Dr Kerryn Phelps, AMA President, to the 2002 AMA Parliamentary Breakfast, Parliament House, Canberra

There are many topics I could raise with you today and talk for hours.

I could talk about aged care, medical indemnity, bulk-billing, the Trade Practices Act, private health insurance premiums, the Medicare rebate, no gaps insurance, indigenous health, the dangers of boxing, provider numbers, corporate medicine, mental health, depression, body image, statins, public hospital funding, any number of things.

But I won't. Not today anyway.

I don't want to bore you with complex health messages this morning.

There is only one message I want you to take away from this breakfast - and that is that health policy should be based on evidence.

To help sell this message the AMA is today releasing the most comprehensive survey ever of Australia's General Practice workforce - and a solid body of evidence it is, too.

You are the first to receive it and you will find a copy in your media kit.

Last year, the AMA commissioned Access Economics to carry out a detailed analysis of the demand and need for GP services, to look at the factors affecting availability of the GP workforce, and to project the longer term demand and supply trends for GP services.

Access sent a very detailed questionnaire to every GP in Australia and received some 7,500 responses from roughly 20,000 practising GPs.

In tandem with analysing and reporting these findings, Access also conducted an appraisal of other data.

In particular, they looked at the GP workforce data analysis provided to the Government by the Australian Medical Workforce Advisory Committee (AMWAC).

Access found the AMWAC analysis wanting, in the same way the AMA found the recent Productivity Commission report on the GP workforce wanting.

Access Economics found the AMWAC analysis wanting in several critical areas.

The most important weakness was their failure to support their chosen benchmark for GP services with any analysis or justification. AMWAC's benchmark was GP utilisation in large rural centres.

Only 9 per cent of the Australian population lives in these centres, and utilisation in these areas is substantially below urban utilisation, and well under the Australian average.

Both the AMWAC and Productivity Commission data defy reality. Their statistics don't reflect what doctors and patients and whole communities are telling us: there aren't enough doctors!

The AMA/Access survey tells a different picture because it brings a message direct from the coalface. It is a case of personal experience versus statistical analysis from afar.

When it comes to responding to health needs, I'll opt for the former every time.

The survey is not just about doctors, it is very much about patients and patient needs.

It is also about communities.

Doctors have always been prominent citizens in their communities, especially in country towns.

They looked after generations of the same family and provided a very personal style of medical care.

Increasing pressures and demands on doctors mean that the long-term family doctor is disappearing from the Australian landscape.

This is due to a combination of factors.

Medical indemnity insurance, unnecessary use of the Trade Practices Act, stacks of red tape, isolation from training and technology - all these factors make the choice to stay in the city easier for young doctors.

And they make it easier for doctors to leave medicine early.

The key is to make country practice and outer-suburban practice more affordable, comfortable and worthwhile - for the doctors already out there and for the ones we want to move there to grow with their communities.

While remuneration is an important factor, equally important is lifestyle.

These are the sorts of things that came out of our survey and these are the sorts of the things - the evidence, if you like - that must form the basis of future health policy.

Access took into consideration the changing nature of the medical workforce.

There is now an increased proportion of female doctors and younger doctors generally more reluctant to sacrifice family life for a 24 hour a day, 7 day a week GP lifestyle.

The typical male GP is in his fifties and working well over 50 hours per week face to face with patients. Young doctors do not aspire to this life.

Let me touch on a few key findings from the AMA/Access survey.

It is estimated that Australia has an overall shortage of general practitioners of between 500 and 2,000, depending on exactly what assumptions one makes about need.

Given the stories coming out of regional Australia particularly, this reflects what is really happening out there. The AMWAC advice of a net surplus of over a thousand GPs is pure fantasy.

There is a GP deficit in virtually every region in Australia other than middle and upper income areas of the capital cities and a few of the more affluent regions.

Around 25% of Australians live in areas where there is a severe GP shortage.

These areas are characterised by long waiting times to see GPs and overworked doctors who are, in many cases, planning early retirement or looking for alternative work - either medical or non-medical - possibly in another region.

There is now ample evidence that the health of people in areas with doctor shortages is poorer than in those areas with an adequate level of medical services.

This is clearly a significant social problem that needs some serious policy attention.

Here are some of the typical comments from the 7,500 doctors who responded to the survey.

You may have heard similar comments in your own electorates.

"The on-call arrangements destroy my lifestyle. Education costs are horrific."

"I feel like a government employee but without the leave."

"I miss my children when I work long hours."

"No attraction for me. Too isolating, stressful."

"I went bankrupt bulk-billing. I will never bulk-bill again."

"The rebate is a bit strange - $22.95 for potentially saving a life, compared to $35 for a bank computer bouncing a cheque."

The survey shows that many GPs are working long stressful hours for less than

$40 per hour.

I doubt there are very many other well-trained professionals or tradespeople in this country working at those rates.

When the remuneration problems are combined with difficulties for spouse employment and education of children, practising medicine in GP deficit areas is not attractive.

As doctors choose to retire early rather than battle on out of altruism, it is getting harder to get doctors - particularly young doctors - to move in and take their place…for the long term.

At the AMA we are hearing these stories too regularly now. They are turning up in the letters pages of our papers, too.

Just the other week, in The Sydney Morning Herald, I read of the plight of a general practice in Mudgee.

Mudgee is a pleasant wine and farming community just 3 hours from Sydney. They had received just one expression of interest over several months GPs to replace two doctors who have retired…and that was from another rural doctor.

This situation is not restricted to remote regions.

Outer urban Australia and many attractive and easily accessible rural areas are experiencing these problems. Nowra, Stradbroke Island, the south-east of NSW, Laurieton and Phillip Island are hardly outposts of civilisation.

The Government has put significant resources into training for rural practice by providing scholarships and other incentive payments.

The AMA welcomes these initiatives but they haven't really addressed the fundamentals.

And you have got to remember that in some communities, the one and only GP is more than simply a GP.

He or she is the accident and emergency department because the nearest public hospital is 60 kilometres away.

He or she monitors pregnancies because there is no obstetric or midwife service available locally.

He or she is the sole provider of medical care for the aged and frail.

In many cases, the GP population is the catalyst for the provision of other allied health services for communities.

More GPs in an area mean more specialist services, more nursing and more midwife services.

Just like Field of Dreams - 'if you build it, they will come'. If GPs come, others follow - pharmacists, for example.

And the converse also applies. If there is adequate professional support and service provision, then GPs will be more inclined to come to a community and stay.

Greater understanding of the health system and medical practice is necessary if our decision-makers - the people in this hall today - are to provide solutions for their constituents.

The failure of policy makers to understand the clear need for improved patient rebates - as recommended by the Relative Value Study (RVS) last year - has not been missed by GPs.

The RVS is too complex to explain simply this morning.

In the context of your electorates, the important message is that bulk-billing is declining because the RVS was not implemented. The fee that bulk-billing doctors receive under the Medicare Benefits Schedule is just not enough to make a reasonable living without killing yourself.

And I think any day now we will see some figures that show another sharp drop in GP bulk-billing rates.

The cynical might ask: "If there is a shortage of GPs, why aren't more of them bulk-billing?"

"Don't think there are no crocodiles just because the water is calm."

The answer is linked to the results of our survey.

Bulk-billing is more prevalent in areas of need - country areas and outer suburbs, the places where there are more disadvantaged patients and where people get sicker more often and for longer periods.

This is why medical practice defies market forces.

This is where you will find disadvantaged doctors. This is where you will find doctors just surviving financially. Out of concern for their disadvantaged patients, they will not charge a co-payment.

They have a choice - hang on out of altruism or move to a more affluent area where they can charge a co-payment while still providing access for the disadvantaged.

Let me explain it this way. The current Medicare patient rebate for a standard consultation is $24.95.

Now think of a doctor in a remote country town and the number of standard consultations they'd fit into a day and the types of illnesses, ailments, accidents and emergencies that would come their way.

Then think of practice costs like staff, rent, equipment, administration, superannuation, computerisation, accreditation, workers' compensation insurance, and medical indemnity.

There aren't too many small businesses that would stay afloat on a fee basis of $24.95. That is why doctors charge more. That is why patients pay gaps. That is why bulk-billing is now declining at a rate of knots.

Consider how much it costs to call out a plumber, an electrician, a tiler, a mechanic, not to mention an accountant or a lawyer.

Where does the community place health in the pecking order?

The RVS was - and still is - held by GPs as the only true evaluation of their worth.

It is now over a year since it was completed, so even its conclusions are now behind the pace of the increase of practice costs. It should be revisited.

Meanwhile, the Government has relied on overseas-trained doctors, usually in Australia for short periods, to plug the gaps and prop up the system.

The AMA strongly supports the overseas trained doctor program to fill areas of urgent need, but we do not see a rapid rotation of overseas GPs providing for the long-term needs of patients and communities.

Communities expect and deserve some sense of permanence and consistency in their medical services.

With worsening doctor shortages in the UK, Canada and USA, an ongoing ready supply of foreign doctors trained to acceptable Australian standards is by no means assured.

With an ageing population, the demand for GP services will increase significantly faster than the rate of population growth in coming years.

We will need to train more doctors than the Government's current restrictions on provider numbers allow.

We will also have to ensure that it is attractive for doctors to go into general practice in the first place and then take the next step into rural and outer urban practices.

There needs to be a major rethink of GP workforce planning and financing policy in this country.

The solution lies in incentive, not conscription.

Do not even think of geographic provider numbers as a policy prescription. That will be resisted every step of the way.

For a start, you may find the path to conscripting doctors littered with constitutional hurdles.

As a community - politicians, the medical profession and patients - we must make practising medicine in areas of need a more attractive proposition.

We need to make it a lifestyle choice, not just a career choice. Part of your job is to sell the riches of your electorates - not just to doctors, but other professionals, other families…for the long-term.

Most of you already know that health is a big issue in your electorate.

Many of you will look at our survey and see some personal experience.

You will have had doctors and patients contacting you about, for instance:

How hard it is to find a GP whose patient book is not full or does not have a very long waiting list

How bulkbilling is disappearing at a rate of knots

How waiting lists for elective hospital procedures are getting longer

How local hospitals are being forced to close or reduce services

How hard it is to find adequate nursing home facilities

How some private hospitals are refusing to admit older patients with long term medical conditions

How people now need to travel from small towns to major rural centres for a simple GP consultation

How people in country towns have to wait sometimes years for cancer-detecting investigations like colonoscopy

How important services like obstetrics and neurosurgery are harder to access locally in regional Australia, or

How women are having to uproot their families to go the cities to have their babies.

These are the stories from the AMA/Access GP Workforce Survey.

These are the stories happening every hour of every day in our country towns and suburbs.

These are the things we have to all work together to fix.

Political solutions without consultation with the medical profession will not work, no matter how good the bureaucracy can make it sound.

Public health policy in Australia must be built around solutions to the problems your constituents are experiencing.

Health policy must be built on evidence.

Not selective statistics. Evidence.

Not bureaucratic reports. Evidence.

Evidence based on human experience.

The AMA hopes the evidence in our survey helps you in framing future health policy.

I urge you to read the survey and take note of the graphs and other handouts in your media kits. You will see immediately where your electorate falls on the scale of need.

The evidence is compelling. It should come in handy and should prove reliable. After all, it came direct from the doctors and patients of your electorates.

Thank you.