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Bush outlook brightens with classification overhaul

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Thanks to robust lobbying by AMA President Associate Professor Brian Owler and the grace of Assistant Health Minister Fiona Nash, the review of the geographical classification systems used to distribute rural incentives is back on track.

This is significant. In all, 48 incentive programs are operated using such classifications, and I was excited to attend the reconstituted Rural Classification Technical Working Group meeting in Canberra on 25 November, where the newly-adopted Modified Monash Model was presented.

The Modified Monash (MM) Model uses town size as a key determinant in arriving at has seven remoteness classifications:

MM1: (formerly Remoteness Area 1);

MM2: RA 2 or 3 with population >50,000;

MM3: RA 2 or 3 with population 15,000 to 50,000;

MM4: RA 2 or 3 with population   5,000 to 15,000;

MM5: RA 2 or 3 with population <5,000;

MM6: RA 4; and

MM7: RA 5

The new classification system recognizes the fact that the facilities a town is likely to have varies according to its size.

The model includes buffer zones at the edge of Urban Centred Locations (UCLs), as delineated by the Australian Bureau of Statistics. This is in recognition of the fact that small towns sitting on the fringes of larger centres are not treated the same as those located more remotely.

For areas with an MM2 classification, this buffer zone extends 20 kilometres out from the fringe. For areas classified as MM3, the buffer zone is 15 kilometres, and for MM4 areas it is 10 kilometres.

When explored in detail this works well, with far fewer anomalies than the existing system, though they still occur.

One stand-out anomaly under the MM system is Kalgoorlie, which deserves a higher score (MM3) than it has currently been allocated.

State AMAs, workforce agencies and medical Colleges are closely examining the outcomes of the new model and will challenge any further anomalies they identify.

One of the oversights in the introduction of the new system has been that there is no mechanism for review or appeal when problems are identified, and this is something that the AMA will push strongly for.

Importantly, the classification accorded to a town or community is not set in stone – they will be regularly updated using information from the National Census.

No model can be perfect, but the Modified Monash Model is a quantum leap forward in more effectively targeting incentives.

In another welcome development, Senator Nash has decreed that Bonded Medical Scholars can serve their bond in towns of less than 15,000, irrespective of their District of Workforce Shortage (DWS) or Area of Need (AON) status – they will no longer be forced to move on just because of a change in their community’s DWS or AON classification.

Further, she will strive to simplify the DWS and AON systems by scrapping the current system of quarterly reviews. Instead, status will be determined and set on an annual basis. This will be a blessing for overseas-trained doctors.

In overhauling the existing unsatisfactory system, the Government has not stopped there.

A new Panel is to be set up to review current rural incentives and recommend ways to better support the rural training of junior doctors.

It seems this review is expected to work with lightning speed, because on my return from attending the Working Group meeting in Canberra, I was greeted by a letter stating that one of these incentive arrangements, the John Flynn Placement Program, has been placed on hold pending Ministerial Review.

This program has been around long enough for there to be ample evidence of whether or not it has been effective – hopefully it will be found to have sufficient promise and achievement to justify its continuation.