New report aims to address critical health worker maldistribution

The Federal Government has released its ‘Working Better for Medicare Review’, which puts forward a sweep of suggestions to improve how Medicare impacts healthcare worker distribution.
 
As a part of the Strengthening Medicare reforms, Federal Health and Aged Care Minister Mark Butler announced the review in 2023 with the goal of examining classification of the Distribution Priority Area (DPA), District of Workforce Shortage (DWS), and Modified Monash Model (MMM).
 
The independent report, released on Tuesday, lists several looked at whether existing policies to attract and distribute the health workforce are working, and made 26 recommendations for change.
 
Its key recommendation was for the establishment of a small Health Workforce Independent Review Panel to oversee any changes to the DPA, DWS, and GP catchment methodologies.
 
The review comes as remote GPs report being overloaded by a Medicare system that works against them, as the same time as cost-of-living pressures rise.
 
RACGP doctors working rurally have described shortages as becoming ‘catastrophically worse’ in recent years, saying remote areas are turning into ‘professional wastelands’.

The report also analysed section 19AA of the Health Insurance Act 1973, which currently state that doctors who are permanent residents or citizens of Australia must hold vocational recognition or be actively working towards it before they can access Medicare benefits.
 
Section 19AB allows payment of Medicare benefits to international medical graduates (IMGs) only if they work in a DPA (for GPs) or DWS (for non-GP specialists) location for up to 10 years from the date of their first registration as a medical practitioner in Australia, known as the ‘10-year moratorium’.
 
‘Section 19AA should be retained to ensure training standards, currency of knowledge and skills across all medical specialities are maintained,’ the report says.
 
‘Without 19AB, there is a strong view that many IMGs would choose to practice in metropolitan areas.
 
‘While there was support for the retention of 19AB, the extent of exemptions to the 10-year moratorium is undermining the efforts to address workforce maldistribution.’
 
Regarding Section 19AB, and its 10-year moratorium, the report says ‘at least in the medium term’ it should be kept as is, until Australia is ‘closer to self-sufficiency in meeting medical workforce needs and there are improved employment options and/or distribution incentives in place to ensure sufficient doctors practice in areas of greatest need’.
 
It also calls for the potential expansion of 3GA training programs to specific non-GP specialties with significant community-based practice should be assessed.
 
RACGP Rural Chair and Vice President, Associate Professor Michael Clements, told newsGP the review shows some positive changes, but the ‘devil is in the detail’.
 
‘It‘s good to see that they are continuing some of the important features of the 19AA and 19AB exemptions, which is confirming and securing the concepts that rural communities deserve to have doctors that are either specialised and a recognised specialist, or at least working towards that end point,’ he said.
 
The review found the current method of determining DPA status, via ‘automatic application of MMM2–7 blankets’ meant that of the 827 GP catchments across Australia, 85% had DPA status.
 
‘The almost universal view of submissions and consultations suggest DPA in its current format is no longer an effective distribution lever,’ it reads.
 
Associate Professor Clements said this acknowledgement, and suggested review, would be welcomed by the GP community.
 
‘The report flags that the MMM tool, as a way of directing DPA, is going to be reviewed with a view to shifting to GP catchments,’ he said.
 
‘The tool is a very blunt tool, with a small number of catchments that define areas of workforce need priority in a way that disadvantages some towns just because they’re close to a city, and perhaps doesn’t accurately reflect that some of the regional and rural towns can be very hard to fill.
 
‘I think that this is going to be welcomed, but it’s important that we get very clear guidance on what the new GP catchment areas will be.’
 
The review also calls for all training pathways to have financial, professional, and peer support to match the current Australian General Practice Training pathway and a bridging program to upskill applicants to meet the entry requirements for general practice training.  
 
It recommends a focus of the DPA on areas of higher priority need and to use GP catchment as the primary building block for classification.
 
Of all the review’s recommendations, Associate Professor Clements says the move to support overseas-trained doctors is one of the most progressive.
 
‘This is something that we’ve absolutely been calling for because these doctors are often working in some of our most needful communities and do actually need additional supports,’ he said.
 
‘We’ve been talking to the Government about the need to invest in the cultural and medical education support for these overseas-trained doctors on that program, because they certainly deserve as much help and education support, if not more, than our Australian-trained graduates.
 
‘Whether or not these incentives and offers of increased support for international doctors is going to be funded to the level required to be able to give them that equivalent experience.’
 
Moving forward, Associate Professor Clements said clarity on any reforms should be made to GPs as soon as possible to give practice owners time to plan.
 
‘I think it’s interesting and an opportunity for some communities, even in MMM areas that have got very vulnerable populations that do not have access to care could get better access,’ he said.
 
‘But also, some of the communities that perhaps are very well adopted and very well staffed will now lose DPA status, which gives better opportunity to target placement doctors to whoever’s most needed.’
 
The Federal Government will now consider the review.
 
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