THE Review of Australian Government health workforce programs (the Mason review) was released last week. While the report might stimulate reforms to certain rural recruitment and retention initiatives, it represents a missed opportunity to thoroughly evaluate federal workforce schemes.
The review had an incredibly broad brief to analyse and assess all “Commonwealth programs and activities designed to increase, train, support, plan for and distribute the Australian health workforce”. The terms of reference called for recommendations on the “appropriateness, effectiveness and efficiency” of about 70 different initiatives funded by the Department of Health and Ageing.
When first proposed, the review was supported by stakeholders on the basis that it would facilitate a thorough evaluation of health workforce programs. Whether the report has lived up to those expectations remains to be seen, particularly in relation to schemes that are costly to the taxpayer and restrictive for trainees.
Despite its 451 pages and 87 recommendations, the report makes several comments about the need for further assessment. For instance, it suggests a “full evaluation” of the Specialist Training Program in order to “inform its future direction and to ensure existing posts are meeting the objectives of the program”. Some will consider this a disappointing conclusion given the explicit objectives of the review.
There are also likely to be concerns about the methodology. Despite the broad brief, most consultations were held in roundtable format with organisations given limited time to summarise their views. More importantly, no attempts to collect new data were made and the report makes few references to the underpinning evidence base.
These limitations are partly acknowledged in the report and reflect constraints in the terms of reference. Despite this, early indications are that the review will influence government policymaking.
Health Minister Tanya Plibersek has already committed to action two recommendations — the formation of an integrated rural training pathway and the redesign of the Australian Standard Geographical Classification–Remoteness Area (ASGC-RA) system used to determine eligibility for various incentive payments.
Not surprisingly, these have both been strongly endorsed by rural doctor groups. This reflects broad recognition that the ASGC-RA system provides a disincentive to practice in certain rural communities as it allows equivalent incentives to be paid to doctors working in larger regional centres.
Other rural-oriented recommendations include revision of the district of workforce shortage classification system, phasing out of the Medical Rural Bonded Scholarship (MRBS) scheme and “major reform” to the Bonded Medical Places (BMP) scheme. This won’t satisfy those stakeholder groups who oppose the BMP scheme, but the proposed adjustments to the Return of Service (ROS) obligation (including clarification of eligible locations) may appease affected trainees.
Somewhat paradoxically, the report initiates a discussion around the universal conscription of medical graduates to areas of workforce shortage. Despite the constitutional barriers, this suggestion is likely to alarm medical students and professional associations alike.
Other health scholarships, retention schemes, international recruitment processes and Aboriginal and Torres Strait Islander workforce initiatives are also covered in the review. Health Workforce Australia is singled out, with the report proposing three distinct options for addressing “legitimate” concerns regarding overlap with health department roles and responsibilities.
Notwithstanding its comprehensive analysis, the Mason review seems to have fallen short of its ambitious objectives. Many of the recommendations reflect stakeholder opinion, but it has failed to address in quantitative terms fundamental questions in the terms of reference.
In fairness, one of the difficulties in evaluating workforce programs is the timelines involved. For instance, despite operating for a decade, only one graduate has started their ROS obligation for the BMP scheme. It is concerning though that three graduates have already bought their way out of their commitments.
While the complexity of collectively evaluating all federal workforce programs is acknowledged, a robust data collection strategy could have been commissioned as part of the review. Objective evaluation is essential to realising value in workforce programs.
Due to its size, it is likely to take some time for stakeholder organisations to respond to the report. More critical, however, is whether the government will implement any of the remaining 85 recommendations.
The review chair, Ms Jennifer Mason, deserves congratulations on compiling a detailed analysis of federal health workforce programs. Despite its intrinsic limitations, it makes some logical recommendations that deserve consideration.
Dr Rob Mitchell is an emergency registrar at Townsville Hospital and a director of Cor Mentes Health Consulting. Dr Will Milford is a senior obstetrics and gynaecology registrar at the Mater Mothers’ Hospital, Brisbane.