Clever connections

Photo by: Simon Dallinger. Denise Klemm and fellow taskforce member Nicki Melville

It’s rare in life that someone takes you under their wing and solves your problems, free of charge. But that’s the essence of what Denise Klemm does for doctors who move to Albury and Wodonga, regional cities located either side of the Murray River on the NSW/Victorian border.

As the recruitment officer for the Border Medical Recruitment Taskforce, Denise has a novel job, one focussed entirely on attracting doctors and overcoming hurdles that might deter them from staying.

Denise’s efforts are responsible, in part, for the border cities securing 87 new GPs and specialists in just four years. So too is the carefully constructed taskforce of five executive members, who are all ideally placed to convince local high school students, visiting medical students, registrars and junior doctors that the border is a great place to call home.

The taskforce was born in 2007, in a community facing a crisis. In October 2006 Albury and Wodonga had just three general practices that were prepared to accept new patients.

But by May 2011, about 20 new GPs had moved in and 20 practices had open books. Anaesthetists, general surgeons, psychiatrists, and a paediatrician, gastroenterologist, oncologist and urologist, were among the extra 67 specialists who had also joined the ranks.

“Now, we have a growing regional medical population,” Denise says. “We were in decline before that. We were in real strife.”

There’s little wonder the concept has attracted interest from other doctor-starved regional centres.

Bendigo in Victoria looked to Albury for support and advice before establishing the Central Victorian Medical Recruitment Taskforce 18 months ago. So too did Tamworth before establishing the Tamworth Health Recruitment Taskforce in September last year (see box ‘A model worth replicating’, below).

Rather than focusing solely on its own turf, the border taskforce is keen to see the concept adopted elsewhere.

“If enough regional cities gang up on the city, we could form an alliance,” Denise says. She figures that, by working together, they might encourage doctors to stay in regional areas, making any investment in training more worthwhile.

“We’re happy to invest in training if people stay rural. We don’t want to train them up to move to cities.”

Knowing how to overcome the local workforce crisis was something that had troubled border medicos for some time. Dr Peter Vine remembers attending informal lunch meetings with local doctors and hospital administrators. The retired paediatrician, who heads the University of NSW Rural Clinical School campus in Albury, remembers concerned discussions about doctors retiring, there being no succession planning in place, and a lot of shrugging of shoulders and uncertainty about what to do.

The local newspaper was adding heat. It featured a new resident who had moved from Melbourne and waited eight months to get her first appointment with a border GP.

“Since her arrival in Albury she has had to return regularly to Melbourne to see her previous GP and access prescriptions,” the Border Mail reported.

“She said the situation was a deterrent to young families, including her daughter, son-in-law and two grandchildren, who were thinking of moving to the area.”

Then Dr Scott Giltrap, a local obstetrician and gynaecologist, called a public meeting. About 90 local movers and shakers came along. Businesses reported it was becoming hard to recruit staff from larger cities, because prospective new employees were concerned about access to health care.

It became clear it was an issue that was starting to hamper economic development and it was an issue the business community and local councils needed to solve as well.

“That meeting decided to set up a taskforce,” says Dr Vine, who was one of the five people appointed to the voluntary alliance. About $700,000 was secured in donations, council grants, and in-kind donations, to be given over the following three years. The taskforce, headed by Dr Giltrap, was then in a position to employ Denise (see box ‘Joining all the dots’, below).

“The crux of the taskforce is having a project officer who takes care of people, who arranges their visit and accommodation, and introduces them to people they should talk to, so they see the hospital and around the area,” Dr Vine says.

Another taskforce member, Nicki Melville, CEO of Bogong Regional GP Training, agrees. She says it’s what sets the border region apart from other towns that don’t have someone dedicated to the role.

“Denise is the right type of person because what she has to do is a lot of stuff you couldn’t even put in a position description.

“I think it’s been a very successful model because it’s quite informal and very much about relationships.

“Also, we’re not an authority or a body, so we’re not bogged down in red tape.”

There’s an advantage in Dr Vine and Ms Melville being on the taskforce together, as she relies on having access to the rural clinical school to promote general practice as a career. The clever connections don’t stop there.

Ms Melville also works with taskforce member Linda Moon, who is Medical Services Manager for Albury Wodonga Health – Australia’s first cross-border public health service, which merged Albury Base Hospital in NSW and Wodonga Regional Health Service in Victoria.

Ms Melville and Ms Moon combine forces to help medical students achieve jobs as hospital interns, and then appropriate specialist and general practice rotations as junior doctors.

“We can plan well together to plan those jobs for them,” Ms Melville says, adding that taskforce members all believe in the area growing its own workforce, as well as attracting new doctors.

“The taskforce has made it much easier to join the pathway up so they [students] can train for every bit of their general practice career locally.

“They can do all of their training in Albury, from undergraduate medical students right through their hospital work, to Bogong, as general practice registrars, until they come out as fellows.”

The results suggest it’s an approach that is working. Of the 61 doctors who had completed GP training in Albury Wodonga by the end of 2009, 42% are still in rural general practice in Victoria and southern NSW and another 32% are still GPs in the Albury Wodonga region.

Ensuring Denise is in regular contact with taskforce members helps her to meet new doctors’ needs too.

Having recently attracted a top-notch surgeon to the town, she learnt he was interested in lecturing at the university. She rang Dr Vine and the surgeon became a further asset to the community as a senior lecturer.

“It all feeds off itself,” Denise says.

These days the Albury Wodonga GP Network also plays an active role in supporting GPs who come to town. It too has representation on the taskforce, in the form of CEO Trevor Cowell. It also employs a staff member to support GPs who move here.

Mr Cowell says the taskforce’s achievements have had spin-off benefits that continue to make it easier to find GPs.

“Undoubtedly, it’s helpful if they know they have support in town to refer patients to,” he says.

“If they have support of specialists locally it makes living here more attractive.”

Joining all the dots

As the recruitment officer for the Border Medical Recruitment Taskforce, Denise Klemm is required to be a well-connected relationship builder, real estate scout, tour guide, social organiser and self-directed personal assistant.

She works days, evenings and weekends, according to when she’s needed, and cheerfully announces that although she is paid for three days, she often works five.

Denise has learnt that it’s the little things that matter, when it comes to having doctors come to Albury Wodonga and choosing to stay.

While work is important, having a fantastic house, great social connections and feeling part of the community are factors that carry equal, if not greater, weight.

Denise has built relationships with some local real estate agents to ensure they contact her if they have a quality home, before it is listed.

On hearing one new doctor’s partner was feeling isolated, having moved from Sydney with a baby, Denise sweet-talked a tight-knit mothers’ group into accepting just one more member. Another doctor needed executive-style housing out of town with a paddock for a pony. Denise found it.

If a new medical family needs to borrow a car for a few weeks, wants a run-down on local schools, or a non-medical job for the doctor’s partner, Denise knows whom to call. And if they fancy a tour of local wineries, a day trip to the snow, or someone to cycle or water ski with, Denise makes it happen.

She works closely with the taskforce to keep close tabs on how doctors are coping with their workloads and future workforce gaps likely to arise.

They are also keen to keep its mature and experienced doctors in a position where they have time to teach, particularly given the huge influx of medical students.

If there is one thing the past five years has taught her, it’s that work-life balance is the key to retention.

“People come for lifestyle and if it becomes unbearable because they’re working too hard, they’ll go,” she says.

A model worth replicating

The success of the recruitment taskforce in Albury Wodonga has inspired the communities of Bendigo in Victoria, and Tamworth, NSW.

But when a recruitment taskforce was first proposed for Bendigo, some local GPs were concerned. There wasn’t a GPs shortage and while several were facing retirement, it was likely there would be enough new graduates to meet demand.

Specialists, however, were a different matter and the region’s smaller towns were short of GPs.

That’s why the Bendigo-based taskforce, formed 18 months ago, was called the Central Victorian Medical Recruitment Taskforce, according to its executive officer, Peter Hyett (below).

Peter Hyett

Having recruited a few GPs and registrars and 10 new specialists for Bendigo, he says the taskforce is now aiming to support smaller doctor-starved communities in the region such as Echuca, Kerang and Swan Hill.

The not-for-profit taskforce has received state and local government funding, and donations from the public and private hospitals, local day surgery, radiology and anaesthetic services, Bendigo Bank and local specialists.

“However, we are self-funding and it is necessary to hold fundraising events, like a golf day, where local businesses support us financially or provide prizes,” he says.

Tamworth, in northern NSW, has also watched the Albury Wodonga experience with interest. The new Tamworth Health Recruitment Taskforce appointed a recruitment officer in September last year. Tamworth needs 10-12 GPs and there’s a shortage of specialists across the region, according to the interim CEO of the New England Medicare Local, Graeme Kershaw.

He says the taskforce, which includes representatives from Council and the business community, understands the broader financial imperatives of the region having an adequate medical workforce.

“We’re seeing it very much as an economic development issue, as well as a health issue,” he says.

Bunbury, WA, was also inspired by the Albury Wodonga experience, but hasn’t been able to secure funding for a full-time employee. The South West Medical Attraction Taskforce was formed in 2009, and local consultant Alison Comparti was commissioned to write a report on local medical workforce issues, and recommended employing a recruitment officer as the Taskforce’s first priority.

Funding for the position was attempted through the Royalty for Regions agreement in WA, but was not successful, so Alison now works voluntarily in the role, part time, without the support of a Taskforce.

“I’ve been doing it for love ever since and we’ve had limited success,” says Alison. “It’s frustrating we don’t have a dedicated organisation to oversee it.”

Despite that, Bunbury has managed to overcome its severe GP shortage, largely due to recruitment efforts by individual general practices.

In October last year the Bunbury Mail reported that 81 doctors now worked in the region, up 35% on the 60 GPs working in January 2010.

A helping hand for students

Albury Wodonga’s efforts to recruit and retain medical staff extend beyond the efforts of the Border Medical Recruitment Taskforce. A range of scholarships to study medicine are also offered in the hope that local students who graduate from medical school will decide to return and apply their skills on the border.

“If a child spends five years in the country, there is a 30% chance of [their] returning to the country if they become doctors, increasing to 50% if they spend 10 years in the country,” says Dr Pieter Mourik (below), a retired obstetrician and gynaecologist who raises funds for the Border Medical Association scholarships, which 82 students have received since 1991.

Dr Pieter Mourik

Dr Mourik, who is the association’s social secretary, says almost 80% of these scholarship recipients have entered a rural training program or are practising in the country. While few have yet settled on the border, he’s confident that once they finish their training, many will.

The golf day he runs each year raises up to $24,000 for scholarships, which is divided equally among the number of local high school students accepted to study medicine.

For the past five years, students have received a minimum of $1000, sometimes more, and one student is given $1000 for each of six years. The National Australia Bank provides an extra $500 for each student on a bank card.

Each scholarship recipient is also allocated a GP mentor, or sometimes a specialist. “We look after them like our own children,” he says.

“Having part of your medical training in the country, even a work attachment, increases your chances of returning after graduation.”

Albury Council also gives $5000 scholarships to two local high school graduates accepted to study medicine. Also, a past president of Albury Rotary left a bequest three years ago that funds seven $1000 scholarships for fifth-year medical students studying at the local University of NSW rural clinical school.

Dr Mourik believes the border is more conscientious about achieving an adequate medical workforce than anywhere else in Australia.

“All rural towns have the opportunity to attract future Australian-trained doctors, reducing our reliance on overseas-trained doctors,” he says.

“Sadly, very few have anything like the robust program we have. Every local town can follow our lead. Go to your local businesses, get your local council on board, get a leader with some drive and run with it.”



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