'Not fit for purpose': Doctor of the year calls for rural health overhaul

Unfortunately that seems like a long way off for a health system Dr Miller describes as "not fit for purpose for rural families and children."

The 2023 rural and remote health professional of the year said there is growing inequality.

"I'm faced with families in my community that just don't have access and to me that's unjust and that's not what I stand for as a doctor," she said.

Dr Miller believes innovation is the path forward. In 2021 she donated her time and expertise, scratched together some funding and setup a wellbeing hub at Eden Marine High School, on the NSW Far South Coast.

Named the The Djing.gii Gudjaagalali Kids Clinic, Dr Miller collaborates with educators and engages with students identified as having learning difficulties. She said the clinic was a big step forward, breaking down barriers to care whilst not being limited to a traditional 15 minute consult.

"I've already got this rich wealth of information from those educators that know this child, know the family," she said.

There are plans to open another school-based health clinic in Batemans Bay next year. She said the problem though was a patchwork approach, creating under-resourced locations and adding further pressure on parents because of where they live.

"We've got the bottom up solution happening as grassroots initiatives are taking off all over the place...but now what we need is a top down approach, we need state and federal governments to collaborate more effectively," she said.

"The family and children are in the middle as I see it and the services such as education, health, non government organisations, even child protection if necessary, they all need to come together to support these children."

Dr Miller said there were huge challenges facing the rural health sector but pointed to changes the state government could make now.

A rural generalist colleague specialising in paediatrics recently moved to Queensland because she couldn't get a job in NSW, she said.

"They (Queensland government) pay them well and they give them good jobs at the end of the training whereas in NSW it's a bit short sighted," Dr Miller said.

"We're focused on training up these professionals but then NSW Health doesn't offer jobs to them at the end even though it's in their regional health (strategic) plan."

ADHD medication prescribing reform is also a priority, Dr Miller said. In Queensland a GP can prescribe stimulants to children with ADHD while in NSW they can't.

Dr Miller is doing a PhD on strengthening paediatric care in rural Australia - part of her work involves looking at the success of SUSTAIN, a virtual GP-paediatrician co-consultation trial program. She said the model, linking kids with city based paediatricians was a good one, but needed to be funded properly.

"With the SUSTAIN model of care we know that GPs that we've interviewed love the model," she said.

"But time and time again what we're hearing is that because the SUSTAIN paediatrician can't officially diagnose and treat things like ADHD or autism, we're actually not meeting the needs of the community or the GP as much as what we would be able to do if we were able to secure ongoing funding for a full time paediatrician beyond the end of the trial."

More than 85 per cent of paediatricians work in a major city according to a 2024 report by the Australian Institute of Health and Welfare.

The report also found 12 per cent of children in Australia aged four to 12 had externalising or internalising behavioural problems - rates among the highest in the world for neurodevelopment issues.