Under new arrangements, bonded medical graduates will have greater flexibility and more certainty over where they work
The reformed Bonded Medical Program strikes a better balance in the obligations it imposes on young graduates, but will have to be evaluated to see whether it improves the distribution of the workforce, says the peak body for rural doctors.
The changes to the nearly 20-year-old scheme, announced in last year’s budget and passed by federal parliament this month, affect all new applicants from January next year.
Participants will receive a Commonwealth-supported medical course in exchange for three years’ work in a regional, rural or remote area within 18 years of finishing their course. It can be undertaken full or part-time or fly-in, fly-out, and half of it can be done before attaining fellowship.
This return-of-service obligation was set at six years when the program began in 2001, then was reduced to one year.
The Rural Doctors Association of Australia’s CEO Peta Rutherford said six years had proved too onerous and created substantial pressure, while one year was “very minimal and almost tokenistic” considering the level of financial support participants received as well as a place in medical school.
“Giving three years back into a rural community is a good period of service,” she told The Medical Republic.
“In that period, if they do like it, they will make some decisions in relation to their children’s school, maybe purchasing a house, things like that. But it’s not so long that they actually feel like they’re forced into something that isn’t satisfactory and rewarding to them and their family.
“We want the recipients of these scholarships to enjoy the rural experience and see the benefits of working rurally, as opposed to being forced into things.
“It’s about ensuring that these people actually feel like they’re in a supportive program that fosters their rural interests, not one that actually beats it out of them.
“Some people look back and wish they’d never taken one of these scholarships. We’re hoping these changes provide a much more supportive environment, and that people make choices to stay rural or to work in those specialty areas that would benefit our small regional centres, if not doing also outreach to rural.”
Individual contracts and deeds of agreement are being replaced with an online platform, the Bonded Return of Service System.
Current participants in the Bonded Medical Places and Medical Rural Bonded Scholarship programs can opt in to the new arrangements, without having years added, or stay with their existing contract or deed of agreement.
AMA president Dr Tony Bartone has welcomed the reforms, saying the program – which is part of the Health Department’s Stronger Rural Health Strategy – had so far failed to make meaningful progress in addressing workforce shortages.
“The new arrangements will provide participants with greater flexibility, more certainty in relation to where they can work in the future, and will require much less red tape and compliance,” Dr Bartone said.
“This is good news for bonded medical graduates and for communities in desperate need of local doctors and medical services.”
However, Ms Rutherford said maldistribution was a longstanding issue in the rural medical workforce that required significant reform, “not just tinkering around the edges of existing programs”.
“We’ve got an opportunity to really look at the landscape of general practice training with the responsibility of training going back to the colleges, the RACGP and ACRRM. There’s an opportunity there.
“Once a doctor finishes medical school, we’d certainly like to see significant investment in internships and and PGY2 years in small regional and rural hospitals, whether on rotation from a larger hospital or a full-time position. We see that as a significant void.
“When doctors finish medical school, often they’re being forced back into the city in the early years because that’s where the jobs [for juniors] are.”
She said the program would need to be evaluated in about five years to see whether participants were staying rural or heading straight back to the city.
“What we need is to keep doctors once they’ve fellowed. It’s really in that period once they can work unsupervised that they become a real asset to a community, because they can start to train the next generation of doctors into these communities.”
