Health workforce

Budget Review 2015–16 Index

Dr Rhonda Jolly

Health workforce measures in this Budget are minimal and essentially involve re-distribution of funding.

Rural and remote scholarships

The budget papers have announced that the 100 government-supported places for medical students under the Medical Rural Bonded Scholarships Scheme (MRBS Scheme) will be transferred to the Bonded Medical Places Scheme (BMP Scheme).[1] Currently, students trained under the MRBS Scheme commit to working for six continuous years (after completing their specialist training) in rural or remote areas (less any credit obtained through a scaling scheme that can reduce the return of service dependent on the rurality of the area in which they choose to practice).[2] Students on the BMP Scheme, on the other hand, have a greater geographical choice in terms of fulfilling their return of service obligation[3]. They commit to work in a district of workforce shortage area of their choice (districts of workforce shortage can be in outer metropolitan, rural or remote areas) for a period of time equal to the length of their medical degrees, less any credit obtained through scaling.

A further measure will achieve savings of $72.5 million over four years from 1 July 2016 by combining nine existing allied health workforce scholarships into one. According to the budget papers this measure will not affect scholarships aimed at Aboriginal and Torres Strait Islander students. The Government intends that this measure will produce a more effective program and encourage more students to embark on rural practice.

The decision to transfer the MRBS Scheme was most likely premised on the fact that it has been unsuccessful in increasing the numbers of medical practitioners working in rural and remote areas. As Jennifer Mason, former Director-General of the New South Wales Departments of Human Services and Community Services, observed in her review of health workforce programs, critics of the program claim that not only do its participants lack ‘a positive connection’ with the bush, they also demonstrate an unwillingness to participate in rural life.[4] The Mason review added that rural bonding is seen as ‘stigmatising’ of rural practice and it is common for scholarship participants to seek release from their obligations, some pursuing employment overseas as a means of avoiding working in rural areas. And, as Mason pointed out, after a decade of investment by the federal government fewer than 50 MRBS recipients had commenced their return of service period.[5]

For these reasons the Mason review suggested that the Government phase out the MRBS Scheme and redirect funding to support the Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme, which targets students with a significant rural background. In Mason’s words  RAMUS ‘is both popular among rural communities and rural medical students’.[6] Importantly, with regards to the ongoing policy of successive Australian governments of improving health services in rural and remote areas, the Mason review recommended that at least a portion of the savings made from phasing out the MRBS Scheme was allocated to support rural allied health scholarships.[7] Mason pointed out that these are already oversubscribed. Hence, there is the potential for an increased number of scholarships to make a difference to rural health outcomes.

While the Budget has announced that the MRBS Scheme will cease, it appears that the number of medical students to receive government support will not be diminished and there will be no savings from the demise of the Scheme. However, there is equally no compensation provided for the loss of a scheme intended specifically to increase the presence of medical practitioners in the bush.

However, as noted above, the budget papers predict that there will be savings from the consolidation of allied health scholarships. Given the Mason review recommendation and its acknowledgement that a greater investment in allied health will be of benefit to rural communities, it is significant that the savings from that consolidation have not been reinvested in more scholarships or incentives for allied health students and workers.

The Services for Australian Rural and Remote Allied Health organisation (SARRAH) which administers scholarships for allied health workers, has commented on the lack of detail in the budget announcements relating to rural and regional scholarships.[8] SARRAH has also observed that the measures do nothing to address the fact that government support and initiatives for allied health workers is less than comparable with that given to other health practitioners.[9] And, given that the new allied health scholarships will entail a return of service obligation to work in rural or regional areas for one year, it likely that SARRAH and other advocates of more government support for the allied health workforce will be concerned that an existing similar obligation imposed on medical students has most likely been a primary reason behind the demise of the MRBS Scheme.

As the Minister for Infrastructure and Regional Development, Warren Truss, highlighted in his Budget Statement, rural and remote health is a priority area for Government policy.[10] Therefore, it is possible that health workforce advocacy groups, such as SARRAH, may ask why the Government has not used savings from the consolidation of allied health scholarships to invest in more rural and remote places for allied health students. Given the impending demise of the MRBS Scheme, this may have been an effective way of pursuing the Government’s stated priority.

Other re-directions of funding

A small amount of funding (just over $3.0 million over four years) from two programs, the More Doctors for Metropolitan Areas Relocation Incentive Grant and the Higher Education Contribution Reimbursement Scheme, is to be re-directed to the General Practice Rural Incentives Program (GPRIP). GPRIP aims to encourage medical practitioners to practise in regional and remote communities and the budget papers state that the ‘expanded’ GRIP as a result of this measure ‘will be redesigned with a refined geographical classification system to increase the incentives for General Practitioners in smaller rural communities’.

A second re-distribution measure will transfer responsibility for a training program for junior medical officers at two former repatriation hospitals from the Department of Veterans’ Affairs to the Department of Health. Funding of $40.0 million has been provided over four years for this program.



[1].          The budget information in this article has been taken from the following document unless otherwise sourced: Australian Government, Budget measures: budget paper no. 2: 2015–16.

[2].          See more information on the Medical Rural Bonded Scholarships Scheme and scaling for the scholarship on the Department of Health website.

[3].          See more information on the Bonded Medical Places Scheme on the Department of Health website.

[4].          J Mason, Review of Australian Government health workforce programs, Department of Health, April 2013, Chapter 3.

[5].          Ibid., p. 107.

[6].          See more information on the RAMUS Scheme on the National Rural Health Alliance website.

[7].          Mason, op. cit., p. 107.

[8].          Services for Australian Rural and Remote Allied Health (SARRAH), Government’s health budget needs rural proofing, media release 12 May 2015.

[9].          Ibid.

[10].       W Truss (Minister for Infrastructure and Regional Development) and J Briggs (Assistant Minister for Infrastructure and Regional Development), Partnership for Regional Growth 2015–16, ministerial budget statement 2015.

 

All online articles accessed May 2015. 

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