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It's a G'day down under for doctors

Dr Ernan Hession

The new Australian correspondent for the Irish Medical Times, Dr Ernan Hession introduces himself with a brief description of his life as a doctor in Australia and the challenges facing rural doctors there.

It’s nearly 20 years now since I left Ireland with my wife to work ‘in country’ Australia. It was 1989 when the Celtic Tiger wasn’t even a cub and when the ‘journeymen’ of the Irish medical profession went wherever there were jobs.

After four years in the Irish hospital system rotating through six-month positions in the city and country, (there were not many vocational training schemes), and a year in Plymouth as a GP registrar, Australia or Canada were two of the only places where jobs were available.

The Irish health system was in terminal decline, (what’s new?), GP positions in the UK were hard come by and, in any case, Irish graduates were certainly not the first choice for UK employers. We were the ‘Economic Refugees’ in the late eighties.

Made a good team

We settled on a job in Victoria, Australia, along the Murray river (Newfoundland seemed a bit too cold). I think at the time because Paula had seen the series All The Rivers Run, and thought it didn’t look too bad! The plan was to get some more experience and perhaps to try and ‘get back’, after a few years. I was fortunate to be married to a nurse, (as lots of us are), and we made a good team.

We arrived in February in the middle of a very hot summer, ‘heat, dust and flies’, and were introduced to a motley group of GP’s in the tea-room enjoying a beer and a few fags in their Bermuda shorts after their day’s work. I wondered what we had let ourselves in for!

The fact that the job also involved Emergency Medicine, Obstetrics and Anaesthetics at the local District Hospital also seemed daunting, particularly when you were ‘it’. In fact, the General Practitioners here were similar to Irish GPs in the 50’s and 60’s, you were expected to be able to put your hand to anything that came through the door because there wasn’t anyone else — these were days before the work/life balances’ we all talk about now, but often never quite achieve.

Our town, Swan Hill, has a population of over ten thousand, with a catchment of a further fifteen thousand. It is the most isolated town of its size in Victoria, and a fast two hours by road from a regional hospital in Bendigo and four hours from Melbourne. General Practice Services are provided entirely through a privately-owned 12 Doctor Medical Centre, directly across the road from our local district hospital. Our staff include five Practice Nurses and a part time Diabetic Educator and Psychologist. Almost all visiting specialists also consult from our rooms.

Having them on-site offers an excellent in house service for our patients, helps with early appointments as well as providing easy communication between Specialists and GP’s. We are lucky to have even a Nephrologist and Rheumatologist visit, (they are all supported by Government Out Reach Grants and frequently fly in and out on the same day). There are two older Surgeons based permanently in town, but Anaesthetics and Obstetrics are entirely GP-run.

Stay for a couple of years

The local district hospital has about fifty beds and a large nursing home. We have five junior medical staff, who are under the supervision of the local GPs, and are all overseas-trained, mostly their first position in Australia, and tend to stay for one to two years until they have passed their full ‘AMC’ exam.

We are paid by the Hospital on a fee per service, which is State Government controlled (all patients are entitled to free hospital care). Our General Practice work is funded through medicare, which is through the Federal Government, and again this is on a fee per service. You can accept this fee as the only amount for the consultation, (bulk bill), or charge a gap fee on top so your patient may be out of pocket by five to six euros after claiming back from the medicare office.

We also receive Practice Incentive Grants, Rural Retention and Procedural update grants.

About 50 patients a day

Patients also have Private Insurance, mostly to cover procedures in Private Hospitals, often without any gap fees. Our Practice has four partners, with the others working as associates or assistants. Associates are paid a percentage of their earnings as are the partners and the assistants are salaried. We see forty to fifty patients a day, including Hospital Ward Rounds.

General Practice patients are identical to those seen in Ireland, apart from Skin Cancers, which are very common and removed in-house with simple excisions or flaps. You admit your own patients directly to the local Hospital and manage them yourself, so there’s no need to plead your case to any SHO! Luckly we have a 24-hour X-ray with CT Scanning and Ultrasound as well as 24-hour Pathology Services. Very sick and unstable patients are air-lifted to City Hospitals after intubation etc.
The work is enjoyable and fulfilling but equally stressful and tiring, particularly as Procedural GP’s are becoming a rare resource and the need for your services ever increasing.

I have and continue to enjoy the life of a Country GP in Australia. I feel I am using my skills to the maximum (and at times beyond!). I remain committed to General Practice in all its ever evolving forms. I regret at times that GPs so well-trained in Ireland don’t get more opportunities to continue more hospital-based roles or speciality interests, particularly in smaller communities poorly serviced by specialists.

The system often actively discourages it under the convenient umbrella of ‘you’re not qualified to do it’. Myself and my colleagues are not specialists but we still do over three to four hundred deliveries a year, do our own Caesarians and Anaesthetics.
Clearly local needs do dictate, (unconveniently at times), how qualified you are to do the job — as does patient expectations.

I remain an Irishman

After 20 years overseas, I remain and always will be an Irishman, this is despite having Dual Citizenship and Serving in the Australian Army. We have three children who were all born in our local hospital and delivered by my GP Colleagues.
When I had an Arthroscopy on my knee some years ago a GP Colleague gave the anaesthetic and I still woke up! I wouldn’t have had it any other way.
The Editor of the Irish Medical Times Terence Cosgrave, asked me if I would ever return to Ireland, it always hard to say ‘Never’. Despite my 47 years on the clock, the old ties and sense of belonging will always be there — together with the desire to have your children experience Ireland for longer than a few weeks a year.
My two sons would love to have a go at Gaelic Football or Hurling and follow in their grandad’s tradition, (not my side, I’m afraid). Who knows maybe a twelve-month stint in a teaching role?

The weather here is great as is the lifestyle, property prices and the cost of living. You also develop a strong sense of loyalty and belonging to your local community — a large part of which is of Irish and Italian descent, and also I suppose you are really needed and appreciated (mostly!), but the grá for the home soil never leaves you!
Such is the lot of the Irish emigrant.

Posted in Features on 11 March 2008
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