Doctors for Rural Communities
a practical solution to the shortage of rural doctors
Distribution, not numbers
Evidence-based policy required
Collaboration is key
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.
$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.
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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.
|MDMS||Doctors for Rural Communities|
|Cost||$46 Million AUD||$46 Million AUD|
|Number of Doctors||0 – will create 110 medical students each year||306 working doctors for 1 year OR 61 doctors a year for 5 years|
|When will the doctors start work?||In at least 5 years time||Immediately|
|Community Expansion||More students||More 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||Unknown||100% guarantee as all doctors will work in rural areas during expenditure period|
Dr Darryl Mackender
Gastroenterologist at Orange Base Hospital
JMO Prince of Wales Hospital
Rural Generalist Registrar in Cleveland