Chapter 3
The nature of the medical profession in rural areas
Medical Specialisms
3.1
The committee has received evidence that the growing trend towards
medical specialisms and sub-specialisms has a disproportionate impact on the
supply of doctors in rural and regional areas. This is principally due to
specialisation causing a reduction in generalist training pathways which has
been cited[1]
as the area of medical practice most required in rural and regional areas.
3.2
Professor Richard Murray, Dean of the Medical School at James Cook
University, and President of the Australian College of Rural and Remote
Medicine (ACRRM) described this trend:
I have watched the tide go out in the rural remote workforce.
Once upon a time we would be able to look for a doctor with qualifications in
public health and obstetrics et cetera to hold together services in the remote
Kimberley, for instance, and I just watched all of that disappear over a period
of a decade. So it felt like a shortage to me.
In fact, through that period and to now, we have continued to
grow our medical workforce above population growth. We have more doctors than
at any point in history...and we do very well compared to the other comparable
countries. So, arguably, the greater problem is not so much absolute numbers;
it is both geographic maldistribution and discipline maldistribution, in
particular too many subspecialties—subspecialists in the cities—and too much of
what we call multiple professional care.[2]
3.3
The reasons for the general increase of specialisation and
subspecialisation are varied and range from the higher remuneration and greater
career opportunities, to doctors "feeling comfortable within a domain of
practice"[3].
The committee also heard from the Australian Medical Association (AMA) that the
Medicare Benefit Schedule (MBS) contributes to the culture of rewarding
specialisation over generalism:
...there is a consensus that the MBS generally speaking
rewards subspecialty, [...] particularly in the procedural areas ... the
thinking doctors, such as the generalist physicians, generally speaking are not
looked after as well. [4]
3.4
The AMA go on to suggest that this is achieved through higher rebates
for particular MBS item numbers, and there are consequences for attracting new
recruits into general medicine:
There certainly does need to be a review of those particular
areas to try and restore some of the balance. So, ultimately, if you have got
young graduates looking at careers in these areas they will see that if they
want to go into generalism financially they will not suffer as a result
compared to some of the other specialties.[5]
3.5
The MBS outlines the difference in rebates for initial services from a
GP and a general physician. An initial attendance by a general physician for a
single course of treatment commands a fee of $148.10, while a typical
attendance at consulting rooms for a GP commands a fee of $35.60.[6]
While there are many other factors such as length of training, these basic
figures illustrate the challenge of attracting students into general practice,
even without bringing the rural and regional dimension into the equation. Comparisons
between generalists and sub-specialists that would support the AMA's assertions
are difficult on a purely fees basis because the MBS provides fees for specific
activities rather than paying for who provides the service.
3.6
The numbers of GPs in Australia also support the suggestion that it is
difficult to attract doctors into general practice. The most recent figures
from the Australian Institute of Health and Welfare's (AIHW) Medical Workforce
Survey in 2010 state that out of the 81 639 registered medical
practitioners in Australia only 35.3 per cent of these were general practitioners
compared to 36.1 per cent who were specialists.[7]
3.7
The figures in the Survey also provide valuable data about the
distribution of the workforce. The number of full time equivalent[8]
medical practitioners across the country ranges from 400 per 100 000
population in Major Cities, to 185 per 100 000 in Outer Regional Areas,
but if we look at general practitioners only then the variation is 105 to 103
respectively.[9]
3.8
These figures provide a picture of the workforce that shows the
numbers of general practitioners across areas defined by the Australian
Standard Geographical Classification-Remoteness Area (ASGC-RA) classification
system are consistent, but proportionally they represent a much smaller
percentage of medical practitioners in Major cities than they do across Inner
Regional, Outer Regional and Remote areas.[10]
3.9
The figures point to a conclusion that the rural and regional
populations are not served poorly in relation to GPs, rather it is that
patients cannot access the services provided by specialists without travelling
across significant distances at great cost to the patient and the health
system. The submission from the Australian Institute of Health and Welfare
supports this conclusion stating:
The number of clinical specialists decreased with increasing
remoteness (142 FTE per 100,000 for Major cities; 24 FTE per 100,000 for
Remote/Very remote areas).[11]
Medical Specialist Colleges
3.10
In order to be registered as a Medical Specialist in Australia you have
to be assessed by an Australian Medical Council accredited specialist college
as being eligible for fellowship of that college, although actual fellowship is
not a requirement.[12]
This arrangement gives the specialist colleges a key role in shaping the nature
of the medical workforce in Australia.
Royal Australian College of General
Practitioners
3.11
General Practice itself is classified a specialism by the Australian
Medical Council and the Royal Australian College of General Practitioners
(RACGP) is the primary specialist college representing GPs. The RACGP also has
a National Rural Faculty (NRF) with over 7600 members including more than 4,400
GPs living and working in regional, rural and remote Australia.[13]
The faculty's stated policy focus is to develop strategies that will produce
rural GPs with procedural and advanced skills to meet the demands of rural
medicine. They also emphasise the need for flexible policies and strategies to
be developed through local needs-based assessments.[14]
3.12
Aside from the issue around procedural training discussed in the
following section the RACGP's submission and evidence to the committee
reflected the complex and localised nature of the problems that exist in the
delivery of rural health. They propose the enhancement and expansion of
current programs that have made an impact such as:
- expanded university placements and Medical Rural Bonded
Scholarships;[15]
- an emphasis on rurally orientated general practice at
undergraduate as well as postgraduate level;[16]
-
initiatives that increase training capacity by attracting new GP
supervisors; [17]
- adequate remuneration for GPs for teaching roles;[18]
- an increase from 25% rural origin students for the Commonwealth
Supported Places in medical schools to 33%;[19]
and
- decreasing student debt for those locked into rural pathways. [20]
Royal Australian College of
Physicians
3.13
The Royal Australian College of Physicians (RACP) is the college
representing General Physicians. General Physicians or Consultant Physicians
are often the first point of referral by a GP seeking expert medical advice.[21]
While having a different perspective than the RACGP, the RACP's position is
consistent with the RACGP's focus on training that will address:
...the impediments for the supply of sustainable health care
delivery in rural and remote communities: [that is] maldistribution of
specialists in rural areas and chronic disease management.[22]
3.14
The RACP contends that growth in the number of physicians, particularly
those that are dual-trained in one or more specialisms, could lead to
significant cost savings and other benefits in rural communities:
Facilitating the growth of accessible medical specialist
services in small communities could lead to reduced hospital admissions,
improved quality of life for patients through reduced interactions with the
healthcare system and the development of system-wide savings over time. One of
these savings could be the reduced cost of patient transfers and travel to
metropolitan settings.[23]
3.15
The RACP specifically propose a model of dual-trained physicians who
will have "core training in general medicine and further training in an
additional specialty."[24]
This would result in physicians with:
...expertise in the diagnosis and management of acute,
undifferentiated illnesses and complex, chronic and multisystem disorders in
adult patients. Additional training in a specialty such as endocrinology,
oncology or respiratory medicine, will increase the level of expertise of the
general physician. For example, a general physician with an additional
specialty in endocrinology would be able to manage complex acute complex
diabetes cases in a population with a high rate of diabetes. [25]
3.16
The current training program to become a physician takes upwards of six
years, with the last three years involving advanced training in one (or more)
of 30 possible specialities. The RACP proposal is that this three-year segment
include the undertaking of two advanced training programs that would be
assessed simultaneously.[26]
3.17
According to the RACP the success of its proposal is contingent on a
number of factors:
There is anecdotal evidence to suggest that trainees are
interested and keen to participate in dual training with generalism as the core
specialty, within a rural area. This is provided there is the capacity to train
physicians within the rural facility and there is a clear career pathway and
program to follow. Increasing the capacity of rural clinical schools and
training facilities as centres of excellence and linked to universities will
support this proposal.
There is also evidence that basing General Medicine physician
training in rural areas, or longer-term rural placements, attracts the trainee
to the area. They are more likely to stay in the areas as a physician,
providing the community with a sustainable and secure workforce.[27]
3.18
The 'dual-training' model proposed is similar to one that is has been
running in New Zealand for over ten years. However the employment conditions
for a physician in New Zealand are different, as the provision of services in
local regional communities is included in their contract. This is unlike the
Australian model where the physician decides if they want to provide services
in a particular area or not.[28]
3.19
The RACP used an example of a cancer patient with co-morbidities that
require a coordinated approach to care as an illustration of the benefits that
a general physician can provide:
We have a rural and regional oncology service in
Albury-Wodonga. We have their specialist come down one day a week to
Wangaratta. We have delivery of regional treatment in Wangaratta. I supervise
the oncology on day to day. These patients have multisystem disease. They do
not just have cancer; they have diabetes and heart disease. That is where I
come in. The oncologist tells us what they are going to have and supervises
that. But as soon as they end up with pneumonia or their diabetes is out of
control or their heart disease has been right, they end up being coordinated.[29]
3.20
Professor Koczwara, President of the Clinical Oncology Society of
Australia (COSA) also stated that cancer patients need access to a number of
medical services, not just oncological:
...cancer care is multidisciplinary—very rarely do we deliver
care by one professional. You often need surgery, chemotherapy, radiotherapy,
allied health care staff, supportive care not to mention prevention and so on.[30]
3.21
The representatives from the RACP expanded on the service they operate
out of Wangaratta. The have six general physicians who have undertaken to
visit up to 100 kilometres from Wangaratta at least one day a week. This
service is carried out under the Medical Specialty Outreach Access Program (MSOAP).[31]
However as much as they endorse this model it is dependent on the specialists
involved, and there is no coordinated approach to manage the integration of
specialist services into ambulatory and primary care. According to the RACP
this is in part because one setting, the local hospital networks, is with the
states, while the Medicare Locals are the Commonwealth's coordinating tool for
the delivery of services.[32]
Australian College of Rural and
Remote Medicine
3.22
The Australian College of Rural and Remote Medicine (ACRRM) is the
specialist college specifically engaged with the issues contained in the
committee's terms of reference. The College is an accredited medical college
for the specialty of general practice,[33]
however rural medicine itself is not a recognised medical speciality so the
ACRRM is not the only college with a rural dimension. It has however played a
key role in the development of Rural Generalist Pathways.
Rural Generalists pathways
3.23
There is a recognition that services once delivered by rural and
regional GPs such as obstetrics or anaesthetics are now largely delivered by
specialists in large regional towns or in major cities. Dr Mara from the Rural
Doctors Association of Australia (RDAA) considered this trend to be
unsustainable:
...we have lost the concept of generalism in medicine as
being a vital thing...We simply cannot afford to have an ever-increasing
superspecialisation, because it is going to cost the government and it is going
to cost the taxpayer too much. At the end of the day, we have to start putting
some investment into people who can do basic things very, very well in a
comprehensive sense.[34]
3.24
Professor Murray from James Cook University and the ACRRM agreed that
the focus should be on producing more generalist practitioners to address the
maldistribution of doctors across the country, and recent actions in the form
of rural generalist pathways are already proving successful:
The big challenge for us in the regions now is to build the
training pipeline into all of the medical specialties, with an emphasis on
generalism. I will close perhaps on the rural generalist point. It is hard to
explain how much of an impact this model has had locally. I have been around
the rural and remote space for a long time. It was a very depressed space.
Doctors' meetings would be full of woe and stories of gloom. I have watched
that turn around, in particular in this area, as there is an obvious prospect
of generational renewal and as people are coming through. What was once a
shrinking healthcare facility now has a buzz and a life to it where people have
taken on new and expanded roles within a teaching-intense healthcare service
that in fact helps to underpin and secure their future. There has been a
profound impact already.[35]
3.25
Doctors Meagher and Douch, who practice in Young, suggested that there
is a lack of "training in procedural skills"[36]
for GPs working in rural areas and there are barriers for GPs wanting to access
that training:
The first one might be a traditional barrier. A lot of the
procedural training appears to have been an add-on to training GPs. If you take
my own case, I was a little unusual in that I did my anaesthetics training
before going out into rural GP practice, so I arrived skilled and trained to
perform an anaesthetic. The usual routine in the past was to make that
procedural training occurred at the end of your time. It meant that you were
getting GP trainees moving out to the country who had no procedural skills.
They were more or less committing to a line of work and a pathway of
development, with family circumstances et cetera. To pick up and leave all that
to go back and do procedural training was difficult.[37]
3.26
They believed that barriers could be overcome in the long term through
generalist pathways:
We see a light on the hill with the ideas being pushed about
generalist pathway training—training people in a more fulsome sense for
practice in the country. That would incorporate, I would expect, some form of
procedural training rather than having it as an add-on. That may be a hope for
the future but, as Dr Meagher pointed out, that will be a long-term solution
rather than a short-term solution.[38]
3.27
The rural generalist pathway that Professor Murray referred to is the
initiative taken by Queensland Health in 2002. Queensland Health explained the
development of the pathway through a paper it delivered at the committee's hearing
on 10 July:
The Rural Generalist Pathway concept was developed in 2002
through a consortium of Queensland Health, the Australian College of Rural and
Remote Medicine (ACRRM), General Practice Education and Training, Remote
Vocational Training Scheme and the Royal Australian College of General
Practitioners (RACGP). The concept responded to the data analysis of rural
medical officer attraction and retention, which indicated longitudinal decline
of rural medical services with increasing dependency on international medical
graduates.[39]
3.28
Dr Denis Lennox, Executive Director of the Office of Rural and Remote
Health at Queensland Health, described the pathway in detail:
We have developed a joined up, principle based pathway from
secondary education at high school through medical training to postgraduate
establishment in practice and registration, and then to vocational training in
Australian general practice training, along with other elements that we require
for the credentials in rural generalist medicine in Queensland, and that
particularly relates to advanced specialised disciplines. We have eight
approved advanced specialised disciplines covering areas of obstetrics,
anaesthetics, emergency medicine, Indigenous health, adult internal medicine,
paediatrics and mental health. These are all disciplines in which these doctors
practice in rural settings that would otherwise be the prerogative of
specialised practitioners in those disciplines.[40]
3.29
The Queensland Health submission defined a Rural Generalist as:
...a rural medical practitioner who is credentialed to serve
in hospital or community-based primary medical practice as well as
hospital-based secondary medical practice in at least one specialised medical
discipline (commonly, but not limited to obstetrics, anaesthetics and surgery)
without supervision by a specialist medical practitioner in the relevant
disciplines. The practitioner may also be credentialed to serve in hospital and
community-based public health practice – particularly in remote and indigenous
communities.[41]
3.30
The first rural trainees have now exited the program, and have been
awarded fellowship of the ACCRM in 2012.[42]
3.31
The committee found that there is significant support for the pathway
from a number of submitters. Rural Health Workforce Australia reported that:
Our advice is that it works in Queensland and that it is
being rolled out. What we need is pathways to rural practice. If that is one of
the pathways then we would welcome it. We need to look at all the pathways that
are available for domestic and overseas doctors.[43]
3.32
The Royal Australian College of Nursing also endorsed the Queensland
Health model suggesting that it could provide opportunities for advanced
nursing practice in rural areas as well:
[The] whole idea of valuing being a generalist—we do not do
that...Well, they do in Queensland now. And I think that the Rural Generalist
Pathway that they have established in Queensland is actually a very good model.
It probably could provide some sort of pathway for nursing to go down as well,
but of course that would require external funding because it is outside of
state government remit.[44]
3.33
However the model has not attracted consistent support across the
professions. Despite being one of the founding partners of the Queensland
Health program the RACGP now say that:
State-based medical workforce initiatives (e.g. Queensland
Health Rural Generalist Program) are working as deterrents to the recruitment
and retention of rural general practitioners...with perceived success in
Queensland due to lucrative salaries which cannot be matched by private
practice. It should also be noted that the term 'rural generalist' represents
a state jurisdictional term and is not a recognised specialty by the Australian
Medical Council.[45]
3.34
In their submission they state that their opposition to the measures
taken in Queensland through the Rural Generalist Program are due to the lack of
evaluation[46]
and the emphasis on secondary or hospital based skills rather that the
enhancement of the GP's skills in the community. The RACGP would rather see a
broad suite of measures designed to "expand the availability and
flexibility of procedural training"[47]
and offer the NSW Rural Generalist Training Program as a good example.
3.35
When appearing at the committee's hearing in Albury the RACGP expanded
on the comments made in their submission:
The feedback we have from some of our members in Queensland
is that private general practice cannot compete with the amounts of money
through the industrial award that Queensland health offers to attract private
GPs. So if as a fourth- or a fifth-year you can get $300,000 working for
Queensland health in a Queensland health facility, private general practice
cannot compete with that.[48]
3.36
Dr Kirkpatrick, the Chair of the National Rural Faculty of the RACGP
provided the example of the situation in Dalby to illustrate the RACGP's point:
At Dalby we have a 20-bed hospital. There are four doctors
employed by Queensland health at the hospital. They work purely in the
hospital. We have three medical practices in town. I work in one of the major
ones there. We have eight full-time-equivalent GPs. We work as VMOs to the
hospital, but we are not employed by Queensland health. If the doctors are not
at the hospital then the private GPs would be picking up the patients. The
patients would get a Medicare rebate and then pay us, whereas the doctors at
the hospital are paid by Queensland Health to see the patients that present at
the hospital.[49]
3.37
The committee is aware of the pressures involved in running a small medical
practice in a rural or regional area. The doctors from the Young District
Medical Centre described the margins they work on as a private practice:
We have a minimum of 55 per cent running costs before the
individual doctors look at their own indemnity, their own running costs,
equipment, superannuation and all of those things so it is only just a viable
proposition. If we are not here working full time then it is not a viable
proposition.[50]
3.38
They then described a typical scenario which impacts heavily on their
ability to staff the practice on a full time basis while also providing public
hospital emergency services:
The demands of the hospital for the four of us doing that
work is not only aligned to the time that we are on call for emergency or for obstetrics
or for anaesthetics when we may get calls but also when we need to do rounds in
the morning to follow-up patients. We can be up there for two to three hours in
the morning. We receive numerous phone calls during the day about patients who
are in-patients, which disrupts the services here, and then we receive
emergency calls during the day to assist Caesareans or emergency airways or
anything during that time.[51]
3.39
When asked about the views of the RACGP, the ACCRM defended the program
on the results it has achieved to date:
I do not really want to comment on another college's approach
or what they have said but I can only talk about what we have seen and the fact
that the rural generalist program and generalist medicine is now very much on
the agenda within other states. We have a successful model now that addresses
what the real workforce needs are within rural and remote communities. Hence,
we would like to see that extended into general specialists within it. Those
are the skills that are missing out of the area, too, so we have a challenge
with that. The strength of it is that it is local training. As I said in my
opening, it is about a totally different approach to workforce, wherein there
is benefit to the community and the doctor providing the services out there.[52]
3.40
Dr Lennox from Queensland Health also countered the perspective of the
RACGP saying that it had "resulted in an increased number of medical
graduates applying to be trained through Australian General Practice Training
to general practice."[53]
Dr Lennox also posed the question of whether the program, and its success in
meeting its objectives, could be replicated nationally:
My response is overwhelmingly, yes, indeed it could. The need
is common with variations upon the theme in each jurisdiction. The innovation
we have embarked upon has been principle based; it is based upon evidence; it
is based upon joining up policy and strategy, and existing operations. It is
evidence based, it is systematic, it is principled and it can be extrapolated to
other jurisdictions, and adjusted according to local need. Providing that
happens, providing that it occurs in a principled way, I would argue very
strongly that, yes, the transformation could be nationalised.[54]
Indigenous Health
3.41
The issue of attracting health practitioners, GPs, and specialists to
Indigenous communities was discussed in the committee's hearing in Alice
Springs and Darwin. The nature of Indigenous health care in rural areas is
often unique in its scope, the type of issues that health workers deal with,
and the management and delivery of health services. The committee heard
evidence from the Central Australian Aboriginal Congress who outlined their
innovative approach to attract health practitioners:
We went from having three FTE GPs and about eight unfilled
positions in 1995 to having 13 FTE GPs and no unfilled positions in the last,
say, four years. The median length of stay is more than seven years and the
average is more than nine years. What made the difference? Remuneration back in
the mid-nineties was terrible, so we had to get more funding. That came both
through greater grants, the Primary Health Care Access Program was very
important, and access to the MBS, which happened in 2006. That meant we had
more funding so we could offer more money. We also needed better working
conditions. We had to get rid of the after-hours on call service because we
were the only ones offering that service. We hung onto that for a long time. We
got rid of it in about 2005. That has further improved workforce retention.[55]
3.42
Dr Boffa from Congress also emphasise the importance in having good
governance and multidisciplinary teams to make the positions more sustainable:
We have effective multidisciplinary teams, so our doctors are
working in an organisation that has good clinical governance processes. We have
psychologists, social workers and alcohol treatment programs. Our doctors do
not feel like they are on their own; they feel like they can refer to other
services, they can make a difference and they can see how they are going in
terms of outcomes. They get that feedback.
That has all helped, but I think Michael Wooldridge's 1999
overseas trained doctors scheme was critical. Without that we would not have a
complete workforce. The GPs...from those countries have all now got their
fellowships. They came under the five-year scheme and got their fellowships,
but most stayed after that. We have only lost a couple at the five-year point.
Most have stayed. [56]
3.43
The importance of collaboration between key stakeholders is another
theme that came out of the evidence in Alice Springs. Congress discussed the Northern
Territory General Practice Education (NTGPE) which is a training provider of
general medical education in the Northern Territory. NTGPE was established in
2002 by:
...a consortium of partners including Flinders University,
Charles Darwin University, GP Divisions of the NT, Aboriginal Medical Services
Alliance NT, the Royal Australian College of General Practitioners and the
Australian College of Rural and Remote Medicine. It is funded by the Federal
Government to provide postgraduate training in general practice, vocational
placements for prevocational doctors and to provide specialised community based
primary care placements to students from medical schools in all Australian
states and also overseas.[57]
Committee View
Queensland Health Rural Generalist
Program
3.44
The committee is of the view that the purpose of a rural health
workforce is to provide access to quality health care for communities in rural
areas and that this goal is best advanced through a significant increase of
rural generalist GPs. The committee is strongly supportive of the efforts of
the ACCRM, the AMA and the other colleges to increase the numbers of rural
generalists in the rural medical workforce through the development of rural
generalist training pathways. The Queensland Health Rural Generalist Program
and the NSW Rural Generalist Program are two such pathways.
3.45
The NSW program endorsed by the RACGP has very similar objectives to the
Queensland program, with an emphasis on providing practitioners in rural
settings who provide:
...primary care to a rural community whilst being
credentialed at the local health service to provide procedural / advanced
skills on their chosen speciality (obstetrics and gynaecology and/or
anaesthetics).[58]
3.46
While the committee did not receive specific evidence on the NSW model,
one of the differences between the two programs is that the NSW program is
aimed at up-skilling GPs in private practice to provide the services required
in a rural setting, for example, providing "care in a rural community and advanced
procedural services at a rural hospital";[59]
whereas the Queensland Health program provides salaried doctors to "serve
in hospital or community-based primary medical practice as well as
hospital-based secondary medical practice"[60].
3.47
On evidence received, both in written submissions and orally, the
committee is not convinced by the argument from the RACGP that the Queensland
program is a long term deterrent to the retention and recruitment of rural
general practitioners. The program is now training an additional 50 new
graduates per year and is committed and funded to do so over the next five
years.
3.48
The committee is strongly supportive of the Queensland Health initiative
to develop a program based on local needs. The evidence the committee has
received has also endorsed the program as being successful in delivering
increased access to healthcare in rural areas.
3.49
The committee accepts that this program may not be suited to all areas
of the country, and each state and territory Government may wish to explore
different pathways to provide increased access to health care tailored to local
need. However it does not consider this to be sufficient grounds to reject
innovative programs such as the Queensland model.
3.50
The model adopted by the Central Australian Aboriginal Congress displays
innovation necessitated by need. The emphasis on multidisciplinary teams
allows professional development across the health specialties and appears to be
successful in combating professional isolation. The collaboration between
different education providers to provide health workers and training
opportunities has also led to a steady flow of GPs, nurses and allied health
workers that appears to be sustainable. As discussed in Chapter Two there are
difficulties in the supply of Aboriginal Health Workers that need to be
managed, but the committee was impressed with the systems put in place by
Congress to provide a blueprint for centrally managed healthcare in remote
areas.
Increasing the number of
Specialists in rural areas
3.51
The committee welcomed the evidence from the RACP and COSA as it
illustrated the complex nature of health care delivery in rural areas. The
changing pattern of chronic disease management requires more than GPs to
provide care to rural and regional populations and the description of the
Wangaratta model of physicians' outreach provided a template for the type of
care the committee would like to see delivered across rural and regional
Australia. The committee also took an interest in discussion about whether medical
practitioners could be contracted to provide care in these areas.
Recommendation 3
3.52
The committee recommends that the Commonwealth place on the
agenda of the Council of Australian Governments' Standing Council on Health an
item involving consideration of the expansion of rural generalist programs. It
further recommends that, as part of that agenda item, the Council consider an
evaluation of the Queensland Health Generalist Program and whether it should be
rolled out in other jurisdictions.
Recommendation 4
3.53
The committee recommends that the Commonwealth government work with
education providers and the medical profession to address the issue of the
inadequate supply of rural placements for medical interns in their pre-vocational
and vocational years.
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