Winners and losers as cities win DPA status

GP practices in all MM2 and some MM1 areas are now DPA, so they can attract IMGs and rurally bonded medical students.

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Cairns, Ballarat and Newcastle are now classified as workforce priority areas in the eyes of the government, putting the regional cities on equal footing with the most rural and remote areas of the country.

Labor has delivered on its pre-election pledge to expand the criteria for Distribution Priority Areas (DPA), and now automatically classifies practices in Modified Monash (MM) 2 areas as DPA, as well as some MM1 areas under exceptional circumstances.

Being classified as DPA means practices can recruit overseas trained doctors who can bill Medicare via a 19AB exemption, as well as rurally bonded medical students fulfilling their return-of-service obligation.

Previously, to be classified DPA a clinic had to be in a MM3 to 7 area. This left practices in regional towns in the “dead zone”, unable to recruit moratorium-bound IMGs but also unable to attract free-agent GPs away from capital cities.

Last year, then-rural health minister Dr David Gillespie initiated a review into the system and allowed clinics which did not meet the rurality criteria to apply for DPA classification under extenuating circumstances.

Under the new Labor rules, there are now 700 DPA locations in Australia.

Is that a good thing? Depends who you ask. Here are three different takes on that change.

These changes will hurt “real rural” towns

The Rural Doctors Association of Australia has been against the changes since they were but a twinkle in the Health Minister’s eye.

“This will drain doctors from rural and remote towns,” RDAA president Dr Megan Belot told The Medical Republic.

“Without some significant workforce policy change for rural and remote at the same time, this is going to have really negative consequences for our rural and remote GPs, rural generalists and our patients.”

Dr Belot is quick to admit that DPA has never been a perfect system for rural doctors – but at least it was their imperfect system.

“DPA basically dictates where someone can practice – so yes, it’s always been a stick policy,” she said.

“But now, it’s basically a free for all. There’s no actual difference within the policy to recognise [the difference between] MM3 to 7, as opposed to MM2.”

The RDAA president acknowledged that there were definitely some pockets of MM1 and 2 areas which did need help with their workforce shortage but argued that tweaking DPA was the wrong approach.

“I guess our message is that [the government] shouldn’t actually change a rural and remote policy for that setting … it should have its own separate policy,” she said.

In any event, now that the change to DPA has gone through, Dr Belot would like to see new policies which would specifically benefit doctors in MM3 to 7 areas.

This could include creating a policy mandating a minimum number of junior doctor rotations in remote Australia, or investment in the retention of rural and remote GPs and generalists.

But first, Dr Belot wants to speak to Health Minister Mark Butler.

“We have been quite strong in warning against this, and if you read the [government] media release, it’s saying that it’s trying to improve health outcomes for rural and remote people,” she said.

“But from our perspective, this policy will actually take away from rural and remote communities.”

These changes mean medium-sized towns can keep their trainees

GPs in Mackay, an MM2 city about 12 hours north of Brisbane, successfully applied for the area to get DPA status earlier this year by submitting evidence of a sudden reduction in doctors between January and September 2021.

Dr Nicole Higgins, one of the Mackay GPs involved in the exceptional circumstances application for the region, said that having DPA status helped regional towns compete with capital cities.

“Now that we’ve got DPA status, people who are training here [on bonded places] can stay here, they don’t have to relocate,” she told TMR.

“It means doctors who are overseas trained now have a lot more options about where they can work.”

Having DPA status and being able to attract and retain more doctors in regional centres will still benefit rural Australians, Dr Higgins argued.

“A quarter of our patient load live in rural areas outside of town, so it actually increases the access for rural patients to be able to see a GP,” she said.

These changes are a symptom of the wider problem

National Rural Health Alliance CEO Dr Gabrielle O’Kane saw the DPA changes as indicative of the broader issue in general practice: workforce.

“The underlying problem here is that, really, outside major cities – the MM1s – it’s actually very difficult to attract the GP workforce, because there’s fewer people going into general practice anyway,” she said.

“It is hard to get them even to some of those outer metro areas, and it’s really hard to get them out further.”

The system, Dr O’Kane said, “is pretty much in crisis”, and the fact that the government had seen fit to expand the DPA criteria was just one symptom of that.

“The Albanese government is basically saying, ‘look, there are shortages anywhere outside of the major cities,’” she told TMR.

Dr O’Kane also said that, now relatively large towns were on equal footing with the smallest towns, there needed to be a rural and remote-specific solution.

“Some would argue that MM3 areas shouldn’t be automatically classified DPA, because the whole idea of it is to try and get overseas trained doctors and bonded students into real rural places,” she said.

“If you’ve got a choice between going to a really large place that’s MM2 or Bourke, what’s the most likely choice you’re going to make?”

Her solution? Review the whole DPA system.

“We’ve potentially got enough GPs in the country, but it’s where they’re distributed [that is the problem],” she said.