Online version of the 2012-13 Department of Health and Ageing Annual Report
- An extra 60 doctors are working in Australia’s hospitals after extra intern places were created to ensure all Australian trained medical graduates were offered an internship starting in 2013.
- More of our future doctors, dentists and nurses have experienced rural practice, following the successful delivery of rural training. This training supported 815 graduating medical students to complete long term rural placements; 4,851 medical, nursing and allied health students completed shorter term clinical placements organised by University Departments of Rural Health; and 242 dentistry students completed rural clinical placements.
- Patients will be better able to see doctors. More doctors are training to be GPs – 1,108 in 2013 compared to 1,000 in 2012 – and specialist training places have increased – from 600 in 2012 to 750 in 2013.
- To help more overseas trained doctors to live and work in rural and remote areas, new guidelines were introduced that provide greater clarity on the factors considered in granting exemptions to allow them to access Medicare and reduce red tape and paperwork.
- The nation’s dental workforce is being boosted – 50 dental graduates started the Voluntary Dental Graduate Year Program in January 2013.
- Nearly 4,000 accredited general practices across Australia are funded to assist the employment of nurses and other allied health workers to provide immunisations, wound care and other services, working as a team to provide coordinated health care.
- Managing the ongoing demand for places in the Government’s medical vocational training programs, and for most health professional scholarships, which exceeds funded places available.
- Supporting the GP Rural Incentives Program, which continues to exceed forecast expenditure due to high demand.
- Increasing Australia’s dental workforce, particularly in rural and remote Australia and areas of need.
10.0% SUBSTANTIALLY MET
10.0% NOT MET
|Period||Met||Substantially met||Not met|
Programs contributing to Outcome 12
Number of Specialist Training Program places for each academic (calendar) year from 2010 to 2013.
Figure 12.1 Specialist Training Program places per year
Number of emergency medicine training places for each academic (calendar) year from 2011 to 2015.
Figure 12.2 Emergency medicine training places per year
Outcome 12 aims to ensure that Australia has the workforce necessary to address its current and future health needs. In 2012-13, the Department worked to achieve this Outcome by managing initiatives under the programs outlined below.
Program 12.1: Workforce and rural distribution
Program 12.1 aims to increase the number of health professionals in regional, rural and remote Australia; increase investment in health workforce training; and increase access to health services through overseas recruitment.
Increase the supply of, and support for, health professionals in regional, rural and remote Australia
The Department recognises the challenges faced by regional, rural and remote communities in accessing health care. It continues to tackle this through delivering programs aimed at increasing the number of health professionals working and living in these areas.
Australian General Practice Training Program
The Australian General Practice Training Program (AGPT) offers post-graduate vocational training placements for medical graduates wanting to pursue a career in general practice in Australia. At least 50% of all AGPT training is undertaken in regional, rural and remote locations to encourage health professionals to work in these areas. In 2013, the number of training places increased to 1,108. All these places were filled by General Practice Education and Training Limited, which manages the program through a network of Regional Training Providers.
Prevocational General Practice Placements Program
The Prevocational General Practice Placements Program (PGPPP) is a prevocational training program that enhances junior doctors’ understanding of primary health care and encourages them to take up general practice as a career. The program gives junior doctors experience outside of hospitals with 12 week training placements in GP practices. At least 50% of all PGPPP training is undertaken in regional, rural and remote locations. In 2012, the target was 975 with 918 places filled. It is expected that the 2013 target of 961 will be met with General Practice Education and Training Limited working with Regional Training Providers around Australia to increase interest in this program.
Specialist Training Program
In 2012-13, the Department continued to support specialist training by funding medical specialist training posts situated beyond the traditional public teaching hospitals, including private, community and regional and rural settings. The Department funds these posts through specialist medical colleges. The Department has seen continued growth in training places in the public and private health sectors. This has strategically positioned the medical workforce to respond to the dual demands of a growing and ageing population.
Meeting demand for places in the program is an ongoing challenge. The Department will continue to work with program stakeholders to ensure that allocation of new places meets the needs of communities, including in rural and regional areas.
As part of the Tasmanian Health Assistance Package, the Department began planning for additional specialist training places and clinical supervisors in Tasmania’s public hospitals.
Deliverable: Number of training positions funded through the Specialist Training Program86
2012 Academic Year Target: 600
2012 Academic Year Actual: 600
- In the 2012 academic year, 600 places were funded through the program. This compares to 518 places in 2011 and 360 in 2010. 750 places are being funded in the 2013 academic year.
Remote Vocational and Procedural Training
In 2013, the Department increased access to maternity services for women living in rural and remote communities by awarding 50 training grants under the General Practice Procedural Training Support Program. This included 35 obstetric training grants and 15 anaesthetic training grants, enabling GPs in rural areas to attain procedural skills.
In addition, the Remote Vocational Training Scheme, which allows GP registrars to remain working in rural and remote areas while training through distance education, filled all the 22 new places available in the 2013 training year.
Practice Nurse Incentive Program
The Practice Nurse Incentive Program (PNIP) provided incentive payments to accredited general practices and Aboriginal Community Controlled Health Services that employed practice nurses and Aboriginal and Torres Strait Islander Health Workers and other allied health workers to provide services such as immunisations, wound care and cervical screening. This support has enabled more effective use of practice nurses within their health care team and provides Australians with access to more coordinated and comprehensive primary care and better chronic disease management.Top of Page
Deliverable: Support general practices, Aboriginal Medical Services and Aboriginal Community Controlled Health Services across Australia to employ practice nurses and Aboriginal and Torres Strait Islander Health Workers
2012-13 Reference Point: Incentive payments paid quarterly to all participating practices
- Incentive payments were paid to all participating practices.
KPI: Number of practices supported through the Practice Nurse Incentive Program
2012-13 Target: 4,000
2012-13 Actual: 3,978
Result: Substantially met
- The PNIP is progressing in line with expectations. PNIP began in January 2012, with 3,978 practices approved by the end of 2012-13, including 83 Aboriginal Medical Services and 49 Aboriginal Community Controlled Health Services.
General Practice Rural Incentives
The Department continued delivery of the General Practice Rural Incentives Program to provide financial incentives for doctors to move to and/or remain in regional, rural and remote areas. Payments are scaled to provide the greatest incentive to those living and working in the most isolated regions. The more remote, the larger the incentive. Doctors receive a retention payment based on their length of service in a rural community, clinical workload and location of the practice.
KPI: Number of doctors relocating to rural or remote locations under the General Practice Rural Incentives Program payments
2012-13 Target: 70
2012-13 Actual: 31
Result: Not met
- Participation in the Rural Relocation Incentive Grant has increased slightly from previous years.In 2011-12, 22 medical practitioners relocated under the program.
Increased investment in medical training and education
The Department delivered a range of innovative training and education programs to improve workforce capacity.
Rural Clinical Training Support
In 2012-13, the Department continued to support 17 Rural Clinical Schools, 11 University Departments of Rural Health and six dental schools under the Rural Health Multidisciplinary Training (RHMT) initiative. People who train and work in rural and remote areas are more likely to relocate there. Recognising this, programs under the RHMT ensure that medical, dental, nursing and allied health students can complete a proportion of their clinical training in a rural or remote area.
Drawing more medical graduates, nurses and doctors to rural areas
More than 5,000 patients in regional Victoria were able to get high quality health care in 2012-13, as a result of an innovative clinic using the talents of medical and nursing students.
The University of Melbourne Shepparton Medical Centre is the first dedicated student-assisted clinic in Australia.
The clinic allows medical and nursing students and student Aboriginal Outreach Workers to gain clinical experience under supervision, while also filling a gap in health services in the region.
An active partner in the clinic is the University’s Rural Clinical School, which operates in Ballarat, Shepparton, and Wangaratta. It is one of 17 rural clinical schools for medical students operated by 16 universities across Australia, funded by the Department’s Rural Clinical Training and Support program.
The premise of the program is strong evidence that medical students and graduates who spend time training in country areas are much more likely to choose a “country practice” when they qualify.
The University of Melbourne’s student-assisted clinic has expanded the ability of the program to correct the chronic shortage of doctors in rural and remote areas.
Students who attended the University of Melbourne’s Rural Clinical School also showed benefits from their hands-on experience, achieving better educational outcomes than their city cohorts in terms of both aggregate marks and the percentage of first class honours.
The Rural Clinical School has also established another innovative program to attract more doctors to rural Victoria.
The Extended Placement Year provides community-based training posts to prepare graduates for any medical specialty and also showcase the rewards of rural generalist practice.
This encourages interns to undertake postgraduate training in the region and ultimately to practice in a rural area, providing an integrated learning environment using infrastructure funded by the Department.
The Victorian Government’s Murray to Mountain intern program provides pathways for medical graduates wishing to undertake their postgraduate training in rural Victoria. In 2012, four out of five interns who completed their first postgraduate year elected to continue training in the region.
In 2013, the Mason Review of Health Workforce Programs recommended the development of an integrated rural training pathway for medical students – building on the model supported by University of Melbourne’s Rural Clinical School.
KPI: Percentage of medical students participating in the Rural Clinical Schools program
2012-13 Target: ≥25%
2012-13 Actual: 32%
- 32% of Commonwealth Supported Places medical students who graduated in 2012 completed at least one full year of clinical training in a rural or remote location. This exceeds the minimum 25% target agreed by the Department and universities under the Rural Clinical Training and Support program.
Deliverable: Number of rural placements by University Departments of Rural Health
2012 Academic Year Target: 3,500
2012 Academic Year Actual: 4,851
- In 2012, the University Departments of Rural Health facilitated 4,851 rural clinical training placements of two or more weeks duration for nursing and allied health students. This exceeded the target of 3,500 rural clinical placements for the year.
Building Emergency Department Workforce Capacity
Under the More Doctors and Nurses for Emergency Departments Program, the Department funds the Australasian College of Emergency Medicine (ACEM) to deliver an additional 22 emergency medicine specialist trainees each year over four years from 2011, reaching a total of 110 in 2015.
In 2012-13, the Department worked with ACEM to deliver 66 emergency medicine specialist trainees. These specialist trainees provided an immediate boost to the delivery of emergency medicine services and will be a critical component of the future specialist workforce. The Department has also engaged with private sector emergency departments to support new senior clinical training supervisors. These private sector positions are critical in building the capacity to train more doctors in new settings, complementing investments in public sector clinical training.
KPI: Number of additional emergency medicine specialist trainee positions delivered in private settings
2012 Academic Year Target: 44
2012 Academic Year Actual: 44
- In the 2012 academic year 44 places were funded through the program. 66 places are being funded in the 2013 academic year.
Training for telehealth
In 2012-13, the Department continued to fund activities to support the introduction and uptake of Medicare-eligible telehealth. Through the Telehealth Support Program, which began in 2011, 28 organisations were funded to develop education, continuing professional development activities, and other support services.
Projects across all states and territories supported rural health professionals and specialists to establish telehealth-ready practices. These activities were funded as part of the broader commitment to increase access to services in rural and remote areas, specifically access to specialist services. Many of the projects funded have delivered educational material that will be used for many years.
The program has met its objectives and ceased on 30 June 2013.
Additional Medical Internship 2013 Initiative
In 2013, the Additional Medical Internships 2013 (AMI 2013) initiative resulted in an additional 60 junior doctors starting work as medical interns in Australia. This ensured that all Australian-trained medical graduates who applied for a medical internship were offered a position. The Department worked closely with state and territory governments, private hospital operators, accreditation bodies, the Medical Deans of Australia and New Zealand, and the Australian Medical Students’ Association to establish and implement the AMI 2013.
Of the 60 additional intern places created, 22 were directly funded by the Commonwealth and are located mainly in private hospitals in Western Australia, Queensland, the Australian Capital Territory, Northern Territory and New South Wales. The AMI 2013 has also delivered additional clinical training capacity through encouraging and supporting private hospitals to take a greater role in training junior doctors, and created opportunities for greater collaboration between private and public hospitals to improve medical education and training opportunities for all Australian doctors.
Increase access to medical services through overseas recruitment
The Department continued to support the recruitment of overseas-trained doctors (OTDs) to work in outer-metropolitan, regional and remote areas through the International Recruitment Strategy (IRS). Funding to Rural Health Workforce Australia (RHWA) and its seven-member Rural Workforce Agency network provides a case managed recruitment service for appropriately trained OTDs as well as orientation for the doctor and family members into the local community.
In 2012-13, the number of OTDs recruited through the support of the IRS increased by 51% compared to the previous year. During this period, RHWA undertook an international market expansion project and for the first time subcontracted an overseas recruitment agency to help identify suitably qualified OTDs from the United Kingdom. As a result, 124 OTDs were recruited, which has exceeded the target by 8.8%.
KPI: Number of suitably qualified overseas-trained doctors recruited under the International Recruitment Strategy
2012-13 Target: 114
2012-13 Actual: 124
- In 2012-13, the Department worked with RHWA to increase the number of OTDs supported under this program. The result is an improvement on previous years, with 98 OTDs recruited in 2010-11 and 82 in 2011-12 under this program.
19AB Exemptions for overseas trained doctors and foreign graduates of an accredited medical school
In 2012-13, the Department introduced new legislative guidelines to provide greater clarity for OTDs and foreign graduates of an accredited medical school (FGAMS) on the factors considered in granting exemptions under Section 19AB of the Health Insurance Act 1973.
OTDs and FGAMS are required to seek an exemption so they can obtain a Medicare provider number.
Medicare provider number restrictions are one of the mechanisms used to achieve a more equitable distribution of the Australian medical workforce. OTDs and FGAMS are restricted from accessing Medicare arrangements unless they practice within a district of workforce shortage for their medical specialty. A district of workforce shortage is defined as an area that has less access to medical services when compared to the national average. At 31 March 2013, more than 9,708 OTDs and FGAMS (both GPs and specialists) were accessing the Medicare arrangements across Australia.Top of Page
Program 12.2: Workforce development and innovation
Program 12.2 aims to develop innovative workforce models in specific health disciplines, such as mental health and dentistry.
Mental health nurses
In 2012-13, the Mental Health Nurse Incentive Program continued to enable eligible general practices, private psychiatrist services, Medicare Locals and Aboriginal and Torres Strait Islander Medical Services to engage credentialed mental health nurses to provide coordinated clinical care for people with severe and persistent mental illness. Incentive payments for up to 160,000 credentialed mental health nurse sessions were available to eligible organisations. Support provided under this initiative targets patients with severe and persistent mental illness living in the community during periods of significant disability.
Deliverable: Evaluation of the Mental Health Nurse Incentive Program
2012-13 Reference Point: Evaluation completed before the end of 2012-13
- The evaluation of the MHNIP was completed in December 2012 and is available on the Department’s website.87
The evaluation notes support for the program from GPs, psychiatrists and mental health nurses with evidence that patients experience improved health outcomes. However, the report highlighted a number of areas for improvement including the need to address the uneven geographic spread of MHNIP services, better control program expenditure, strengthened operational guidelines and improved data collection.
The Department will work with stakeholders in 2013-14 to redesign the program in response to the evaluation findings.
Increased investment in the dental workforce
In 2012-13, the Dental Training – Expanding Rural Placements (DTERP) Program continued to address the shortage and maldistribution of dentists, especially in rural and remote areas. It encourages dental students to take up a career in rural practice by providing positive, high quality clinical education and training experiences for dental students in rural areas.
In the 2012 academic year, 242 placements were funded through the DTERP Program.
Voluntary Dental Graduate Year Program
In 2013, the Voluntary Dental Graduate Year Program (VDGYP) provided 50 dental graduates with a structured program for enhanced practice experience and professional development opportunities, increasing dental workforce and service delivery capacity. Where possible, graduate placements have been directed towards the public sector and areas of need.
KPI: Number of dental graduates participating in the Voluntary Dental Graduate Year Program
2012-13 Target: 50
2012-13 Actual: 50
- In 2013, 50 graduates are participating in the VDGYP. Of these, 27 placements are being undertaken in metropolitan areas, 18 graduates are placed in regional areas and five graduates are placed in remote areas.
(A) Budget Estimate 2012-13
(B) Actual 2012-13
Variation (Column B minus Column A)
|Program 12.1: Workforce and Rural Distribution|
|Ordinary Annual Services (Annual Appropriation Bill 1)||1,020,248||1,026,159||5,911|
|Departmental Appropriation 1||13,766||13,482||( 284)|
|Expenses not requiring appropriation in the current year 2||433||685||252|
|Total for Program 12.1||1,034,447||1,040,326||5,879|
|Program 12.2: Workforce Development and Innovation|
|Ordinary Annual Services (Annual Appropriation Bill 1)||300,920||295,963||( 4,957)|
|Departmental Appropriation 1||10,111||9,921||( 190)|
|Expenses not requiring appropriation in the current year 2||342||523||181|
|Total for Program 12.2||311,373||306,407||( 4,966)|
|Outcome 12 Totals by appropriation type|
|Ordinary Annual Services (Annual Appropriation Bill 1)||1,321,168||1,322,122||954|
|Departmental Appropriation 1||23,877||23,403||( 474)|
|Expenses not requiring appropriation in the current year 2||775||1,208||433|
|Total expenses for Outcome 12||1,345,820||1,346,733||913|
|Average Staffing Level (Number)||164||163||( 1)|
- Departmental appropriation combines 'Ordinary annual services (Appropriation Bill 1)' and 'Revenue from independent sources (s31)'.
- 'Expenses not requiring appropriation in the budget year' is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses - please refer to the departmental financial statements for further information.