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.
For copyright reasons some linked items are only available to members of Parliament.
© Commonwealth of Australia
Creative Commons
With the exception of the Commonwealth Coat of Arms, and to the extent that copyright subsists in a third party, this publication, its logo and front page design are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Australia licence.
In essence, you are free to copy and communicate this work in its current form for all non-commercial purposes, as long as you attribute the work to the author and abide by the other licence terms. The work cannot be adapted or modified in any way. Content from this publication should be attributed in the following way: Author(s), Title of publication, Series Name and No, Publisher, Date.
To the extent that copyright subsists in third party quotes it remains with the original owner and permission may be required to reuse the material.
Inquiries regarding the licence and any use of the publication are welcome to webmanager@aph.gov.au.
This work has been prepared to support the work of the Australian Parliament using information available at the time of production. The views expressed do not reflect an official position of the Parliamentary Library, nor do they constitute professional legal opinion.
Any concerns or complaints should be directed to the Parliamentary Librarian. Parliamentary Library staff are available to discuss the contents of publications with Senators and Members and their staff. To access this service, clients may contact the author or the Library‘s Central Entry Point for referral.