to do. It's becoming very stressful for us and for our patients."
Likewise, Eaglehawk Medical Group GP Talitha Barrett said the practice had received a lot more calls for people looking for general practitioners in the past 18 months.
She said a drop in medical students applying to train in general practice streams was contributing, along with under-funding.
The federal government said on Friday that Bendigo would become a priority area to attract general practitioners.
Minister for Regional Services, Decentralisation, and Local Government Mark Coulton said Bendigo would become a "distribution priority area" under a new system to be implemented on July 1.
This means Bendigo practices will be able to recruit overseas trained doctors, and medical students who have agreed to work in a rural area in exchange for a Commonwealth Supported Place at University.
The system will replace the previous model, which deemed certain areas as districts of workforce shortage.
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Murray PHN chief executive Matt Jones said regions like Bendigo needed better incentives to attract health services from metropolitan areas.
Primary health networks are funded by the federal government to increase the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, to make sure patients receive the right care at the right time.
Mr Jones said Bendigo needed more doctors to provide the same level of health care as in the past.
He said general practice availability needed to be accompanied by complex care for other conditions, such as mental health care, and care for chronic conditions.
There was a maldistribution of general practitioners in Australia, Mr Jones said.
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Rural Doctors Association of Australia chief executive Peta Rutherford said general practice was still suffering from the ramifications of the Medicare freeze.
This had damaged the reputation of general practice among junior doctors, she said.
It was important to support a rural general practice model, and more general training in medicine and surgery, she said.
For many years we were under-producing the number of doctors that were needed, particularly GPs.- Richard Kidd, chair of the Australian Medical Association Council of General Practice
Ms Rutherford said younger doctors also had different expectation from their work life, which meant it was not necessarily a one-to-one replacement when an older doctor retired.
The next generation did not want to work 80 hours a week, which meant it might sometimes take two, three or even four doctors to replace a retiring clinician, she said.
Ms Rutherford said Bendigo clinics needed to provide supportive training environments to attract new doctors.
She said the Federal government also had a lot of work to do so young doctors saw general practice as a good career choice.
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"A number of the doctors who are thinking about retiring, they're either in that transition to retirement... we also are aware then that the emerging workforce has different expectations, they do want a work life balance," Ms Rutherford said.
"The reputational damage as a result of the Medicare freeze ... has created a huge negative impact for general practice as young doctors consider their career options."
Australian Medical Association Council of General Practice chair Richard Kidd said the organisation had been trying to alert the government for years to an approaching shortage of GPs.
He said many doctors were reaching retirement age, putting the health system on a cliff edge.
"For many years we were under-producing the number of doctors that were needed, particularly GPs," Dr Kidd said.
"Now we're in a catch up situation, where we are trying to produce more doctors."
Chief executive of GP training organisation Murray City Country Coast Greg McMeel said it was hard to fill trainee positions in regional centres because the number of people coming into the program was low in all areas.
Mr McMeel said there had been a downward trend in applications to general practice training over a number of years.
He said MCCC was doing what it could to bolster numbers.
"There's a need to limit the numbers of registrars that go to the bigger regional towns and try and disperse the doctors further afield," Mr McMeel said.
"The general population outside of medicine are all wanting to move into metropolitan areas. It's becoming harder not easier to recruit into the rural areas."
Victorian Minister for Health Jenny Mikakos said the federal government needed to do more to address rural and regional workforce shortages.
She said the Victorian government was investing in more regional health services and hospitals.
Federal Minister for Health Greg Hunt was approached for comment.
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