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Doctors for Rural Communities

a practical solution to the shortage of rural doctors

Regional, rural and remote Australia continues to experience workforce shortages despite an increase in the number of medical graduates. The rural doctor shortage is not one of gross numbers in Australia but rather one of maldistribution, as doctors are faced with a lack of adequate training and working opportunities in rural communities. We need greater opportunities in rural Australia for doctors to complete their training. It is time to train more doctors in the bush, for the bush.

Distribution, not numbers

Australia has a shortage of rural doctors because the masses of medical graduates do not have adequate rural training opportunities.

Rural focus required

The Specialist Training Programme (STP) is a step in the right direction however requires a heavier rural focus and longer placement options.
What is the STP?

Evidence-based policy required

There is no evidence to prove that regionally-based positions are inferior to Australia’s current metropolitan-centric system.

Collaboration is key

The development of regional training hubs is dependent on the collaboration of hospitals, colleges and governments to deliver high quality training to high quality applicants.

Training system infrastructure

This proposal calls for long-term training positions in regional centres to retain rural students and junior doctors who are in these areas. It would require the specialist training colleges to review the evidence of their accreditation levels which currently dictate that doctors must move to metropolitan hospitals if they are to complete the majority of their specialist training.

The Colleges of General Practice and programs such as the Remote Vocational Training Scheme provide models to learn from if we are to rural training hubs. A partnership between existing rural clinical schools and hospital administration would have great utility in providing non-clinical support and rural community immersion for the doctors who would be funded in this proposal

 

Evidence Base of the Doctors For Rural Communities

The base public funding requirement for a registrar training position was calculated as a part of the Department of Health Specialist Training Programme (STP) – a federal initiative that currently funds 900 Registrar positions Australia-wide. A recent review of this programme identified that the public cost of each position as $100, 000 per annum. This was further augmented by a rural loading of $20,000 per annum. Any further proposals that incorporated similar public funding contributions would therefore be similar in nature.These targeted outcomes provide a fundamental advantage over a generalised approach to rural shortfalls and exists as a funding expansion of an already successful programme.

Cost Breakdown

$120 000pa is the cost of having a registrar-level trainee doctor in a regional area. In addition, costs of clinical supervision and training infrastructure in private sector is set at $30 000 pro rata per FTE per annum.

What people are saying

“From my experience as a student, the longer you’re able to stay in a rural community the more trust you’re able to build with the staff, and ultimately that translates to more clinical opportunities. That’s something that many of the heavily populated metropolitan sites are often unable to match.” Skye

Medical Student in Melbourne, from Bendigo, Vic

“I have trained medical students and young doctors in Wagga Wagga only to see them forced to leave the country to undertake 6 years of training in Sydney or Melbourne. Post graduate training tends to occur at a critical time in a young persons life and coincides with ‘putting down roots’ . Losing our young country doctors to the city for training may well mean we lose them forever.” Dr John Preddy

Paediatrician, Head of Department, Wagga Wagga Rural Referral Hospital

“My rural background makes me passionate about rural health and determined to live and work rurally. However the current training structure makes it difficult for me to keep my career options open. Rural doctors shouldn’t be restricted by their choice of specialty” Michelle

Medical student in Albury, from Orange, NSW

What is your experience?

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“It is clear that longevity in rural practice is determined by quality over quantity.Rural background students are well known to be more likely to work rural and research is growing around positive rural experiences and personality. Current medical schools use these principles however opening yet another medical school is not an evidenced-based solution.” Emily

Medical Student in Katherine , from Alice Springs NT


A Case Comparison

Another suggestion to tackle the rural doctors shortage is to build more medical schools in rural areas. The benefit being, more rural people will study medicine, stay in the bush and fix the rural doctor shortage.However, this does not account for the challenges in the rural training pathway after graduation, which would force many rural graduates to move to the city.

  The simple table below conveys the opportunity cost between the two ideas using the Murray Darling Medical Scheme proposal, requiring a public contribution of $46 million, and a rurally focused Specialist Training Program of the same investment.

MDMSDoctors for Rural Communities
Cost $46 Million AUD$46 Million AUD
Number of Doctors0 – will create 110 medical students each year306 working doctors for 1 year OR 61 doctors a year for 5 years
When will the doctors start work? In at least 5 years timeImmediately
Community ExpansionMore studentsMore doctors, higher expenditure and economic injection, more likely to have families and settle, increased medical facilities will draw in more patients who usually have to go to the city
Doctors who will work rural form the investment Unknown100% guarantee as all doctors will work in rural areas during expenditure period

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Our Supporters

Dr Darryl Mackender

Gastroenterologist at Orange Base Hospital

Amelia Street

JMO Prince of Wales Hospital

Michael Mclaughlin

Rural Generalist Registrar in Cleveland