Reducing Remote Doctor Shortages Via Changes To Workforce Classification

Federal Assistant Minister for Health Fiona Nash has announced major changes to workforce classifications to encourage doctors to leave the big cities and help ease regional, rural and remote doctor shortages.
As the Minister with responsibility for regional, rural and remote health, Senator Nash has directed changes to the District of Workforce Shortage and the Australian Standard Geographical Classification - Remoteness Area (ASGC-RA) systems to help encourage more doctors to work in country towns.
“I have been working closely with the sector doctors and people in regional, rural and remote communities have made it clear that these two classification systems are outdated, and needed a complete overhaul," Senator Nash said.
“We need to make it easier to get doctors to where they are needed most with the right doctor, with the right skills, in the right place.”
Senator Nash said one of the biggest concerns by doctors and communities told to her was the current District of Workforce Shortage (DWS) system, which depends on outdated population data that does not accurately reflect the workforce needs in towns that have experienced population growth.
“The Government is acting to address these problems by moving to a new DWS system, that will use the latest ABS population data and the most recent medical services data to more accurately determine which town is the most underserviced,” she said.
“Communities classified as being a DWS are eligible to recruit doctors who could not normally bill Medicare for their services, including overseas trained doctors (OTDs); foreign graduates of Australian medical schools; and Australian trained bonded doctors.
“The new system will create more stability for towns that fluctuate in their DWS status. DWS determinations for GP services will be updated every year, instead of every quarter, as at present.”
Senator Nash said another major change to workforce classifications will be an updating of the Australian Standard Geographical Classification - Remoteness Areas Classification which doctors and communities have said consistently is not working for rural Australia.
“It is creating perverse incentives for doctors to move to large, coastal towns, and does not recognise the challenges of recruiting doctors to small rural towns,” she said.
“The Coalition Government has listened to these concerns, and will now introduce a new classification system, the Modified Monash Model, for the purposes of health workforce programmes.
“Using the Modified Monash Model will allow support and resources to be focused on areas where there is the most need – in small rural and remote communities.”
Minister Nash said that while the Modified Monash Model uses the current ABS remoteness classification structure as a base, it classifies areas in Inner and Outer Regional Australia according to the local town size. As a result:

• Charters Towers will be in a different category to Townsville;


• Port Fairy will be in a different category to Ballarat;


• Gundagai will be in a different category to Hobart;


• Sale will be in a different category to Mildura.

“The ABS Remote (RA4) and Very Remote (RA5) areas will be maintained in the Modified Monash Model, in recognition that these areas face greater challenges than the rest of Australia in recruiting and retaining a health workforce, regardless of how populated the town is. This includes locations like Mt Isa and Alice Springs,” she said.
One of the first programmes to transition to the Modified Monash Model will be the General Practice Rural Incentives (GPRIP) programme.
“This current ASGC-RA system, implemented by the previous government, has been widely criticised by rural stakeholders as creating inequities between rural and regional locations and further exacerbating the issue of maldistribution of doctors,” Senator Nash said.
“Following the announcement of updating the classification system to the Modified Monash Model (MMM) the Government will now work through the process of deciding how the GPRIP programme will change to adapt to the MMM.”
Senator Nash said she would be appointing an expert panel to provide advice on these changes.
“The panel will lead public consultation and report to the Government with recommendations on how the GPRIP could be redesigned in relation to the new classification system to ensure incentive payments are targeted to getting doctors to the areas of most need.
“The panel will also consult with the sector and advise about the value of providing exposure for junior doctors to rural general practice.”
To assist in getting doctors to areas of need the Bonded Medical Places programme will be changed to allow any bonded student to complete their return of service obligation in small towns, with a population of less than 15,000, in inner and outer regional areas, and in remote areas. This will be regardless of whether those areas are Districts of Workforce Shortage.
“We will continue to work closely with stakeholders, particularly the Australian College of Rural and Remote Medicine, the Rural Doctors Association of Australia, the RACGP and the AMA to phase in these new arrangements over coming months,” Senator Nash said.