Removing the shackles of bonding
In late 2017, I wrote an article about the Medical Rural Bonded Scholarship (MRBS) and Bonded Medical Places (BMP) programs. The AMA has long been critical of bonding as a tool to recruit and retain a rural health workforce in Australia. We’re bigger fans of carrots than sticks. In the case of the MRBS and BMP, the stick had well and truly been worn out, with no appreciable gain in a rural medical workforce. We were inundated with concerns about the program, and we have been lobbying the government to see meaningful reform to these programs. Ultimately, these programs have doctors who genuinely want to work in rural Australia being hamstrung by bureaucracy that is a nightmare for both the Department of Health and the doctors who are part of these programs. It’s a bleak scenario.
Following extensive lobbying by the AMA Council of Doctors in Training (AMACDT) and the AMA, both the Bonded Medical Places (BMP) and Medical Rural Bonded Scholarship (MRBS) programs will be radically overhauled as part of measures announced in the 2018/19 Federal Budget, and will effectively standardise conditions for bonded medical graduates, moving away from the current contract-based arrangements.
The reformed arrangements will apply to all new participants from January 2020, and will be available to MRBS recipients, BMP recipients who signed up in 2015 or earlier, and BMP recipients who signed up from 2016 onwards (while retaining their twelve month return of service obligations). Key details include:
- The introduction of a standard three-year return of service (ROS);
- ROS eligible locations to include Modified Monash Classification areas 2 – 7 and outer metropolitan Districts of Workforce Shortage;
- Up to 50 percent of prevocational and vocational training in ROS eligible locations can count towards ROS obligations, with the remaining 50 per cent required post Fellowship;
- Where Fellowship is not achieved within 10 years of internship, the remaining balance of ROS can be completed in a non-specialist role;
- ROS can be served in three-month blocks, including in the post Fellowship years;
- Scaling of ROS according to rurality will continue;
- Compliance with ROS requirements will be managed through a web-based portal, avoiding some of the administrative problems currently encountered; and
- Bonded graduates will have more options to work in ‘ineligible’ areas during their ROS period.
Further details can be found at https://ama.com.au/bonded-medical-graduate-programs-%E2%80%93-2018-budget-changes
I am particularly proud of what we’ve achieved here. We’ve taken an issue that has plagued a number of members and continued to work sensibly and solidly towards tangible reforms. We’re now looking at a program than not only helps the doctors involved in the program, but also reduces administrative workload for the Department of Health and helps to form a sustainable rural medical workforce for Australia. It’s not often you can cook up a solution where everyone wins, but this is one of those times.
At its core, this is what the AMA is about. Advocacy for doctors and patients alike, to create a better healthcare system for Australia. I’m proud to be a part of it, and I hope that you are too. For those of you who want to be more involved with the AMA, please contact your local State branch, keep an eye on our social media channels, or send us an e-mail at firstname.lastname@example.org.
Dr John Zorbas
Chair AMA Council of Doctors in Training