The college has warned the government not to encourage subspecialisation over generalism and reliance on IMGs.
After a push to return Distribution Priority Area to MMM3-7, ACRRM is raising concerns over the other workforce classification system — District of Workforce Shortage – that encourages subspecialising, and the rural workforce’s reliance on overseas doctors.
In November 2023, federal health minister Mark Butler announced a review into the national maldistribution of doctors and other health workers in an attempt to improve access in “outer suburbs of major cities and in regional, rural and remote Australia”.
The review focused on workforce levers including the Modified Monash Model, Distribution Priority Area (DPA) and District of Workforce Shortage (DWS) classification systems, as well as Section 19AB of the Health Insurance Act 1973.
To address what the college labelled “relatively minor” workforce shortages in MM2 and outer urban areas, the DPA program – which allows IMG doctors, and rurally bonded medical student employed in DPA areas to bill Medicare via 19AB exemption – was extended from only MMM3-7 to MMM2 and above.
In its submission to the Working Better for Medicare review last month, the college recommended the DPA system return to its former state where only practices in MMM3-7 were eligible for the scheme.
“Within a short space of time, [the expansion] triggered significant movement of IMG doctors out of MM3-7 to take up positions in MM1-2 and has made it substantially harder to recruit to MM3-7 vacancies,” said the college.
“In the view of the college, Section 19AB and the DWS are relatively blunt tools which should regarded as just one of a number of components of the overall workforce and recruitment strategy,” said the college.
An area is classified as DWS if its ratio of specialists to population is less than the national average.
According to the college the measure is “problematic”.
“It can support the perverse outcome of exacerbating increased subspecialisation and cementing inappropriate/uneconomic models of care into health systems.
“This is because the process does not consider models of care, but rather simply reacts to an identified individual health service need in isolation without considering the optimal context appropriate models of care, or the cost implications when individual decisions are scaled.”
The college suggested the system should incorporate consideration of models of care.
“For example, areas seeking an RG or specialist General Practitioner (GP) may need one with a specific skillset.
“Likewise, an area applying for a specialist obstetrician may be better served by a RG Obstetrician who can provide general practice services as well as obstetric services.”
The college, while less scathing of its review of Section 19AB, cautioned the reliance it facilitated on IMGs.
“It should be acknowledged that a reliance on an IMG workforce should not be viewed as a longer-term and sustainable strategy for addressing the geographic and skillset health workforce maldistribution in Australia.
“However, given that rural and remote areas continue to remain substantially dependent on IMGs, the College would view the complete removal of Section 19AB as a solution of last resort, given that it would undoubtedly result in rural and remote areas having limited local access to a doctor.”
The college encouraged individual reforms to be considered in partnership with other solutions.
“Any reform of Section 19AB and the DWS should be viewed as part of a suite of workforce solutions which address a range of issues including workforce supply and distribution together with trends such as increasing sub specialisation at the expense of generalism and changing expectations of younger generations.
“There is clear evidence that these policy levers need to be restricted to and/or tailored towards areas of substantive intransigent shortage and other more suitable strategies should be adopted for less difficult to recruit to areas.”