Tuesday, 2 December 2014

New model to ease rural doctor shortages

An innovative model designed by two Monash School of Rural Health (SRH) researchers has underpinned major changes initiated by the Australian Government to ease doctor shortages in rural and remote communities.

The Australian Government recently announced an overhaul of its workforce classification systems as part of an effort to allocate retention grants more equitably, based on what rural doctors do and the different contexts in which they practice.

The new scheme, known as the ‘Modified Monash Model’, is the result of research undertaken by Emeritus Professor John Humphreys and Dr Matthew McGrail, both Chief Investigators of the Centre of Research Excellence in Rural and Remote Primary Health Care at Monash University School of Rural Health.

Federal Assistant Health Minister Fiona Nash has facilitated the changes, working closely with doctors and residents of regional, rural and remote communities. She described the existing system as “outdated” and in need of “a complete overhaul”.

She said the current ASGC-RA scheme held back progress in encouraging doctors to work outside big cities. “We need to get doctors to where they are needed most with the right doctor, with the right skills, in the right place,” she added.

Professor Humphreys described the existing basis on which retention grants are currently allocated, set up in the 1990s, as “seriously flawed”, a claim supported by Senator Nash.

“In north-west Victoria, for example, doctors practising in small towns such as Elmore are eligible for the same amount as doctors in Bendigo,” he said. “This is clearly quite inequitable, something about which the Rural Doctors Association in particular is very concerned.”

Professor Humphreys and Dr McGrail have been undertaking research on issues of access and equity in primary health care in rural areas for many years. Professor Humphreys trained as a geographer, moving to the Monash SRH in 2000, while Dr McGrail has a strong background in statistics, specialising in mathematics.

“The previous scheme was not evidence-based so it has been difficult for the Australia Government to adjust anomalies,” Professor Humphreys said. “Our research focuses specifically on medical workforce retention. If the government is prepared to offer incentives to keep doctors practising in rural and remote areas, then it is vitally important to allocate them equitably.”

Both he and Dr McGrail work with academics from the University of Melbourne in the Medicine in Australia: Balancing Employment and Life (MABEL) Project – Australia’s national longitudinal survey of doctors. Annual data from the project formed the basis for creating an alternative classification for rural doctors.
MABEL research explores factors such as working hours, specialties and life influences including the importance of employment for partners and children’s education.

The survey data were melded with geographic data across rural and remote areas of Australia.
“This proposed alternative scheme was shown to be much fairer and more statistically significant in terms of differentiating between doctors doing different activities in different contexts,” Professor Humphreys said.
The two researchers made a submission to a Senate Inquiry on Rural Medical Workforce issues in 2012. Since then, rural doctor organisations have supported and actively promoted the alternative model.

The final report of the Review of Australian Government Health Workforce Programs (the Mason Review), publicly released on 24 May 2013, recommended the Modified Monash Model be adopted.

Professor Humphreys said the government now planned to ‘fine tune’ some modifications to the model. Senator Nash is establishing an “expert panel”, to oversee and recommend changes by the end of the year.
“The real motivation for us is is to maximise access to quality medical and health care, no matter where people live,” Professor Humphreys said. “If they are given good life chances, then people have better health outcomes.”

Background
The current Australian Government systems in place to encourage doctors to work outside big cities based on the District of Workforce Shortage (DWS) and the Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) systems.

According to Federal Assistant Minister for Health, Fiona Nash, concerns about the DWS have been expressed by both doctors and communities. They told her DWS relied on “outdated population data and is not accurately reflecting the workforce needs in towns that have experienced recent population growth”.

Senator Nash said doctors and communities also said the ASGC-RA was 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 town,” she added.