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Rural Health System Resources


Bonded rural program fails


Holly Payne


The Bonded Medical Places scheme was established in 2004. In return for the payment of the student contribution to the HECS fee, participants agreed to work in an area of medical workforce need for a specified period after they completed their Fellowship (which could be 10-15 years after commencing medical school).

Why is this useful for rural and remote people?

There are numerous programs promoted by governments, universities and industry to rural and remote communities as a solution to 'rural doctor shortages'. But how effectively are they really? The fact that we have had these programs for more than 20 years, and rural doctor shortages are now worse than at any other time in Australian history, suggests that these programs have not delivered the outcomes that were promoted to rural and remote people.

In 2013 the Mason Review of Rural Health Workforce Programs concluded that the Bonded Medical Places program was being used by predominantly city medical students as a ‘low interest loan scheme’. The Mason Review found that only 3 of some 7,000 medical students had actually completed their return of service obligation by 2013. In 2017 an independent audit found that of nearly 10,000 participants who receive a fully funded medical student place under the Bonded Medical Places scheme since 2001, less than 1% had actually completed their return of service obligation to work in an area of workforce need. A Senate Inquiry recommended that the program be abolished.

Ochre Health is a large provider of health services in rural communities. When asked about the attitudes of bonded medical students he has spoken to, and whether bonding has encouraged them to work rurally, one of its directors Dr Hamish Meldrum said: “They laugh at me and say: ‘No. Nobody wants to go rural. We just put down that we want to be rurally bonded students so that we can get into medical school.”

This article is important reminder that rural and remote people need to be constructively sceptical about claims made about rural health programs. Rural and remote people need to rely more on their own eyes, and common sense, in evaluating claims that are made about whether a program or funding is likely to result in more doctors in their community. After 20 years the question rural and remote people should be asking is not "will this deliver more GPs who live and work in rural and remote towns" but rather "how many more GPs are now living and working in rural and remote towns as a result of this program". If the answer is 'nil' or a small number, then clearly the program does not work and the money needs to be redirected to rural and remote communities to support their ability to recruit and retain workforce.

Over the last 2 decades the number of rural GPs has fallen dramatically, despite the expenditure of billions of dollars on rural medical workforce programs. If rural health is to improve, rural and remote people need to openly test claims about rural medical workforce programs and hold their local members, governments and universities to account for outcomes.

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