More carrots and less sticks, say RDAA and RACGP.
Yesterday, a bill to ban Modified Monash Model MM1 and MM2 areas from being classified as Distribution Priority Areas was introduced into the House of Representatives… and swiftly rejected.
In 2022, to address what ACRRM labelled “relatively minor” workforce shortages in some regional centres and outer urban areas, the federal government expanded DPA eligibility.
DPA status allows international medical graduates to bill through Medicare in those areas.
Automatic DPA status was extended from MM3-7 to MM2 and above, with some MM1 areas garnering the status in exceptional circumstances.
This prompted concern from ACRRM, the Rural Doctors Association of Australia and the RACGP over the relocation of rural and regional doctors.
Yesterday, Independent MP Andrew Gee introduced the Doctors for the Bush Bill 2024, which aimed to undo the 2022 changes by prohibiting MM1 and MM2 areas from garnering DPA status.
When introducing the Bill, Mr Gee said it remedied “blatant unfairness”.
“The rural doctor shortage is at crisis point,” he told parliament.
“It’s a health disaster unfolding before our eyes, and its consequences are devastating.
“For many rural areas, this [DPA] policy was a lifeline, providing competent GPs where there were none and ensuring that country people had access to basic medical services.”
The Bill was defeated 64 to 12.
Speaking to The Medical Republic, RDAA CEO Peta Rutherford said that the DPA model as a distribution tool had become redundant.
“Our members have reported a drop in the number of applications for vacant positions,” she said.
“When [the change] was first introduced, we did see people flagging that they would be relocating … to take up jobs in the city.
“It has had an impact.”
But, overall, the RDAA was not overly supportive of forced distribution, added Ms Rutherford.
“When the changes came in, we called for greater investment into targeted initiatives to offset the potential damage that policy change would do,” she said.
“We’ve seen things like single employer model pilots start to roll out.
“We’ve seen the government support an over subscription to the training numbers in GP training.
“But none of this is permanent.”
Ms Rutherford said that the association wanted to see these policies embedded on a long-term basis and a national rural health strategy to pull it all together.
“We’ve got the pilots for the single employer model now running in every state other than WA.
“We need to give people confidence that this is going to be something here to stay.
“What we want to see is that it’s an opt in model, no one should be forced to participate, but that it is a really important option that is available to people.”
Ms Rutherford said RDAA wanted to see “carrots”, as opposed to sticks, but there was no one silver bullet.
“There has to be a range of initiatives, things like the workforce incentive program, doctor’s payment and the rural advanced skill incentives are really great in recognising the additional skills and the length of service to these [rural and regional] communities.
“We need a range of initiatives that are targeted to align with encouraging individuals, but also practices, in providing the services that meet local community need.”
Ms Rutherford said there had been “active discussion” around whether DPA would be here to stay.
“The discussions have been around things like GP catchment areas, that’s been part of the [Strengthening Medicare] review processes, and those reports have been released, and that’s certainly something we’re open to.
“However, we do want to see Modified Monash Model retained as rural classification and that we don’t revert to previous models for rurality scaling, because they’re flawed and we wouldn’t be able to support them.”
Speaking on the short-lived Bill, RACGP Rural chair Associate Professor Michael Clements said it had been good to see bush doctors “back on the agenda” as the maldistribution of doctors was a “very real frustration” that was only getting worse.
“I think this should be the start of more conversations, as opposed to the end,” he told TMR.
Professor Clements agreed that the changes in 2022 “certainly had an effect”.
“I have my own practice in an MM5 location and the day the government announced that it was going to follow through on that promise, I had resignations from people saying that they’re going to move back to the bigger towns.
“I think what we’re seeing right now is a huge – we’re talking hundreds and hundreds – [number] of overseas trained doctors moving into Australia now under new pathways and due to policy changes.
“That’s actually really flooding many MM2 communities, even in Townsville, and some of the MM1 DPA exemption areas with doctors that could be going bush.”
The RACGP opposes the moratorium, which requires international medical graduates to work in rural and remote areas for up to 10 years and instead supports incentives, said Professor Clements.
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He added that the Bill was redundant if the government was planning on following through on the recommendations of the Strengthening Medicare Review.
However, the review did note that while we have no better system than the moratorium, it should stay, he said.
“I think we should be sympathetic to that, [but] we do need a better system to drive the doctors [which] should be based on the incentives and supports.”
Professor Clements mentioned the pre-fellowship pathway and incentive payments to doctors, like WIPs, as initiatives that work.
“We’ve also got to work with the communities themselves and address everything else, like childcare and spousal employment and housing and all those other complex pieces of the puzzle.”
