Interview - Dr Bill Glasson, AMA President, with Kathy Bedford, ABC Gippsland, Morning Show - Federal Government proposed medical bonding scheme

COMPERE:     Well trying to get doctors to work in smaller country towns is an ongoing battle.  Recently, the Federal Government proposed their bonding scheme, which was not supported by medical students or doctors.

Well as of today the AMA has come up with their own plan to get more new doctors to work in country areas.  Joining us to explain is AMA president, Dr Bill Glasson.  Good morning, doctor.

GLASSON:      A very good morning to you Kathy.

COMPERE:     Now what's your scheme, doctor?

GLASSON:      Well essentially, Kathy, what we've done, we've gone to the - We did a survey on 700 medical students around this country and essentially they have, you know, openly rejected the Government's proposal of this unfunded bonded scheme.  And essentially it has - feels that it has no merit to - particularly from the point of view of solving the real medical workforce crisis.

And so we said to them listen, what system do you then feel is appropriate, what would be attractive to you?  And they essentially came back and said listen, first and foremost is that students should obtain a medical school position based on merit and not on their - not on a basis of them having to accept a government unfunded position.

Now the reality there is that students with higher qualifications or higher up the ladder may in fact miss out on positions because somebody decides, lower down the ladder, to accept one of these so called government bonded positions.

Now as well those positions were going to be totally unfunded.  A lot of people don't realise that.  They thought it was going to be sort of a scheme whereby the students were given some assistance during their course.  But essentially all they were going to be given was a medical school place.  They would be given no funding during the period of their training and then approximately 12 years after they started they would have to give 6 years of service back to a of need.

COMPERE:     But these university positions, these bonded positions, that was going to create 234 fully funded new medical places, that's got to be a good thing.  We'd at least get more doctors.

GLASSON:      But Kathy, you said fully funded.  That's not true.  Essentially they weren't going to be funded at all.

COMPERE:     Not funded - no, no funded as in they were new places that the universities could offer.

GLASSON:      Absolutely.

COMPERE:     The students still have to pay, which is a reasonable thing of course.

GLASSON:      But what we're saying - listen - the 234 places we totally agree with.  We in fact need more than that.  We think we need probably near a thousand places.  But the reality is that the mechanism that the Government was proposing will not address the workforce shortage.

What we're suggesting is that if the students get their places on merit and then you go to that group and say listen, we've got in Victoria, for instance, we've got 20 scholarship positions here, and that's what we're suggesting a scholarship position, where we will pay all or part of your medical school training and at the end of your training as a medical student, you may then move into say general practice training.  You can then begin to give your return of service to areas of need.

Now that may be in rural areas or may be in some provincial areas.  And essentially it will attract people in particularly the area of general practice.  The current scheme in fact will be a - will detract people from doing general practice because what'll happen they'll tend to try and do those specialities in which they cannot be shipped out to rural areas.  And so it is a disincentive to do general practice.

Under our proposal I think it will be a definite attraction to go into general practice.  It will attract those - importantly as well they'll have a workforce much earlier.  In other words they'll aim to return service probably within five years of starting.  So it'll address the workforce shortages much quicker.

COMPERE:     Doctor, I think you're confusing for our audience the bonding system a little bit.  If the students accept one of these bonded places then they are - that was the whole deal that they would be contracted to work in a regional area.  So it is addressing that problem of getting doctors to work in country areas.

GLASSON:      Yes but under our scheme its - you'll take that scholarship on with clear light, that you already have a medical school place and with the clear knowledge that you take this as a scholarship.  In other words you have part of your course funded with the full knowledge that you do have to give return of service.  Now there is an important difference to that, Kathy.

COMPERE:     Not surprising that your students are much happier with a scheme where they're going to get a university degree at a very cheaper price.

GLASSON:      Absolutely.  I mean that's the carrot approach.  What you do is say to students, listen, here's an incentive for you to take the scholarship on board, that will help you through your medical course, and as you know they're getting quite expensive now to fund medical courses, and you have a return of service obligation.  That's given in the full light you already have your medical school place.

The previous system: You only get your medical school place if you agree to a 6 year bond which is unfunded that you return 12 years after you start your medical course.

COMPERE:     You don't think that's a good carrot for students?  And we know how hard it is to get into medicine these days.  These are students that might miss out by half a percent on their final VCE score, who would get a place just to give 6 years in a rural area.

GLASSON:      That's true.  But the reality is in 12 years time most of those students might in their early 30s and essentially they'll have established their life, married or whatever.  And I can tell you that they'll think about every way possible how to get out of the scheme.  They will not be committed to the process.

But if you accept a scholarship with the full knowledge that it's not being forced upon you, that you really want to do this, then you are more likely to return the service obligation.

COMPERE:     What's your scholarship program likely to cost?

GLASSON:      Well essentially for the 234 students, we're probably looking at about $4 million a year.  Now we think that's small bikkies when you're talking about 234 doctors that you can put into the needy rural areas around, you know, the likes of Victoria and New South Wales etcetera.  So we think it's got - we think it's got legs.  We think that it's attractive and importantly we think it will make a difference.

But the current government scheme, our feeling is that it will not make no difference at all.

COMPERE:     Well Health Minister, Kay Patterson, hasn't seemed too concerned that the AMA isn't supporting the Government's bonding scheme.  She says the Australian public support is the important thing and the public wants access to doctors.

GLASSON:      You're right Kathy.  But I don't think the public understands the implications of the Government package.  In fact I don't think half the politicians in Canberra here understand the implications of the Government's package.

What we're say - what I say to my rural colleagues, and that's where I come from myself, is that I want a scheme that will work and the current Government scheme will not work and will not solve the problem.

I feel the proposal that we're putting up here will work, I was a Government - I was a bonded scholarship holder.  I went out west and served my time in the bush, and I loved it.  And what I want to say is that those people who accept these scholarships will have a similar philosophy in a sense that they want to go and service the people in the bush and I think it's the answer that we need.

COMPERE:     It sounds a little bit like semantics.  If they're accepting a university position that they wouldn't otherwise normally get, what's different to accepting a scholarship if they are accepting those are the terms, that you go out and work in the bush, it is just semantics?

GLASSON:      No.  The big difference is that you are getting your medical student place on merit, first and foremost, and then you're offered - you're not forced into it, you're offered a scholarship that you consider that it's going to help your financial needs during the time of the course.

COMPERE:     Yeah, which will then bond you to working in the bush.

GLASSON:      Yeah, which will then give you a service obligation to return to the bush.  And that will work.  Now that's a very, very important difference to saying to a student, you can only have this place, by the way, and you might jump the queue above other people who should have got the place, in the grounds that you'll return of services - you'll give 6 years of return of service in 12 years time.  That will not work.  And by the way we're not going to fund you a dime.  That is a stick, not a carrot.

COMPERE:     Doctor, have you had any response from the Federal Government with your plan?

GLASSON:      I went up to Parliament House yesterday and spoke to a number of politicians on both sides, putting our proposal very strongly.  And essentially at this stage we got a good hearing.  But for the final result is, you know, yet to be heard.

COMPERE:     You're a doctor who practices in a rural area.  Why do other doctors seem to need so much persuading to do this?

GLASSON:      Kathy, I always say the solution to the rural medical workforce crisis is three things: The doctors have to - the students have to come from the bush in the first place; they have to in part train in the bush and I always say the most important thing is they have to marry in the bush.

Now if you've got those three elements in fact you've got a doctor for a lifetime.

COMPERE:     So we need more bush wives?

GLASSON:      We need more bush wives.

COMPERE:     And husbands.

GLASSON:     And bush husband too, by the way, because 50% of the medical workforce are females.

COMPERE:     All right doctor, thank you very much for that.

GLASSON:      Thanks, Kathy.

COMPERE:     Doctor Bill Glasson is the AMA president.  The AMA scheme to get more doctors into the bush is to give scholarships to doctors who will then be bonded to country areas.  Sounds like a bit of a play on words to me.  What do you think?

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