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Tuesday, 8 May 2018
Page: 3369

Medical Rural Bonded Scholarship

(Question No. 910)


Ms Sharkie asked the Minister representing the Minister for Rural Health, in writing, on 05 February 2018:

(1) What measures is the Government taking to ensure that participants in the Medical Rural Bonded Scholarship (MRBS) scheme are completing their return of service obligations to work in a rural or remote area for up to six years. (2) How many doctors who were recipients of an MRBS are yet to complete their return of service obligations. (3) What other measures has the Government taken to ensure a proportionate distribution of doctors across regional and rural Australia.


Mr Hunt: The Minister for Rural Health has provided the following answer to the honorable member's question

(1)

The Australian Government is looking at ways to maximise its return on investment of an estimated $172.6 million from 2000-01 to 2020-21 in the Medical Rural Bonded Scholarship (MRBS) Scheme and is considering how best to support MRBS participants to undertake their Return of Service Obligations. This includes reforms to the Bonded Programs (which includes both the MRBS and Bonded Medical Places Schemes) to provide greater flexibility in relation to the return of service obligations, more support for bonded doctors and to better target return of service to underserviced areas in most need.

Rural Workforce Agencies (RWAs) currently provide assistance to bonded doctors as part of their funded activities to attract, recruit and support the rural and remote health workforce. Options to deliver earlier and more effective support for participants of Bonded Programs by expanding the role of RWAs are being considered. The Rural Health Multidisciplinary Training Program which includes Rural Clinical Schools and Regional Training Hubs provide access to rural clinical training and promote rural careers to health professionals including bonded medical students.

(2)

1,106 Medical Rural Bonded Scholarship (MRBS) participants are yet to commence their Return of Service Obligations (RoSO) as they have not reached the Fellowship stage. A further 268 MRBS participants are currently undertaking their RoSO and 33 have completed their RoSO. 107 MRBS participants have left the program and will not complete their RoSO. The number of MRBS participants commencing their RoSO is expected to increase over time as more doctors complete their vocational training and attain Fellowship.

(3)

Other measures to address the distribution of doctors across regional and rural Australia include:

Rural Health Multidisciplinary Training (RHMT) Program

Through its RHMT Program, the Australian Government is providing $542.8 million over the period 1 January 2016 to 31 December 2018. This program is designed to encourage the recruitment and retention of rural and remote health professionals by universities delivering effective rural clinical training experiences to medical, dental, nursing and allied health students. The program supports a network of 18 Rural Clinical Schools, 15 University Departments of Rural Health, 6 dental schools offering extended rural dental placements; and 26 Regional Training Hubs.

Rural Health Outreach Fund (RHOF)

The Australian Government is providing $82.9 million from 1 July 2017 to 30 June 2020 for the RHOF, which improves access to medical specialist, GP and allied and other health outreach services for people living in regional rural and remote Australia. Funding is provided to address a range of disincentives incurred by health professionals in providing outreach services such as travel, accommodation and lease of equipment. The RHOF is administered by fundholders in each state and the Northern Territory and they are responsible for needs assessment and prioritisation of outreach services to where they are needed most.

Rural Clinical Schools

Rural Clinical Schools support the clinical training of medical students and provide an ideal environment to promote rural careers to Bonded Medical Places (BMP) and Medical Rural Bonded Scholarship (MRBS) students and to support them while on rural clinical placement. This includes ensuring that students are well supported by rural academic staff, health professionals and community representatives. They ensure that students receive positive, relevant rural practice training opportunities to an equivalent standard of that delivered in metropolitan settings.

Regional Training Hubs

Regional Training Hubs have been established at existing Rural Clinical Schools and University Departments of Rural Health sites across Australia to support the coordination of rural training opportunities for doctors at all stages of their medical training (from undergraduate through to vocational training). These Regional Training Hubs provide an enhanced level of support to Rural Clinical School students/trainees in their region. They consist of a team of people that are dedicated to integrating medical training opportunities for students within their catchment area, and can provide general and specific information for all students including BMP and MRBS students about the steps and pathways into rural careers and contacts for assistance.

National Rural Health Commissioner

The Government has established a National Rural Health Commissioner (the Commissioner) to address the shortage of doctors in regional, rural and remote areas, with a particular focus on rural generalists that provide skills to meet community need.

The Commissioner will develop national training pathways for rural generalists to help attract and retain more doctors in regional, rural and remote communities.

District of Workforce Shortage

A Distribution Working Group has been established by the Government to consider the implications of changing the existing policy for the District of Workforce Shortage system. The working group will also provide advice on how to improve the levers designed to attract more Australian trained doctors to regional, rural and remote areas. Recommendations proposed by the working group will inform future rural health workforce distribution policy.

Rural Workforce Agencies

The Government provides support to the regional, rural and remote health workforce through recruitment, retention and sustainability which includes $86 million over three years from 2017 for the network of Rural Workforce Agencies. Rural Workforce Agencies are located in each state and the Northern Territory, and they are funded to support a range of on-the-ground activities to meet community needs. This includes providing increased access to health professionals, as well as building the quality and the sustainability of all health professions in regional, rural and remote Australia.

Section 19AB of the Health Insurance Act 1973

Section 19AB of the Health Insurance Act 1973 (the Act) is one of the key distribution mechanisms used by the Government. Section 19AB of the Act requires overseas trained doctors and foreign graduates of an accredited medical school to work in a location that is classified as a district of workforce shortage in order to access the Medicare benefits arrangements. This restriction applies for a period of ten years from when the doctor gained medical registration in Australia.

Rural Junior Doctor Training Innovation Fund (RJDTIF)

The RJDTIF gives rurally based interns an opportunity to experience rural primary care. Exposing interns to rural primary care, typically General Practices or Aboriginal Medical Services will make it more likely they will practice in these locations after becoming more qualified. The RJDTIF is a part of the Government's Integrated Rural Training Pipeline for Medicine. Around 121 junior doctors will rotate into rural primary care each year under the first round. A second round is currently being finalised which will improve the national distribution of the program to support training in more rural areas across Australia.

Specialist Training Program

The Specialist Training Program seeks to extend vocational training for specialist registrars into settings outside traditional metropolitan teaching hospitals, including regional, rural and remote and private facilities. The program aims to improve the quality of the future specialist workforce by providing registrars with exposure to a broader range of healthcare settings. Specialist Training Program also aims to have a positive influence on future workforce distribution. The Government has recently implemented two key reforms to STP that will bring significant benefits to rural, regional and remote communities:

From 2018, distribution targets have been implemented for the 13 participating colleges to enhance training in rural areas and the private sector. These targets must be achieved over the next three years of funding. The new rural training target that will increase rural posts by over 18 percent, up to 400 of 900 Specialist Training Program posts.

Through the Integrated Rural Training Pipeline for Medicine measure, we are supporting a targeted expansion of the Specialist Training Program to provide up to 100 dedicated new training places in rural areas. Fifty new posts commenced in 2017, with the remaining 50 being implemented in 2018.

Australian General Practice Training (AGPT) Program

The AGPT program is a Commonwealth funded postgraduate vocational training program for medical graduates wishing to pursue a career in general practice. The AGPT program provides training towards three endpoints:

Fellowship of the Royal Australian College of General Practitioners;

Fellowship of the Australian College of Rural and Remote Medicine; and

Fellowship in Advanced Rural General Practice.

Entry to the program is competitive, with 1,500 new training places available each year. In 2017 there were 5,423 doctors training on the program with 50% of these doctors training and providing services to patients in rural and remote locations across Australia.