The $45,000 golden prescription to heal rural health
Unlimited fresh air and blue skies, a daily walk to work, a healthy drop of fine wine, two NRL games each year, an extra $45,000 in the bank and an idyllic life in "God's country".
This is what the Mudgee community has prescribed to entice city doctors to the famed wine region in central western NSW in a bold bid to ease a dire shortage of GPs.
"We like to call it their prescription for a better work lifestyle in the vines," Doctors 4 Mudgee Region program co-ordinator Kate Day, who is also a winemaker, tells AAP.
The bucolic remedy has been enough to attract a new GP to the picturesque gold rush village of Gulgong, while a doctor from Queensland will return to work in Mudgee after training in the region.
The push to get more doctors, complete with financial incentives provided by three mining companies, began after Gulgong's only GP left in early 2024 and clinics in nearby Mudgee closed their books.
Locals began travelling to neighbouring towns - or even 260km to the city - to see a doctor, an experience familiar to many across rural Australia where there are only 78 full-time GPs per 100,000 population.
After securing two new GPs, the region has an ambitious plan to lure 10 more from urban centres over the next three years in a sophisticated campaign that could inspire other towns.
"What rural communities can take from this is locals, companies and businesses banding together, not sitting on their laurels and waiting for someone else to come in," Ms Day says.
"It is community-led change."
The Mudgee region's campaign, which also includes a "concierge" service linking doctors to childcare, schools, housing and even hairdressers, is one of many examples of country communities fighting for healthcare equity.
Half a million Australians live in "GP deserts", receiving 40 per cent fewer services per person than the national average, according to research by the Grattan Institute.
With poorer access to check-ups, screening and medication, the burden of chronic disease is higher in rural and remote areas and life expectancy is shorter.
Fed-up and frustrated, many rural communities have gone to extreme lengths to bridge the gap.
The WA Wheatbelt town of Quairading offered a $1 million salary package for a GP in 2023, while locals in Kerang, northern Victoria, parodied the Queen hit I Want To Break Free in a social media video called We Want a GP.
When two long-time western NSW Bogan Shire GPs approached retirement in 2015, the council began operating a medical centre at a cost to ratepayers of between $600,000 and $900,000 per year.
The Royal Flying Doctor Service has stepped in to run clinics in several rural towns, including Robinvale, in Victoria, where the only GP to 2500 people was under immense pressure.
While these grassroots efforts are admirable, rural communities should not have to do the work of federal and state governments, Council of Presidents of Medical Colleges chair Sanjay Jeganathan says.
"Australia is a wealthy nation and each and every Australian should receive the same kind of healthcare irrespective of their postcode," Associate Professor Jeganathan tells AAP.
As a radiologist in Perth, Dr Jeganathan regularly sees patients who have travelled thousands of kilometres from Broome or Karratha.
The council, which represents all 15 specialist medical colleges in Australia, believes a "grow your own" approach will boost the numbers of doctors in the bush.
It has introduced guidelines for colleges to prioritise rural candidates for specialist training, as junior doctors from the bush are more likely to stay in the regions, as are those who get exposure to country life during their studies.
"There is no point in training them in Sydney and Melbourne because the likelihood is they are going to stay in the big cities," Dr Jeganathan says.
"We should be really putting our efforts into developing rural and regional training hubs with a selection of appropriate trainees to work there."
The constant cry from the bush to train more doctors is slowly turning the tide.
Australia's two GP colleges are oversubscribed for the first time in many years and more trainees are expressing a desire to work outside the cities, Rural Doctors Association president RT Lewandowski says.
But once they arrive in the bush, a Medicare system designed for the city won't necessarily cover the cost of their work.
Rural GPs tend to see fewer patients with more complex health conditions in longer consultations, while also possibly working across clinics, hospital wards and emergency departments.
Those things partly contribute to an estimated $6.5 billion annual spending shortfall on rural health.
"There is a tremendous underspend ... on rural patients," Dr Lewandowski says.
"Our mortality is still determined by our postcode."
Dr Lewandowski was among of a group of doctors who visited Canberra in late June, imploring national leaders to help train more doctors and fix "piecemeal" rural health funding.
The message is being heard, with the federal government delivering more doctor training places as a start.
"I don't think the government is closing their eyes to the problem but it's going to be a hard change," Dr Lewandowski says.
"We should have an ample supply of GPs but I don't see that realistically coming super soon."
In Mudgee, the local campaign is proving successful if a little frustrating.
"You do look and think 'wow, this is a major problem, what is our state and federal government doing?'" Ms Day says.
"But it doesn't matter what problem you have in life, if you want to fix it, you've got to go out there and do it yourself.
"That's what country towns do so well, they just pull up their sleeves and get on with it."
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