Five-year-old Xander McKenzie became increasingly lethargic in the days after he returned home from brain surgery.
"We'd been home three days and I just thought, 'There's something not right,'" his mother, Kylie McKenzie, said.
Xander, now 11, has hydrocephalus, a build-up of fluid in the brain.
He had just returned from a Sydney hospital, 650 kilometres from his home at Walgett in western New South Wales.
"I took him to the [locum] GP and he said to me, 'Look, he's just had brain surgery, he'll be fine,'" Ms McKenzie said.
"'Just give him some Panadol to help him with the temperature.'"
Ms McKenzie passed Janell Yeomans in the corridor on the way out, a local nurse who had cared for Xander since he was a baby.
The nurse agreed something wasn't right, and organised a flight to Sydney.
"Our doctors weren't regular doctors, and they couldn't look at him and say there was a change," Ms Yeomans said.
"We got down there, they did a brain tap and he had an infection in the fluid surrounding his brain," Ms McKenzie said.
"So if we'd taken him home, he wouldn't be here."
FIFO doctor cost balloons
Walgett relies on fly-in fly-out (FIFO) doctors to provide a GP service and it has been identified as one of more than 40 towns at risk of being without a full-time GP in the next decade.
Its local health administration, the Western NSW Local Health District (LHD), spent almost $16 million on FIFO doctors in the 2019-2020 financial year alone.
The amount has almost doubled in the past 10 years.
Documents released to the ABC through Freedom of Information requests reveal it and other regional health bureaucracies are spending tens of millions of dollars to hire locum doctors to cover hospitals and health services for short periods.
Many of the rural towns affected have vulnerable children, with Walgett twice as likely as the national average to have children with physical, social, and emotional developmental issues.
Ms McKenzie said there was no continuity of care with FIFO doctors.
"They might come for two weeks, and then we get another one for two weeks and they rotate through," she said.
The ABC requested information from six regional LHDs on their annual locum doctor spend.
Together, five districts spent more than $66 million in the 2019-20 period on FIFO doctors.
The Hunter New England LHD did not release the information to the ABC.
2010-2011 |
2019-2020 |
|
|---|---|---|
Western NSW LHD |
$8.7 million |
$15.8 million |
Murrumbidgee LHD |
$29,122 |
$1.8 million |
Northern NSW LHD |
$8.1 million |
$19.4 million |
Labor MP Walt Secord is a committee member for a NSW parliamentary inquiry into regional, rural, and remote health care.
He says the money could be better spent.
"What they have to do is address the workforce issues, have those doctors permanently in the hospitals.
"We had evidence, repeated evidence, of hospitals with the most basic medical supplies not there, nurses having to go out and pick up bandages, no antibiotics, kitchen staff having to look after patients.
"That is a health and hospital system stretched to breaking point."
In a statement, a NSW Health spokesperson told the ABC locums were employed in areas where there were challenges attracting staff, and they ensured rural and regional communities continued to have access to healthcare services.
The spokesperson said the COVID-19 pandemic reduced the number of international medical graduates entering Australia, which increased the reliance on locums.
Looming crisis
Rural GP Ian Spencer has spent about half a century practising at Bourke and Wellington in the state's Central West.
He said the cost of using FIFO doctors had implications for hiring other staff.
"The cost per shift to hire a locum doctor stops the hospitals from employing two or three nursing staff for a week," he said.
"So you've got this serious staff shortage, shortage in doctors, and very serious staff shortage in the nursing fraternity."
He said country GPs had been aware of a developing crisis for years.
He said the use of locums acted as an additional deterrent to anyone considering working as a rural GP and created a false career path.
Only 15 per cent of graduates are choosing to be a GP.
The number has plummeted in recent years, with the workload of a rural GP, the cost of running a clinic and professional isolation seen as deterrents.
Dr Spencer said their reputation had been dented, with more and more trainee doctors being urged to pursue more lucrative and prestigious specialities.
"General practice, I think, is a very difficult career option because you've got a very broad knowledge base," he said.
"I think the generalist has always been looked upon as the lesser part of the profession."
Hospitals without doctors
The NSW regional health inquiry heard Walgett was among dozens of NSW towns with limited access to medical services.
The inquiry, which has already prompted the NSW government to apologise to regional communities for substandard care, is due to deliver its report to the state government on May 5.
Federal health secretary Brendan Murphy has warned "disruptive changes" are needed to fix the crisis.
A 96-page National Medical Workforce Strategy lists drastic measures like capping locums' salaries and limiting the number of students trained to become specialists so it is based on demand, rather than personal ambition.
The ABC has asked federal Health Minister Greg Hunt if the recommendations have been accepted and will be enforced, but it has not received a response.
In rural communities, it is the GP who tends to be the doctor staffing the country hospital. Dr Spencer said that was another deterrent to potential local GPs.
"The hospital component is so overloaded with rules, regulations, documentation, electronic medical records, discharge summaries that there just isn't the time to do both jobs properly," he said.
If there is a shortage of GPs, doctors say that has implications for staffing emergency rooms.
In April 2021, one-quarter of those in the Western NSW Local Health District did not have a doctor rostered for certain periods.
In a statement, NSW Regional Health Minister Bronnie Taylor said she was committed to listening to and learning from the issues raised.
She said she was considering measures to attract and sustain frontline health staff in rural and regional NSW, as well as improve accessibility to health services for patients and their families.
