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Concerns persist over rural health fix

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The Federal Government has rebuffed calls for an increase in the quota of medical students who come from rural backgrounds despite concerns initiatives to boost medical services in country areas will continue to fall short.

The Government has been accused of sending mixed messages on its rural medical workforce policy after using some of the funds freed up from cutting almost $600 million from health and aged care workforce spending to fund new programs intended to improve rural training opportunities.

It used its 2015-16 Mid Year Economic and Fiscal Outlook (MYEFO) to unveil a $93.8 million Integrated Rural Training Pipeline intended to improve the retention of postgraduate prevocational doctors in country areas.

The Pipeline includes the establishment of 30 regional training hubs (which will receive $14 million a year); at least $10 million a year for a Rural Junior Doctor Training Innovation Fund to foster new training approaches; and $16 million a year to fund up to an extra 100 places in the Specialist Training Program through to 2018.

Minister for Rural Health Fiona Nash said the funds for the initiative had been obtained by improving the targeting of existing health workforce programs and activities.

“The Australian Government invests more than $1 billion a year in programs to build the health workforce,” Senator Nash said, citing as an example the fact that, in 2014, almost 80 per cent of clinical placements were in metropolitan areas.

A further $130 million of health workforce spending is to be redirected into an expansion of the Rural Health Multidisciplinary Training program, with particular focus on addressing workforce shortages and increasing support for training in nursing, midwifery and allied health.

“Our objective is to provide the most effective support for health students to train in areas of need,” Senator Nash said.

But the impact of the announcement has been tempered by concerns that the overall effect of the changes is a net loss of funding for health workforce programs.

Health Minister Sussan Ley admitted as much when, in a statement released on 15 December, she confirmed that only a proportion of the $461.3 million the Government expects to save by “rationalising” existing workforce programs would go to fund the new initiatives, with the rest “being sensibly invested into Budget repair”.

Prior to the release of MYEFO, the AMA had urged the Government to make it mandatory that one in every three medical students be recruited from a rural background, and that the proportion required to undertake at last a year of clinical training in a rural area be increased from 25 to 33 per cent.

The AMA has welcomed the expansion of the Specialist Training Program, but President Professor Brian Owler said that country areas were still struggling to attract and retain sufficient locally-trained doctors despite record numbers of medical graduates.

“The ‘trickle down’ approach to solving workforce maldistribution is not working,” he said. “Australia has enough medical students, and the focus must now shift to how to better distribute the medical workforce.”

The AMA President said there was good evidence that medical students from a rural background, or those who undertook extended training in rural areas, were more likely to take up practice in the country upon graduation.

The AMA said less than 28 per cent of commencing domestic medical students came from a rural background, and recommended that the Government increase the current intake target from 25 to 33 per cent.

Professor Owler said significant action was needed, with a recent survey showing less than a quarter of domestic medical graduates lived outside the nation’s capital cities.

“The implementation of more ambitious targets may prove challenging in the short term, but there is evidence that this approach would be more successful in getting more young doctors living and working in rural Australia,” he said.

But the Government has so far resisted the suggestion.

Instead of increasing the rural medical student quota, universities have been directed to set their own targets for rural background students.

A Health Department spokesperson told Medical Observer that, even without a higher quota, a third of medical students in 2014 were of rural origin.

Adrian Rollins