Currently in Australia, the topic on the supply of general practitioners (GPs) is controversial; there is an argument from one Australian Government agency that doctors are under-utilised and misallocated, not under-supplied. Then, there are many government and medical school representatives who believe strongly that Australia is presently facing a chronic shortage of doctors as a result of many years of ineffective medical workforce planning. This thesis is based on the premise that there is a supply shortage of doctors in many parts of Australia, and in particular, that there is a shortage of GPs in the rural areas.
The aim of this thesis is to investigate the various explanatory factors affecting the supply of GPs, who are responsible for delivering primary healthcare in Australia. The key aspects to be examined in this research are (1) motivation (financial and non-financial incentives), (2) geographical location (rural and urban), and (3) regulation (obstacles to entry) factors. It is hoped that the findings drawn from this research will help to address an important policy problem and enhance general public awareness about the factors in developed countries such as Australia, that are the key determinants of the supply of GPs, thus informing future policy choices.
With these explanatory factors in mind, the thesis addresses four research questions:
(1) How satisfied are GPs with the financial and non-financial incentives of their current rural or urban geographical location?
(2) Are urban GPs more satisfied with the incentives of their current geographical location than rural GPs?
(3) How does the number of hours GPs work affect their lifestyle?
(4) What are the opinions of GPs on current general practice entry requirements?
To answer these questions, in addition to using secondary sources, this research has collected primary data in three ways using: (1) structured in-depth interviews with 13 representatives of 10 health workforce agencies and associations, State and Federal Governments, a hospital, and medical schools in Australia, (2) data from the Medical Directory of Australia, and (3) a stratified random sample questionnaire survey of 1,000 GPs in three Australian states, namely New South Wales, Victoria and Queensland; and the Australian Capital Territory.
Univariate and bivariate probit estimation techniques are used to estimate the likelihood that GPs are satisfied with the financial and non-financial incentives of their current urban or rural geographical location as a function of their demographic characteristics. More specifically, the recursive bivariate probit selection model is used as a means of handling potential sources of sample selection bias. The theoretical framework for this thesis comprises relevant theories from economics and other disciplines. Two theories are discussed with respect to regulation in the doctor labour market, namely the public interest theory and the special interest theory. For the motivation and geographical location aspects of GP supply, two approaches are discussed: (1) the material incentives approach (financial and non-financial) and (2) the normative incentives approach (non-financial).
The results of our analysis suggest that there are a number of non-financial incentives, work hours, and even some regulation issues which are of particular relevance to policy makers. The key conclusions of the thesis may be summarised as follows:
1) On the whole, GPs appear to be satisfied with the existing financial incentives. Hence, the focus of policy making needs to be expanded to include non-financial incentives.
2) With respect to non-financial incentives, GPs are particularly unsatisfied with the flexibility of their working hours and the level of professional support they receive at work.
3) The views of GPs on the Australian medical regulatory environment are mixed. However, we conclude that about half of GPs surveyed are satisfied with current general practice entry regulations.
With the new information our research has uncovered, policy makers may be better able to develop appropriate strategies to recruit and retain GPs, particularly in the rural areas of Australia.