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4102.0 - Australian Social Trends, 1994  
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Contents >> Health >> Health Services: Distribution of general practitioners

Health Services: Distribution of general practitioners

Between 1986 and 1991 the ratio of the number of general practitioners to the population decreased slightly, while the specialist to population ratio increased.

The geographic distribution of general practitioners (GPs) is an important issue for health services because the proximity to GPs is probably the most important factor affecting access to primary medical care. The issue is also important for GPs since the numbers and types of doctors and their distribution among the population affect the nature of their work life.

In Australia there has been concern over the high numbers of GPs and the imbalance in their geographic distribution1. In 1991 there were 25,500 GPs working in Australia, 91% of them in urban areas. 85% of the total population lived in urban areas.

Classification of health occupations

People employed in health occupations consist of persons who diagnose physical and mental illness and recommend, administer, dispense and develop medications and treatment to promote or restore good health.

General practitioners refers to registered general medical practitioners who diagnose and treat physical and mental illness, disorders and injuries, recommend preventative action and refer patients to specialist medical practitioners such as cardiologists, dermatologists, gynaecologists and obstetricians, ophthalmologists, paediatricians, psychiatrists and surgeons.


GPs and other occupations
From 1976 to 1991 the number of people employed in health occupations per 100,000 population rose from 1,301 to 1,572. However, between 1986 and 1991 the number of GPs grew only slightly and at a lower rate than the population as a whole. This resulted in a decline in the GP to population ratio.

Most of the growth in the number of medical practitioners between 1986 and 1991 can be attributed to a 48% increase in the number of specialists. This increase in specialist numbers ensured the continuing rise in the doctor to population ratio despite the relatively small increase in GPs.

Between 1986 and 1991 the rate per 100,000 population of GPs, police and social workers remained fairly stable. In comparison there was an increase in the number of lawyers and solicitors and a decrease in the number of ministers of religion per 100,000 population.

PERSONS EMPLOYED IN HEALTH OCCUPATIONS

1976
1986
1991
Health occupations
'000
rate(a)
'000
rate(a)
'000
rate(a)

General practitioners
n.a.
n.a.
23.8
149
25.5
147
Specialists
n.a.
n.a.
9.0
56
13.4
77
Total medical practitioners
21.2
150
32.8
205
38.8
224
Registered nurses
n.a.
n.a.
138.2
863
139.4
804
Total nurses
136.0
969
182.2
1,137
188.6
1,088
Dentists
4.6
33
6.3
39
6.7
39
Total health occupations
182.6
1,301
254.0
1,586
272.6
1,572

(a) Rate per 100,000 estimated resident population.

Source: Census of Population and Housing


SELECTED OCCUPATION TO POPULATION RATIOS(a)

1986
1991
Occupation
rate
rate

GPs
149
147
Police
212
212
Lawyers/solicitors
145
166
Social workers
40
41
Ministers of religion
77
72

(a) Rate per 100,000 estimated resident population.

Source: Census of Population and Housing


Geographic classification

The geographic classification used in this review is based on population size. Proximity of rural areas to major urban centres or the remoteness of any urban area has not been considered.
  • Major urban - urban centres with a population of 100,000 and over.
  • Other urban - urban centres with a population of 1,000 to 99,999.
  • Rural - all other areas including country towns with populations under 1,000.

Data used in this review are from the Census of Population and Housing which collects information about people on the basis of where they live rather than where they work. Given that some proportion of the rural population lives adjacent to urban population centres, it is likely that some rural GPs work in major towns and cities.


GP distribution
In 1991 GPs were concentrated in major urban areas with populations of 100,000 or more. There were 180 GPs per 100,000 population in major urban areas compared to 95 per 100,000 in rural areas.

These rates are also reflected in the distribution of other health occupations, most notably specialists. However, the distribution of specialists is affected by the location of larger hospitals which are usually in major urban centres. Indeed in 1991, there were over twice the number of specialists per 100,000 population in major urban centres than in other urban or rural areas.

However, an important factor which must be considered in relation to GP distribution in Australia is GP mobility. In remote Australia the Royal Flying Doctor Service provides a high degree of mobility for medical workers servicing remote areas and communities, thereby improving access to medical services.

HEALTH OCCUPATIONS, 1991

Major urban
Other urban
Rural
Health occupations
no.
rate(a)
no.
rate(a)
no.
rate(a)

General practitioners
18,906
180
4,002
106
2,387
95
Specialists
10,489
100
1,629
43
1,114
45
Registered nurses
90,997
866
29,300
779
18,712
748
Dentists
4,907
47
1,122
30
649
26
Total health occupations
125,299
1,192
36,053
959
22,862
914

(a) Rate per 100,000 estimated resident population.

Source: Census of Population and Housing



GP characteristics
In 1991 the majority of GPs were male (70%). However, the proportion of female GPs has increased from 25% in 1986 to 30% in 1991. There were also higher concentrations of female GPs in major urban areas where 32% of GPs were women. In both other urban and rural areas three-quarters of GPs were male.

Urban areas also tended to have greater proportions of GPs of younger ages. In urban areas 43% of GPs were aged under 35 years compared to 25% in rural areas. This current age difference may be important in the future if the retirement of GPs in rural areas is not adequately compensated for by recruitment of younger GPs, thereby worsening the imbalance in GP geographic distribution.

Major urban centres also have higher concentrations of GPs from non-English speaking backgrounds. However, this pattern reflects the general settlement pattern of people from non-English speaking backgrounds who are concentrated in major urban areas.

CHARACTERISTICS OF GENERAL PRACTITIONERS, 1991

Major urban
Other Urban
Rural
Characteristics
%
%
%

Male
68.1
74.8
74.4
Female
31.9
25.2
25.6
Aged 15-24 years
4.3
2.9
1.3
Aged 25-34 years
38.7
33.6
23.3
Aged 35-44 years
26.3
32.4
38.6
Aged 45-54 years
15.3
14.4
20.1
Aged 55 years and over
15.3
16.6
16.7
Born in non-English speaking country
26.3
15.1
14.1
Has post-graduate qualifications
17.9
18.9
19.6
Worked 49 hours or more a week
45.3
57.1
51.4
Gross annual income over $60,000
38.7
48.5
46.6

Source: Census of Population and Housing


Work and income
There are some important differences in the work of GPs according to geographic location. GPs in other urban and rural areas reported working longer hours than those in major urban centres. While 45% of GPs in major urban centres reported working 49 hours or more per week, 57% in other urban and 51% in rural areas reported the same.

In accordance with the higher proportions of GPs working longer hours per week, GPs in other urban and rural areas reported higher gross annual incomes with 49% of other urban and 47% of rural GPs reporting incomes of over $60,000 a year, compared to 39% of GPs in major urban centres.

In 1991, 9% of GPs lived in rural areas and in 1989-90, 9% of all consultations took place in rural areas2. In 1989-90 the most frequent treatments received by people consulting a GP were prescriptions for medication (61%) and blood pressure checks (38%). There were no marked differences between urban and rural areas in the types of treatment given by GPs. The majority of consultations occurred in the doctor's office or surgery (94% in urban areas and 95% in rural areas).

International comparison
Australia has a higher GP to population ratio than Canada, New Zealand, the United Kingdom or the United States. Australia also has a higher nurse to population ratio than Canada and the United States. However, these two countries have higher specialist to population ratios and dentist to population ratios than Australia.
RATIO(a) OF HEALTH WORKERS TO POPULATION, SELECTED COUNTRIES

Year
General practitioners
Specialists
Nurses
Dentists
Country
rate
rate
rate
rate

Australia1991
147
77
1,088
39
Canada1990
103
92
841
54
NZ1989
73
n.a.
n.a.
37
UK1990
59
n.a.
n.a.
37
USA1989
22
114
648
56

(a) Rate per 100,000 estimated resident population.

Source: Organisation for Economic Co-operation and Development OECD Health Systems: facts and trends 1960-1991


Endnotes
1 Department of Health, Housing and Community Services (1992) The Future of General Practice National Health Strategy Issues Paper No. 3.

2 National Health Survey.



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