AMA Rural Reference Group Formally Rejects Bonded Medical Places

AMARRG members are GPs, specialists, and doctors in training who live and work in rural and regional Australia.

Their motion reflects the views of the AMA as expressed in a recent letter to Health Minister Tony Abbott from AMA President, Dr Mukesh Haikerwal.

Dr Haikerwal told the Minister that while the AMA is very supportive of the Government's scholarships for rural medical students, rural clinical schools, and measures to increase the number of medical school students with a rural background, the bonded medical places may have short-term political appeal but will deliver no longer-term medical workforce gains.

"The AMA's position has now been endorsed by our rural doctors," Dr Haikerwal said today.

"The AMARRG agrees with the international evidence that you cannot build a sustainable medical workforce in rural areas by conscription.

"They are saying from personal experience that rural communities want doctors who are committed to working in rural areas, not people who are forced to go there against their will.

"The increase in private full fee paying places also highlights the unfairness of unfunded bonding - people with lots of money can avoid bonding, whereas more disadvantaged students may be forced to take a bonded place as their only means of fulfilling their dreams of entering medical school.

"We urge the Government to scrap the unfunded bonded medical places and maximise rural medical workforce efforts on the programs that will actually deliver doctors to our country towns and communities," Dr Haikerwal said.

The AMARRG passed the following motion:

The AMA Rural Reference Group endorses existing AMA policies that oppose the unfunded bonding of medical schools places as international evidence demonstrates that such policies are ineffective in delivering sustainable medical workforce increases in areas of workforce shortage. The AMARRG strongly believes that participation in schemes that include a return of service obligation should be incentive based.

The AMARRG considers that conditions imposed on participants must be fair and equitable, and the return of service obligation should not exceed the length of the medical degree. All periods of service in workforce shortage areas following graduation from medical school should count towards the return of service obligation.

Background

In February, the Council of Australian Governments (COAG) meeting announced an increase in the permitted number of domestic full fee paying medical school places from 10 per cent to 25 per cent of enrolments.

On 8 April, the Prime Minister announced a further increase of 400 HECS-funded medical school places.

The 400 new places will be phased in between 2007 and 2009. The PM's announcement in April stated that a proportion of the 400 new places would be bonded. A specific figure was not nominated.

There are currently 246 bonded medical places available each year and the Government is wedded to this policy initiative. However, available evidence suggests that bonding is ineffective in delivering long term sustainable improvements in workforce shortage areas.

Further, the bonded places provide no financial support for the students, with the entry to medical school the only benefit to offset return of service obligations.

When discussing these types of schemes, a 2003 paper prepared by the Organisation for Economic Cooperation and Development stated that they '…have generally not proven to be successful because a substantial number of students have been able to buy their way out of their return of service commitment and few students remain in rural or deprived urban areas after their required period of service has transpired'.

An international literature review published in 2004 by the Canadian Journal of Rural Medicine also backs these conclusions.

This paper highlighted that long-term retention rates of bonded doctors in workforce shortage areas is very poor, with retention rates around half that of doctors who practised in these areas voluntarily.

Some studies it reviewed showed that up to 38 per cent of students chose to 'buy-out' their bond.