Despite a finding that half its money was being spent in cities, the non-GP specialist training program meant to produce rural doctors has been judged ‘adequate’.
The program intended to train Australia’s rural and regional non-GP specialists has been given a passing grade by a new review, despite continued workforce maldistribution and other indications that it is not meeting its intended goals.
In 2010, the Commonwealth realised it had a problem: there simply weren’t enough non-GP specialists working outside of the major capital cities.
It created the Specialist Training Program (STP), its “key investment” in non-GP training, with the triple aim of broadening training settings, increasing opportunities for Indigenous doctors and “improving specialist medical workforce supply and distribution by enhancing the availability of the specialist workforce in areas of unmet community need, including rural and remote locations”.
The program, which cost taxpayers more than $700 million between 2022 and 2025 alone, provides salary support for around 920 non-GP registrars each year.
At least half of each placement must be spent in either a non-metro setting or a private setting, with rotations lasting a minimum of three months.
But in its 2024 evaluation of the STP, which was published this week, consulting firm Proximity found that more than 90% of specialist sport and exercise physicians, surgeons and pathologists were based in MM1 areas, as well as more than 85% of physicians, ophthalmologists, psychiatrists and radiologists.
The review found that the overall structure of the program was not able to respond to evolving workforce needs and that the allocation of funding between the 13 participating specialist medical colleges was not aligned with needs for each geographical location.
There is evidence to suggest that, despite the association between long (e.g. 12-month) rural rotations and continued rural practice, the STP-funded posts tend to only meet the minimum required length of rural rotation.
“A rudimentary calculation of the STP funding for posts in colleges which provide generalist specialisations indicates the program does not currently align to specialisations needed in each location, with around half of funding in the program going to MM1 settings,” the report said.
“The current minimum placement length in the program is three months and there are no explicit incentives for longer-term placements.
“This does not support the long-term aim of the program to encourage specialists to relocate away from metropolitan areas and support a correction of the workforce maldistribution across Australia.”
Another key issue, according to Rural Doctors Association of Australia CEO Peta Rutherford, is that there are limited checks and balances to ensure that these rural rotations actually happen.
“Certainly, the feedback we get from our members on the ground is that, particularly in the latter half of the year, they often don’t see those [registrars],” she told Allergy & Respiratory Republic.
“Based on resignations or movements within the workforce of the city, the first thing that gets pulled back is the rural rotation.
“It’s concerning that these positions are allocated like that.”
Ms Rutherford said the RDAA would be advocating for posts which only offer the minimum three-month rural rotations to be given the lowest funding priority.
“We hear of really good quality training places that yet haven’t been given an STP [funded] place, and when you hear that half of these [funded] positions are sitting in MM1, it boggles the mind,” the RDAA CEO said.
One recent example, she said, was an ophthalmology STP post being moved from Warrnambool to Hobart.
“It was only allocated [to Warrnambool] temporarily, but why are we not prioritising those more rural and remote training settings within this program?” Ms Rutherford said.
“To see a position move from a smaller regional area to a state capital city – and I get Hobart is an MM2, but it’s still a state capital city – is disappointing.”
Despite the negative findings, the Proximity review ultimately gave the STP a passing grade for its effectiveness in enhancing the rural and remote specialist workforce, noting that it was one of just a few funding sources dedicated to helping change the maldistribution.
ACRRM president Dr Rod Martin told ARR that he would love to see the STP produce outcomes as the good as the rural general and GP college.
“If ACRRM had the amount of money that the STP had, we would have an astonishing number of people out in rural areas,” he said.
Currently, the college delivers around 80% of training in MM4 to MM7 locations. But Dr Martin stressed that this was not the only secret to producing a rural workforce.
“We can predict where people are going to go as they come in through [ACRRM] and where they’re going to stay,” Dr Martin said.
“It’s more than just training and assessment, it is good, high-quality selection as well.”
Selection for rural background is an area in which the non-GP specialty colleges have already begun to make tracks.
In June, the Council of Presidents of Medical Colleges and the National Rural Health Commissioner released a new guideline aiming to prioritise rural-original applicants.
“While STP has served important purposes, the significant shortcomings identified present an opportunity to work with the Federal government to co-design a system that works for all Australians,” CPMC chair Dr Sanjay Jeganathan said.
Dr Jeganathan, who is also president of the Royal Australian and New Zealand College of Radiologists, said the finding that over 80% of specialists still concentrate in cities after 15 years of the STP show that the program needs better design and more funding.
“This isn’t about dismantling what works, but enhancing STP to achieve its rural workforce goals,” he said.
CPMC CEO Jodie Long told ARR that the colleges were keen to see more funding going toward training hubs in the regions, which would in turn make end-to-end rural training more viable.
“[Registrars in the STP are] predominantly doing their training in MM1 and are going out to rural areas to train, which is great – however, we’re trying to turn it the other way around,” she said.
“But to be able to do that, you have to have the infrastructure to train in those rural and regional areas.”
The only domain in which the Proximity evaluation judged the STP’s performance as “poor” was in relation to increasing the number of First Nations medical specialists.
The finding here was that the STP rarely funded posts in the Aboriginal community-controlled health sector and that the colleges were “immature” in engagement with Indigenous ways of knowing and being.
