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16 Aug 2017

BY AMA PRESIDENT DR MICHAEL GANNON

The AMA has strongly opposed and questioned the Bonded Medical Places (BMP) Scheme since its inception.

In the latest chapter of our long-running campaign against this flawed and failed policy, I have written to Assistant Health Minister Dr David Gillespie again emphasising our ongoing concerns.

All the available evidence shows that bonding programs are ineffective.

We have recently seen signs that the Government – or at least the bureaucracy – has acknowledged that bonding is ‘a dud’. The 2015/16 Budget saw significant changes that abolished the Medical Rural Bonded Scheme (MRBS) and cut Return of Service (ROS) requirements for future BMP graduates.

According to the Department of Health (DoH) in evidence to Senate Estimates, the Budget change reflected the lack of success of longer bonding periods under the BMP and MRBS schemes.

DoH said that the best available evidence about program effectiveness shows that people who undertook 12 months training in a rural area were more likely to return to those rural areas. It was a significant admission of the failed design of extended ROS arrangements under both the MRBS and BMP schemes.

The evidence shows that recruiting students from a rural background and/or providing early exposure to rural practice are key to the recruitment of more doctors to rural areas.

The Government actually used this evidence to make sound policy decisions in the establishment of an Integrated Rural Training Pipeline, based around Regional Training Hubs, rurally-based General Practice rotations for junior doctors, and the expansion and targeting of the Specialist Training Program.

The prospect of a national rural generalist pathway also holds great promise.

The AMA was then shocked to learn that, despite this evidence, the Government is actively considering increasing the ROS for future BMP graduates, and sought advice on this policy at a recent Rural Roundtable Meeting.

I told Assistant Minister Gillespie that putting more emphasis on a scheme that has not delivered any meaningful results for rural Australia – a policy that is not supported by international evidence, or even his own Department – represents a significant policy failure.

Contrary to widely-held perceptions, there are no meaningful incentives attached to the BMP scheme. Participants are required to repay their HECS in full.

The design and implementation of the BMP scheme, particularly with respect to extended ROS arrangements, also fails to acknowledge that people’s circumstances can change dramatically from the time they enter medical school to the period when they must complete their ROS.

The BMP scheme also has a very poor reputation among stakeholders, as acknowledged in the Mason Review of Australian Government Health Workforce Programs.

It is seen as coercive and does not provide support for participants. BMP participants suffer a stigmatising perception as ‘second rate’ students who failed to meet the requirements for a non-bonded Commonwealth Supported Place (CSP).

People in rural and regional Australia deserve highly-skilled doctors who become integral parts of their community, and who are committed to a long-term career in rural Australia. Importing large numbers of International Medical Graduates (IMGs), while offering them little pastoral and professional support, has been used as a “band-aid” measure.

The AMA Council of Rural Doctors has consistently opposed the BMP scheme because rural doctors understand that the recruitment of a reluctant workforce will do nothing to solve the problems of health care delivery in rural and regional areas.

Medical students and graduates who entered the BMP scheme prior to 2016 are now treated very differently and face a much longer ROS than more recent BMP entrants.

This is unfair and inconsistent with the previous administration of the BMP scheme, where contract changes were traditionally offered to all existing participants.

This simply adds to the poor reputation of the BMP scheme, and fuels dissatisfaction with the scheme among participants.

More and more doctors have and will withdraw from the scheme. DoH advises that 413 original BMP participants have withdrawn or breached, significantly greater in number than the 9 who have completed their ROS, and the 135 who are undertaking their ROS.

Closing the gap in health outcomes between metropolitan and non-metropolitan patient cohorts is a priority for the AMA. Enhancing support for IMGs working in rural areas and increasing the number of Australian graduates working bush are important. But bonding is not the answer to workforce maldistribution.

The BMP is not working. It should really be scrapped. If the Government is intent on keeping it, at least it needs to be made fairer, and simplistic proposals to increase the ROS period for new entrants need to be put in the bin. 


Published: 16 Aug 2017