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Medical Deans’ response to the Mason Review

By | Friday, August 30th, 2013
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August 2013

KEY ISSUES

1.     MEDICAL STUDENT BONDING SCHEMES –MRBS AND MBS

Medical Bonded Scheme (MBS)

Medical Deans acknowledge

  • Options for reform of the Medical Bonded Scheme (MBS) are complex
  • It is too early to know the actual impact of the MBS Scheme – out of the over 5000 participants in the scheme only one has commenced the return of service period and three have bought out
  • A recent survey suggested as many as 26% of participants in 2012 intended to buy out of the MBS scheme

Medical Deans support

  • Any changes to the MBS Scheme are fairer/more transparent/have low administrative costs and support networks that better meet the needs of the bulk of students
  • Any move to phase out of the scheme would result in transfer of MBS places to standard CSP places
  • Changes to the return of service obligation of the MBS to provide greater certainty and fairness (Recommendation 6.8)

Medical Rural Bonded Scheme (MRBS)

Medical Deans acknowledge

  • While there are a number of strategies currently in play to address the shortage of doctors in rural and regional areas there is still limited evidence about the long term effectiveness of these individual initiatives including the MRBS
  • The importance of initiatives that support the training of the current pipeline of medical graduates, particularly in rural and regional settings

Medical Deans believe it would be premature to make significant changes to this scheme at this stage
(Recommendation 3.15)

 2.     INDIGENOUS HEALTH

Medical Deans acknowledge

  • There has been a 61% increase in the number of Indigenous
    Australian doctors between 2006-2011 but that Indigenous
    Australians currently only make up 1.8% of the health workforce

Medical Deans support

  • A consultation process to consider appropriate Indigenous
    Australian health student targets that ‘take account of the capacity of jurisdictions and universities to provide education opportunities for Indigenous
    Australians in different demographic areas’
  • Any targets are incentivised
  • Any redirection of funds does not disrupt activities of universities providing good outcomes
  • LIME Network model be adopted by other health professional networks
  • Priority be given to improving Indigenous medical student retention and graduation rates

3.     RURAL TRAINING and CLASSIFICATION

Medical Deans acknowledge

  • The Government has made significant infrastructure investments in rural training through the establishment of Rural Clinical Schools and the previous RUSC funding
  • One of the most significant barriers to retaining committed graduates in rural areas is the lack of clear and certain training pathways in the prevocational and vocational space
  • Clinical supervision capability of all learners in the medical training continuum in many rural areas is reaching capacity
  • Initiatives in this space require the support of many significant stakeholders including the specialty Colleges

Medical Deans support

  • The Commonwealth taking a lead role in integrating rural training pathways that links its investment in rural undergraduate medical training with new support for rural intern places and continued growth in specialist training positions. (Recommendation 4.1)
  • The distribution of medical graduates should be the priority rather than further increasing domestic graduate numbers (Recommendation 4.4)
  • Development of integrated vocational rural training pathways in collaboration with the existing Rural Clinical Schools(RCS) and their networks where there is capacity and adequate funding support (Recommendation 4.6)
  • The mandatory 4 week rural clinical placement as part of the Rural Clinical Training and Support program should be abolished in favour of longer term high quality electives. This should not affect the total funding to support rural clinical placements. (Recommendation 4.6)
  • Consolidation of RCSs with UDRHs on a case by case basis (Recommendation 4.11)
  •  RCSs be expanded to be multidisciplinary on a case by case basis (Recommendation 4.5)
  • A new rural classification system, which is more transparent, avoids the unintended negative consequences of the current AGSC-RA classification and allows more targeted program investment such as RCTS and RAMUS scholarships
  • The new rural classification system should be appropriately adapted to the needs of health workforce programs to recognise differing access to health services within regions

4.    HEALTH WORKFORCE PLANNING AND PROGRAMS

Medical Deans acknowledge

  • The Commonwealth programs and Health Workforce Australia have made significant contributions to addressing health workforce supply, retention and redistribution issues
  • The availability of multiple programs coupled with the complexity of multiple stakeholders inevitably leads to some inefficiencies and sometimes perverse incentives in clinical workforce training and practice
  • Having a robust evidence base such as reports like Health Workforce 2025 are fundamental to developing sound policy in the workforce space

Medical Deans support

  • A national approach to managing clinical training funding in the public health sector through work by IHPA and HWA
  • The Commonwealth and the States and Territories to work collaboratively to address medical workforce issues

Please click here to view a full copy of the Mason Review.

Welcome Address at LIME Connection V: How can Medical Deans make a difference

By | Thursday, August 29th, 2013
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“Our conference is being held on the traditional lands of the Larrakia people and I wish to acknowledge them as Traditional Owners. I would also like to pay my respects to their Elders, past and present, and the Elders from other communities who may be here today.”

So welcome to all delegates of LIME Connnection V and particularly the members of the organising committee and host institutions who made all this happen.

I think you will all agree – it has been an inspiring and passionate conference – and there is still Day 3 to come.

I wish to welcome people from a range of sectors including government, health service delivery, education and training and advocacy, from every state and territory, from across the ditch and further afar.

And at the heart of this conference are you, our educators. Often forgotten. But not this week. On behalf of Medical Deans I say thank you.

But you are all here because you care.

You are all here because you share the passion to improve the quality of indigenous health care delivery through our education and training pathways.

I also wish to make special mention of the Medical Deans in the room today including Professor Nicholas Glasgow, Professor Christine Bennett, Professor Alison Jones, Professor Michael Kidd, and Professor Ian Puddey. It is your leadership that is vital for realizing the aspirations of all in this room.

On a personal note – it is lovely to return to Darwin – the home of my family too. While I only lived here for a relatively short time, a part of my heart is still here with them.

But this conference is all about you and the power of your networks and commitment.

That is why Medical Deans, as an organisation, wants to be part of this extraordinary movement. This is core business for us.

There is no doubt that my recent time spent in NT Health working alongside long term dedicated doctors in remote Indigenous Health (some of whom are here in the audience today) was very confronting.

In fact it was very distressing and left me initially with an overwhelming sense of hopelessness –I suspect not unlike that felt by many in these communities.

What I saw was band aid medicine…. with the band aids peeling off instantly as patients, children in particular, left the clinics.

And of course this was the very reverse of what was intended and what the health care workers in these areas were striving (and some for many many years) to achieve.

Today I also wish to take this opportunity to publicly thank them for giving me the opportunity to understand these challenging issues first hand.

When it comes down to it I think we can all name what’s not working. The challenge of course is finding solutions.

And we all know it is not one size fits all.

It is not the same for the communities of Manningrida or for Redfern.

But we do know there are some great initiatives and some communities where things are turning around.

And we all need to be part of the solution. Working collaboratively. Working together. Doing what we can in our own way.

It also means being able to say some of the hard things. In safety. With respect. In a way that helps us move forward.

There is room for improvement on important issues in the area where the majority of us work.

These include:

  • improving indigenous medical student graduation rates,
  • looking after our small but growing pool of indigenous health leads as they get pulled in multiple directions
  • building capacity in the system so all health care students grow their passion for Indigenous health while at the same time supporting the clinical supervisors in an already heavily burdened service sector

As everyone here knows, productive work in this space takes time and takes resources.

It also means understanding the complex system in which we work and knowing how best to influence.

It also means learning from others and I am delighted that our colleagues from across the ditch could be here this week to share their experience and examples of significant improvements in Maori health.

In summing up I wish to make some comments about our organisation.

One of the key roles for Medical Deans is advocacy in key areas in health. And as I said earlier, Indigenous Health is core business for us.

We know we cannot do things alone and are thus very proud of the special relationship we have with the LIME Network and our partnerships with AIDA, TeORA and NACCHO.

However we are also an organisation of consensus, a form of federation, if you like. That means we sometimes fall short of the expectations of our partners. But that is not for lack of caring and commitment in this space.

So – on behalf of Medical Deans today I wish to pledge the following.

Medical Deans promises to promote the aspirations of all here today. This includes, as put forward by our key note speaker on Tuesday, aiming for excellence in our graduates.

Medical Deans promises to collect the best evidence where possible to inform policy debate in this space while protecting the confidentiality of our small but growing indigenous medical community

Medical Deans promises to use examples of best practice from here and over the ditch to educate and support all educators and leaders in this space.

Medical Deans promises to continue to learn and grow and be an active participant in the move to close the gap.

That is our pledge. What is yours?

I wish you all a happy and productive day.

Thank you

Professor Judy Searle, CEO Medical Deans
Wednesday 28 August 2013

$8M windfall to boost internship program

By | Wednesday, August 14th, 2013
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The Commonwealth has announced $8M in funding to support new internships.

The Australian – 14 August 2013

Deans welcome support to put junior doctors where we need them

By | Monday, August 12th, 2013
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Medical Deans Australia and New Zealand (Medical Deans) has welcomed the Federal Government’s announcement yesterday to boost the numbers of junior doctor clinical training places in rural and regional Australia and the private sector.

‘This is an important step toward growing the clinical training capacity to cater for our next generation of junior doctors,’ said the President of Medical Deans, Professor Peter Smith.

‘Importantly it supports putting doctors where patients need them. We are all committed to finding clinical training solutions that will meet the health care needs of all Australians regardless of where they live.’

Professor Smith said this increase will also play a significant role in further improving the quality of medical training in Australia.

‘We know that patients seek their medical care in a range of settings including private doctor’s rooms, large public hospitals and country hospitals and clinics. It makes sense that this is where our doctors of tomorrow should be training too’.

The majority of Australian medical schools provide medical students with dedicated rural training as part of the Federal Government’s ongoing investment in Rural Clinical Schools.

Professor Smith said providing clinical training in varied settings offers an opportunity to influence where those new graduates eventually work, with the aim of increasing doctor numbers in areas of workforce shortage.

Professor Smith said that since 2005, Medical Deans has been following medical students across Australia to see how their careers developed and where they chose to practise medicine.

‘This ongoing study (the Medical Schools Outcomes Database and Longitudinal Tracking Project) now covers more than 20,000 students and doctors, and has been a contributory data source for HWA during the development of Health Workforce 2025.’

‘This study is continuing to follow doctors as they progress in their careers, and is proving a rich source of data to inform medical education and workforce planning.’

Professor Smith said all Australian-trained medical students, including those from overseas who paid their own fees, offered the most ethical and effective way of ensuring Australia was self-sufficient in doctors by 2025.

Medical Deans is made up of the Deans of Australia’s 18 university medical schools and the two New Zealand schools.

More information, Peter Smith: 02 9385 2451

The evidence is in – we need to put doctors where we need them, not new medical schools

By | Wednesday, August 7th, 2013
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Medical Deans is very worried about the impact of any proposed new medical school could have on the medical training system.

All governments agreed, in the establishment of Health Workforce Australia, that Australians deserved to have the best evidence available to help us determine how many doctors we need and where we need them.

We now have this evidence

In the past decade a range of initiatives has helped us double the number of medical graduates

The predicted supply of doctors should come close to meeting demand in the next year or so.

The training system now needs to support this expanded pipeline so we get high quality well trained doctors in places where we need them.

A recent Senate inquiry pointed out: “The current pressing issue is not student numbers, but the capacity in the system to adequately train those students all the way along a pathway from student to health professional who will work in rural areas.

We also know that there is still work to do to get doctors in places where patients need them whether that be rural Australia or the western suburbs of Sydney.

Figures for 2010 show that cities have an average of 219.5 specialists per 100,000 people compared with 85.5 for inner-regional areas, 47.6 for outer regions and 59.5 for remote areas. There are serious shortages in demand areas such as obstetrics and gynaecology, pediatrics and psychiatry.

All medical schools are working to achieve this goal.

The majority of the already 18 medical schools in Australia have rural and regional campuses to help train tomorrows doctors in these settings

For example, medical students at UNSW can undertake a significant part of their training at Coffs Harbour, Port Macquarie, Wagga Wagga or Albury and in the near future will be able to complete all six years of medicine in a regional area.

Other schools have focused on outer metropolitan settings where it has been traditionally difficult to recruit and retain doctors

All this has been done with large investments by governments in infrastructure and training

While on first glance a new medical school in a rural or regional setting may seem like a good idea, it ignores the current workforce evidence and the large number of current initiatives aimed at putting doctors where we need them

It also risks wasting large amounts of public money that could be diverted into better support and management of new graduates and doctors we have

Health systems are under increasing pressure and no government can afford to spend its health budget unwisely.

We can’t afford to be distracted by a debate over a new medical school that would take a decade to produce its first graduates and would swallow up large chunks of our limited resources – without addressing the real causes of the problem.

“If the number of medical students in Australia is further increased without extra investment in training infrastructure, it won’t increase the number of doctors serving our communities – it will just increase the number of unemployed doctors in our communities.”

Contacts:
Professor Judy Searle, CEO, 02 9114 1680
Professor Peter Smith, President, 02 9385 2451

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