Doctors on the Move

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-By John Boley

Medical tourism works both ways. Conventionally it concerns people travelling to various parts of Asia to get various parts of their own lopped off or repaired, but it can just as easily mean doctors touring the world and practising while they travel.

This is not the primary purpose of Ochre Health, but it is about to become a slice of business as health authorities around Australia dismantle numerous barriers to employing medical staff with qualifications from overseas. Ochre is an organisation that has more or less flowed into areas of demand as it has grown, and as its chairman Ross Lamplugh explains, the supply of medical staff for rural areas is far from adequate and can be boosted by doctors trained in places such as Canada or South Africa keen to spend some time in the outback.

Ochre Health operates in 12 rural Australian towns, providing medical centre (GP) and hospital staffing (VMO) services. These towns now enjoy record healthcare staff levels and have demonstrated improved health outcomes within their communities. The organisation also operates larger GP only clinics in NSW and Canberra – and will be opening new clinics in Victoria and Queensland in the next 12 months. Ochre Health has main offices in Sydney (medical services), Ulverstone (business development) and Hobart (recruiting) – with smaller offices in Brisbane, Wellington (NZ) and Melbourne (about to open).

Ochre, which celebrates its tenth birthday next month, is also one of the biggest suppliers of rural doctors to New South Wales, Queensland and Western Australia health authorities with over 7000 doctors on its books. There are others that recruit doctors but the difference with Ochre is its focus on non-urban areas, where “it was getting harder to find the right people,” according to Ross. A doctor himself (GP anaesthetist), he and business partner Hamish Meldrum (GP obstetrician) were working in Bourke, NSW, where the guidebooks will tell you that the isolation is one of the tourist attractions, and needed cover for when they would be unavailable themselves. Because they knew the locale and were themselves in the medical profession, “we had a bit of credibility about us and found a surprising number of doctors interested in doing short term work in rural Australia.”

Cutting a long story short, the pair recruited a husband-and-wife team interested in full-time work for a year in another town around 100km from Bourke. The area health authority was interested, as there had been 22 locums in the previous 12 months providing intermittent medical services to the town, so Ross and Hamish put together a simple proposition and “the area health service thought ‘we have these two doctors that have no idea about business, who want us to outsource the medical services in a town to them’ and they were really sceptical.” Eventually they put out a tender. “We thought that was a big breakthrough. Then we opened the envelope and there was an enormous document full of compliance issues and quality assurance that we had no idea about.” Disheartened, they almost abandoned the idea until they met Peter Bailey, former hospital CEO, “who helped us to put our tender together very quickly. We ended up getting the tender; we took on Peter after that as our mentor, a sort of contracted CEO, to help us to put some structure around what we were creating. We were absolutely naïve; we had no idea what we were doing.”

At the same time, the Rural Doctors Network of New South Wales was doing the same thing, gaining contracts to run medical services in a number of rural locations. The area health authority, says Ross, saw the potential for this model and “put the structure around it to make sure it worked.”

Since then, Ochre Health has grown fast.

Meanwhile Ochre Recruitment grew itself as a sort of adjunct, costing the company money until recently, according to Ross, but now having reached a sort of critical mass because it was able to build up a ‘reserve’ of medics, instead of – as at the outset – simply looking for one person at a time to fill specific vacancies. “It is doing well now. It has also expanded from that very difficult market of remote GPs into providing specialist placements, hospital doctors in emergency departments and urban general practitioners. Rural supply is still its prime focus, but 25 to 30 per cent of its work is non-rural.”

Ochre has also developed a serious interest in telehealth – consultations via internet. Indeed at the time we spoke to Ross, ironically one of his staff was in a car dash to Canberra to lodge the requisite three hard copies of a tender application for a grant to run a trial project in telehealth (ironic because of the inherent absurdity of being unable to apply online to run an online service). “I think this could be a really exciting project where we have the local outback division, the general practice, the local health district, and the local rural clinical school, which is part of the University of Sydney, all together in a partnership,” to actually try to make telehealth work in New South Wales, “and then write it all up as a template for how other people can do the same thing. Telehealth impacts on us in a major way; it would greatly enhance the access to specialists.”

The Ochre Health model certainly works in rural areas. But it can also be applied successfully in more built-up areas. Located approximately 630km north of Sydney and 340km south of Brisbane, Grafton is classified as partly rural, but it is also a town (usually referred to in guidebooks as “genteel”) of some 18,000 people. It is the site of Ochre’s first Super Clinic.

Global research, explains Ross, shows that integrated primary health care results in better overall community health. “If you can get primary healthcare providers to work together, that’s the best outcome – doctors, nurses, physios, psychologists, dieticians etc. not working in ‘silos’ as has traditionally been the case but together,” in a single facility.

The federal government decided to throw a lot of money at promoting this kind of integrated primary health care. “It’s always been very expensive to provide allied health services in general practice under the current arrangement, because Medicare funds the doctors but not the allied staffs.”

Federal government has only opened Medicare up to allied professions in a very limited way (possibly because GPs have never shown much willingness to share), but instead put aside a large sum for people prepared to provide integrated primary health care for periods of 20 years. “These sums currently range up to as much as $15 million – you have to sign up to follow an agreed service plan for the full 20 years and if at any stage they are able to say you are not following the plan, they can step in and require their money back.”

Ochre could see there was some resistance in certain quarters among GPs, many of whom had spent years building up their own practices and saw Super Clinics, rightly or wrongly, as undermining them. Ochre did not want to appear to be undermining local GPs either, for they “are our colleagues and clients.”

In Grafton however, a little unusually, there was agreement that a super clinic would be a good idea and that there was a shortage of medical care in the area. “We were invited in by the locals, talked to most everyone locally and got amazing support; federal government was duly impressed, we were awarded the [$5 million] grant mid-2010 and the super clinic officially opened last October.”

Ross believes Ochre is perhaps better suited to this niche through its expertise – not just medical but also in business and administration – than some other very worthy institutions that have been awarded super clinic grants that have not always worked out well. That is probably part of the reason why Ochre has been selected as the preferred provider for a $15 million Super Clinic grant for Canberra, with the university there as a partner. Approximately $8 million is planned to be spent on a hub at the university’s campus, with the university itself building further levels for its own allied health education facilities and health administration. The rest of the money is to be used for two other sites, focussing more on aged care and family and paediatric medicine. Negotiations are well advanced and Ross told us he is extremely optimistic of a successful outcome in the next couple of months.

Ross sums up the expertise required to manage a Super Clinic project in five sectors:
1. Build a medical centre on time and on budget – whilst that was not necessarily Ochre’s forte, it has now successfully built one $5 million Super Clinic, has staff with extensive health construction experience and, as Ross points out, has always been happy to recognise its limitations and contract in experience when required, rather than try it themselves and make a mess of it, as has happened in a couple of highly-publicised examples elsewhere.

2. Management – many people seem to believe that if you open a shiny brand-new building, medical staff will flock to it from all corners of the Commonwealth. “Our experience is that this is definitely NOT the case.” Doctors are asked to move out of their comfort zone, away from a setup they feel happy with and that they believe works. “Doctors have shown a real reticence to just move into something new if they are not confident of the people who are managing it.”

3. Recruiting – recruiting doctors to rural and other challenging areas is tough, and getting harder. Many of the receivers of Super Clinic grants have found it very difficult to attract new staff to their locations. Ochre has the recruitment capacity (Ochre Recruitment) to make this work – and has already attracted a range of new doctors and allied health staff to Grafton.

4. Allied health – not many general practices have significant allied health presences. Ochre has been providing allied health services to its rural communities for much of its 10 years – and at one stage over 50 per cent of the private allied health practitioners in western NSW were located in its practice in Bourke. Ochre has a not-for-profit arm (Ochre Health Foundation) which has provided $1 million for allied health services over the last five years.

5. Experience – “we have been running such services in rural areas for ten years, which gives Ochre the background of knowing what’s required when you take on a project for 20 years.”

It’s possible to add a further factor – knowing your limits. Ross says that although Ochre is already short-listed for a third grant, details of which must remain confidential for the moment, everyone in the company is focussing on ensuring they don’t spread themselves too thinly, by ensuring backup in all senior positions and taking on capable staff to manage existing businesses. “It will be a challenge but we know we can handle it.”

Making Sense of Management

Management is the art, or science, of getting things done through people. Sounds fairly straightforward – except for the fact that people are not robots waiting to do our bidding. People have their own minds, motivations, and goals. So how do managers keep operations – and the people behind them – running as planned?

September 25, 2018, 8:18 AM AEST