Review of Australian Government Health Workforce Programs

Appendix iii: History of Commonwealth investment in the medical workforce

Page last updated: 24 May 2013

Introduction

The Commonwealth’s role in planning and investing in the medical workforce of Australia is based on the principle of ensuring whole community access to quality medical services. Trends in policy development and funding targets have been underpinned by evidence that the geographic and structural distribution of the workforce have not matched population need over time, with the result that parts of the population, notably rural and Aboriginal and Torres Strait Islander communities, and those reliant on the public hospital systems have been underserviced.

In contrast, many analysts argue, oversupply of practitioners in other parts of the country, particularly inner metropolitan areas, has led to price distortions which result in inequitable access to medical services by different sectors of the community as well as unnecessary expenditure of public money. The following is a history of the various key Commonwealth investments, policies and programs which have contributed to the current supply and distribution patterns of medical practitioners in Australia in 2013.

Supply

Sourcing the workforce - domestic education

Historically, policies surrounding medical school places in Australia have fluctuated between phases of restriction and expansion.219 However, the last 10 years have been a cycle of growth with 20 medical schools operating in Australia in 2012 compared to 10 in 2003. The increase in capacity for training has naturally led to an increase of graduates with an expected 3,512 students completing their degree in 2012 up from 1,633 in 2006.220

The current efforts to increase the domestically trained medical workforce are not without precedent. There was a mini-boom in medical workforce supply during the 1970s when the number of Australian medical graduates rose from 851 in 1970 to 1278 in 1980. This may be attributed to the release of the Karmel report (1973) with its recommendation to increase undergraduate medical places to respond to a perceived future shortage of doctors. In contrast – and as a result of a shift to a policy of constraint – graduate numbers remained quite static during the 1980s and 1990s, at around 1200-1300 per year.221

As discussed in Chapter 3, controls on the allocation of Commonwealth Supported Places (CSPs) in medicine were first announced in 1995 and implemented in 1996 in response to the view that there were adequate numbers of medical practitioners to serve the population. Amongst health portfolio considerations were concerns about pressure of graduate numbers on future Medicare rebateable services. Caps on the number of medical places still remain in force however the upper limit was increased in 2006, with 605 additional CSPs announced by the Council of Australian Governments (COAG). A corresponding commitment to Commonwealth investment in new medical schools was also made. To support the 605 new places the Commonwealth, jointly with Victoria, committed to provide a total of $46 million in capital funding for medical schools at Deakin and Monash Universities. The Commonwealth also offered to provide further capital funding of about $26 million for New England, Queensland and James Cook Universities, subject to matching funding from the states.222

Under the Higher Education Support Act 2003 (HESA), the Minister for Tertiary Education has the authority to make changes to the controls on Commonwealth supported places in medicine courses (the only course of study exempted under HESA). Advice on the impact on the health system of additional CSPs in medicine is sought from the Minister for Health and Ageing.

From 2009 domestic undergraduate full-fee paying places (DUFFP) have been phased out and no new intake is permitted in public universities. Universities are able to determine the number of places they offer each year to international medical students. Currently there are no controls on international student numbers. This combination of policy settings produces paradoxical and controversial outcomes.

Sourcing the workforce – overseas trained doctors (OTDs)

In 2009, 25.5% (18,458) of medical practitioners in Australia obtained their first medical qualification overseas.223 Although Australia’s migration patterns had always included those in the medical profession, the 1990’s saw the rise of OTDs entering Australia on temporary contracts. This was likely in response to the long period of stable domestic graduation described above. The Australian Institute of Health and Welfare’s Medical Labour Force 1998 report shows that 893 OTDs entered on temporary contracts in 1993-94, increasing to 2,224 in 1998-99 and that these doctors stayed for an average of one year.

A decade later, the figures reflect that the situation is little changed; more visas were granted to medical practitioners in 2009-10 (3,190 temporary and 1,551 permanent visas) than there were doctors graduating from Australian Universities (2,380) in 2009.224 The goal of achieving self-sufficiency in the medical workforce has been discussed in various policy documents concerned with domestic and international workforce planning. The 2004 National Health Workforce Strategic Frameworkrecommended that the focus of Australian workforce planning be national self-sufficiency and acknowledged that under-investment has influenced approaches to self–sufficiency and use of OTDs to meet workforce needs particularly in areas experiencing shortage.225 The 2005 Productivity Commission’s Review “Australia’s Health Workforce” recommended that:

COAG should consider whether the current wording of the self-sufficiency principle in the National Health Workforce Strategic Framework is unduly restrictive in the context of the international nature of the health workforce and if so, how it should be interpreted.

Currently, the formal goal of self-sufficiency is difficult to reconcile with the pragmatic challenge presented by the projected shortfalls in medical practitioners if net migration is reduced, as reflected in HWA modelling.226 However, the Commonwealth commitment to increasing the domestically trained workforce indicates movement towards achieving this goal.

Accreditation and assessment

Responsibility for the development of accreditation standards, policies and procedures for medical programs of study for entry level courses and vocational training based predominantly in Australia and New Zealand and for assessment of OTDs for registration in Australia lies with the Australian Medical Council (AMC).

Under Section 42 of the National Law the AMC is responsible for:

  • assessing the training and assessment standards of specialist colleges (including their assessment of overseas trained specialists); and
  • assessing authorities in other countries who conduct examinations for registration in a health profession, or accredit programs of study relevant to registration in a health profession, to decide whether persons who successfully complete the examinations or programs of study conducted or accredited by the authorities have the knowledge, clinical skills and professional attributes necessary to practice the profession in Australia.

There are three main pathways for assessing the suitability of OTDs for registration in Australia:

  1. the AMC examination/assessment pathway for non-specialists; (standard pathway)
  2. the competent authority pathway for non-specialists which fast tracks doctors from countries with similar training and assessment standards to Australia; and
  3. the specialist assessment pathway which relies heavily on the specialist medical colleges to provide advice on the suitability and comparability of the candidate to Australian trained specialists.

In the 2006-07 Budget there was a commitment to various initiatives under the Strengthening Medicare package to attract OTDs to Australia. Over 300 additional doctors were expected to be working in areas of workforce shortage as a result of these programs. In 2008, 41% of practitioners in rural and remote areas had received their training overseas.227 These figures also reflect the changes to the Health Insurance Act (1973) which were enacted in 1996, described in more detail below.

Under the Strengthening Medicare initiatives, DoHA endorsed a number of organisations to carry out the recruitment of OTDs to Australia. The Rural Workforce Agencies (RWAs) also have broader responsibility for support services and workforce planning. Rural Health Workforce Australia is the peak body for the seven RWAs that operate in each state and the Northern Territory. RWAs are not-for-profit organisations funded by DoHA as well as their respective state Governments.

RWAs recruit and support doctors in rural and remote communities. This includes crucial assistance and case management for OTDs as well as workforce support for Aboriginal Medical Services. They are funded to deliver programs for non-GP health professionals, such as the Medical Specialist Outreach Assistance Program which enables multidisciplinary health teams to visit rural and remote communities experiencing chronic health issues.

DoHA meets the recruitment costs associated with placing an OTD in an eligible medical vacancy, provided the medical recruitment agency assisting in filling the vacancy is one contracted for this purpose. For a position to be considered eligible for filling by an OTD the position needs to meet specific criteria, such as:

  • the vacancy must be in a recognised District of Workforce Shortage
  • the vacancy must be available for filling for a period of at least 12 months
  • the location must have a current state area of need determination
  • there is a billing component through Medicare.

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Quality and distribution

Until the late 1980s, the size and structure of the medical workforce was largely unregulated by the various state and Commonwealth governments.228 Although the introduction of Medicare in 1984 reduced the role of private health insurance and guaranteed Australians free access to the public health system, the retention of the fee-for-service model still blunted any market pressures which would otherwise encourage the movement of doctors to the areas of greatest need. This is because the provision of a set level of public subsidy per eligible patient service is economically attractive in population dense areas or areas in which an individual practitioner’s specialty is in greatest demand due to the potential for high practice throughput.

In 1989 the Commonwealth established a vocational register for general practitioners to recognise general practice as a discipline in its own right, improve professional standards and to reward high-quality practice. Between 1989 and 1995, medical practitioners already practising in general practice who met the eligibility criteria could apply to be grandfathered on to the vocational register. The grandfathering period for the vocational register ended in November 1996 with the introduction of the Medicare Provider Number Legislation.

As a result of the 1996 Commonwealth Budget, there were major changes to the Health Insurance Act (1973) to include new sections 19AA, 3GA and 3GC, collectively known as the Medicare Provider Number Legislation. These amendments had their basis in concerns about the quality and safety of care being delivered to the Australian community and as a policy mechanism to enable growth of the medical workforce to be kept in line with population needs. Prior to the introduction of this legislation it was possible for interns who had not received their basic registration to enter private practice i.e. to provide services which attract Medicare rebates. It was determined that without specific postgraduate training relevant to a particular field of medicine, the possibility of providing services that were inappropriate was considerably increased.

Under s. 19AA, any doctor who was fully registered as a medical practitioner after November 1996 could not have an unrestricted Medicare provider number until he or she had completed specialist training and gained fellowship of a recognised medical college or was doing an approved placement on a s. 3GA program.229 This continues to be the position. Section 19AB is a related section of legislation, which restricts OTDs’ and foreign graduates of accredited medical schools’ (FGAMs) access to Medicare benefits, for a period of generally 10 years, unless the doctor is working in a DWS. This is commonly known as the ‘10 year moratorium’. OTDs and FGAMs can access Medicare benefits for the services they provide in a DWS if they obtain an exemption under s. 19AB of the Act. OTDs and FGAMs who are Australian permanent residents or citizens and who have yet to gain Fellowship of a specialist college or vocational recognition are also subject to s. 19AA of the Act. This group of OTDs are eligible to work under s. 3GA programs.

Rural workforce

In April 2008, the then Minister for Health and Ageing released a report on the Audit of Health Workforce in Rural and Regional Australia. The findings of the audit were that the supply of the medical workforce, when considered as the number of doctors in comparison to the population area where they practice, was low to very poor in many regional and remote areas of Australia.230

Although there is a heavy reliance on OTDs in rural and regional areas, the rise of needs based planning, focused on health service delivery by region has led to a number of programs and initiatives to encourage Australian graduates to train and remain in rural and regional areas. However, with the exception of s. 19AB restrictions on OTDs and return of service obligations for bonded places and scholarships, these measures are almost all voluntary.

Early initiatives

The Rural Undergraduate Support and Coordination Program (RUSC) established in 1993 was one of the many initiatives developed to promote rural general practice as a career. Funding was provided to universities for rural placements for medical students, to establish rural health clubs and to increase the level of rural health teaching available through Australian medical schools. Participating universities were required to provide 4 weeks of RUSC funded rural placements to all medical students. On 1 July 2011, the RUSC and Rural Clinical Schools program merged to become the Rural Clinical Training and Support (RCTS) program.

Another early measure targeted at individual medical students was the (still extant) John Flynn Placement Program (JFPP), developed as part of the General Practice Strategy (1996-97 Budget) aimed at addressing the maldistribution of general practitioners between urban and rural areas.

A coordinated response to rural workforce development

In March 1999, all Australian Health Ministers approved a policy framework to coordinate rural health efforts. This document: Healthy Horizons, A Framework for Improving the Health of Rural, Regional and Remote Australians was developed in consultation with the National Rural Health Alliance, a key peak organisation representing a broad range of interests in rural health. A $162 million package to further doctors’ and medical graduates’ training and educational needs was later announced as part of the 2000-01 Budget’s Regional Health Strategy - More Doctors, Better Services.

Under the package, nine new Rural Clinical Schools and three new University Departments of Rural Health (UDRHs) were established to allow a rural-focused national network of training. This built on the existing Commonwealth supported regional clinical training school at Wagga Wagga and the seven UDRHs around the country. This was a significant investment in novel models of training delivery spread over non-traditional teaching settings. It represented an investment in both traditional infrastructure and in ‘human capital’ - based on the premise that completing study and training in rural areas will ultimately encourage medical practitioners to settle there permanently once they obtain their specialist qualifications.

Specific measures from the Regional Health Strategy included:

  • The Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme;
  • The Medical Rural Bonded Scholarship (MRBS) Scheme; and
  • The HECS Reimbursement Scheme.

Development of further initiatives

The Regional Health Strategy was reviewed in 2003. The review found that the strategy had been effective in meeting its aims of providing more doctors and better services to people in rural and remote Australia. The review recommended that the strategy continue, with some administrative enhancements and with a greater emphasis on preventative health and providing access to health services in more remote areas. Building on the Regional Health Strategy, the Rural Health Strategy announced in the 2004-05 Budget provided $830.2 million over four years for a flexible package of health and aged care services and workforce measures. Workforce measures included:

  • The Bonded Medical Places (BMP) Scheme; and
  • The Prevocational General Practice Placement Program (PGPPP).

Rural Health Workforce Strategy

The Rural Health Workforce Strategy committed $134.4 million in the 2009-10 Budget in response to the findings of the 2008 Audit of Health Workforce in Rural and Regional Australia. The major component of the Strategy is the General Practice Rural Incentives Program (GPRIP) which commenced on 1 July 2010. GPRIP is a consolidation of two previously separate retention incentive programs available to GPs and registrars and a new relocation grant.

Also announced under the Strategy was the scaling initiative. From January 2010 scaling has been applied to a range of Rural Health Workforce programs that have a return of service obligation, including the BMP Scheme. Scaling increases the attractiveness of working in rural areas by fast tracking the return of service obligation based on the ASGC-RA category which the practitioner is working in. The greatest incentives are for practitioners working in the most remote locations of Australia. Scaling discounts are applied either by the Department of Health and Ageing in the case of salaried officers or based on monthly claiming activity if Medicare is being billed.

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Health reform

In response to the Productivity Commission’s 2005 Report, Australia’s Health Workforce, COAG announced a package of key health workforce reforms on 8 April 2006.

COAG 2006

  • To help ensure that specialist trainees have appropriate skills and experience, COAG agreed that the Commonwealth and the states and territories would establish, by January 2008, a system for these trainees to undertake rotations through an expanded range of settings beyond traditional public teaching hospitals. This would include a range of public settings (including regional, rural and ambulatory settings), the private sector (hospitals and practices), community settings and non-clinical environments such as simulated learning. This became the ‘Specialist Training Program’ (see below).
  • COAG agreed that the Commonwealth would provide about $120 million over four years to fund 605 new medical places. In April 2006, 400 new medical school places were announced with an additional 205 places announced in July 2006. Agreement was also given by states and territories to guarantee high quality internship places to medical graduates in a Commonwealth supported place (CSP).
  • COAG also agreed to establish a taskforce on the national health workforce to undertake project-based work and advise on workforce innovation and reform. The National Health Workforce Taskforce was subsequently established, providing advice and secretariat support to the Health Workforce Principal Committee (HWPC), the Australian Health Ministers’ Advisory Council (AHMAC) and the Australian Health Ministers’ Conference (AHMC).
  • To facilitate workforce mobility, improve safety and quality and reduce red tape, COAG agreed to establish, by July 2008, a single national registration scheme for health professionals – beginning with the nine professions currently registered in all jurisdictions. They also agreed to establish by July 2008 a single national accreditation scheme for health education and training, to simplify and improve the consistency of current arrangements.

COAG 2008

The COAG 2008 Health and Hospital Workforce reform package built on the investments made under the COAG 2006 agenda.

  • A Health Reform package of $1.1 billion of Commonwealth funding was committed, of which $500 million was additional funding for undergraduate clinical training, including increasing the clinical training subsidy to 30% for all health undergraduate places. The package also provided for an increase of 605 postgraduate training places, including 212 GP places, and the establishment of a national health workforce agency (Health Workforce Australia) and health workforce statistical register to drive a more strategic long-term plan for the health workforce.
  • Investment of $175.6 million over four years in capital infrastructure was committed to expand teaching and training, especially at major regional hospitals to improve clinical training in rural Australia.
  • The 212 additional ongoing GP training places were intended to boost the total number of GP training places to over 800 from 2011 onwards, and 73 additional specialist training places in the private sector. Funding was also to be provided to train approximately 7,000 medical supervisors.

Commonwealth funded vocational training programs

Australian General Practice Training Program (AGPT)

Following a ministerial review announced in January 1997 it was determined that a Commonwealth owned company delivering a regionalised approach to vocational education and training would be established. Subsequently in 2001 General Practice Education and Training Ltd (GPET) was established by the Commonwealth for this purpose. GPET is responsible for the management of the AGPT and, since 2010, PGPPP. Previously the Royal Australian College of General Practitioners was responsible for the vocational training of GPs. Unlike training leading to Fellowship of other specialist medical colleges, the cost of GP training is fully funded by the Commonwealth.

Specialist Training Program

The Commonwealth has been supporting the provision of specialist training arrangements in rural and outer metropolitan areas since 1997 with the establishment of the Advanced Specialist Training Posts in Rural Areas (ASTPRA) measure in the 1997-98 budget. This early work was complemented and significantly expanded through the 2006 COAG decision to fund training places in settings other than public teaching hospitals. This initiative became known as the Expanded Specialist Training Program (ESTP). At the same time funding was provided through the COAG National Action Plan on Mental Health (2006-2011) to fund psychiatry training, delivered through the Psychiatry Training Outside Teaching Hospitals (PTOTH) program. Further COAG investment was agreed to in 2008 through the Hospital and Health Workforce Reform - Health Workforce package.

Under the 2009-10 Budget a number of Commonwealth funded specialist training programs were brought together into a single initiative the ‘Specialist Training Program’ (STP). On 15 March 2010 the Government announced the National Health and Hospitals Network initiative “Expand and Enhance the Specialist Training Program”. This provided resources to increase the number of specialist training places to be made available under the Program to 900 by 2014, and allowed for resources to support the private sector via a clinical supervision and infrastructure allowance. The funding associated with the medical components of the Government’s “More Doctors and Nurses for Emergency Departments” election commitment that was announced in 2010 is now being administered under the STP.

Note: accredited training leading to Fellowship of specialist medical college is generically referred to as a ‘specialist medical college training program’. This should not be confused with the Commonwealth Government's STP, which is a discrete funded initiative supporting training places at health care settings, as opposed to places on a training program for individual graduates.

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Workforce Programs

Commonwealth section 3GA workforce programs

All medical practitioners restricted by s. 19AA of the Act are unable to claim Medicare benefits for services unless they apply to participate on an approved training or workforce program under s. 3GA of the Act. There are placements in various approved training programs which allow doctors to access the Medicare benefits arrangements while undertaking vocational training to gain Fellowship of a recognised medical college. Alternatively, the doctor can be placed in a workforce program where workforce shortages have occurred.

The Rural Locum Relief Program (RLRP) was introduced in 1998. It enables doctors who are not otherwise eligible to access the Medicare Benefits Scheme (MBS) to have temporary access when providing services through approved placements in rural areas. RWAs in each state and the Northern Territory administer the program on behalf of the Commonwealth. Doctors without postgraduate qualifications who fall within the scope of the restrictions under s. 19AA of the Act are eligible to make an application to their respective state or territory RWA for a placement on the program. For OTDs who are subject to the restrictions under s. 19AB of the Act, practice locations must be within a DWS. Participants in the program are given clinical support and mentoring throughout the placement. Longer-term participants must undertake appropriate education and training to achieve postgraduate qualifications in general practice.

The purpose of the Approved Medical Deputising Service (AMDS) program is to expand the pool of available medical practitioners who may work for after-hours deputising services. This program allows otherwise ineligible medical practitioners to provide a range of restricted professional services, for which Medicare benefits will be payable, where the medical practitioner works for an approved medical deputising service. The AMDS program was established under s. 3GA of the Act in 1999 in response to concerns about the shortage of medical practitioners providing after‑hours home visit services in metropolitan areas.

The Approved Private Emergency Department (APED) program allows advanced specialist trainees undertaking emergency medicine training to work under supervision in accredited private hospital emergency departments. The program was established to enhance public access to private emergency departments by expanding the pool of doctors able to work in these settings.

Special Approved Placements Program – established December 2003. This program allows medical practitioners to access Medicare benefits in metropolitan areas if they can demonstrate exceptional circumstances that make them unable to participate on any other workforce or training program under s. 3GA of the Act.

The Temporary Resident Other Medical Practitioners (TROMPs) Program was established in 2001. The program was introduced to overcome an unintended consequence of amendments to the 1996 Medicare provider number legislation, which would have resulted in a number of long‑term temporary resident medical practitioners losing access to Medicare benefits. This affected temporary resident medical practitioners who had entered medical practice in Australia prior to 1 January 1997 and who were not vocationally recognised. The TROMPs program provides access to Medicare benefits at the A2 rate for these eligible medical practitioners.

Medical Specialist College Training Programs – for trainees on the pathway to fellowship of a specialist medical college. Under s. 3GA of the Act, a trainee undertaking advanced training in a specialist medical college approved training placement may be listed on the Register of Approved Placements. The specialist medical college must provide written notice of the trainee and placement location and duration to the Chief Executive Medicare. The college must also confirm that the placement is advanced according to the college training program.

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Timeline of key events in the Development of the Medical workforce
Time PeriodPolicy DriversPolicy and Program Activity
1970s
1973Karmel ReportIncrease in undergraduate medical school places
1980’s
1984Establishment of MedicareUniversal public health insurance
1985Australian Medical Council establishedAccreditation of Australian Medical Schools by a local independent body as opposed to oversight from the General Medical Council of the United Kingdom.
1988Doherty ReportLinked medical education with health service delivery
1989Improvement in the quality of general practiceVocational registration for GPs commenced
1990s
1996Rural workforce shortage, concerns about quality and safety in health care delivery.Introduction of Medicare Provider Number Legislation – s. 3GA Workforce Programs, s. 19AB exemptions etc.
1996-97Shortage of practitioners experienced in rural practiceFirst 7 University Departments of Rural Health established
1997-98Shortage of practitioners in rural areasRural retention program – GP retention grants for rural workforce
1999AHMC policy framework to coordinate rural health effortsHealthy Horizons, A Framework for Improving the Health of Rural, Regional and Remote Australians
2000s
2000-01Australian Health Workforce Advisory Committee established under AHMACRural Health Strategy: New RCSs and UDRHs, HECS Reimbursement Scheme, MRBS, RAMUS
2001Un-met need and under supply of doctors in rural areasHealth Insurance Act amendments (Rural and Remote Area Medical Practitioners) Bill 2000. Additional 100 places per year through MRBS.
2002-03Policy to encourage more doctors to relocate from metro to outer metropolitan areasIncentives for doctors to relocate to outer metro, increased levels of GP and specialist registrars undertaking placements in outer metropolitan areas
2003-04Future workforce shortages identified. Additional Commonwealth supported places for medicine. Bonded Medical Places Scheme started Jan 2004.
2004The National Health Workforce Strategic Framework (AHMC)Endorsed by COAG 2006
2004-05Strengthening Medicare Package. Higher Medicare rebates to non-VR GPs if they work in a DWS/AoN.
2005Productivity Commission Review “Australia’s Health Workforce”2006 COAG Health Reform
2005Biennial review of Medicare provider number legislationUpdates to s. 3GA programs including PGPPP and relevant changes to Schedule 5 of the Regulations.
2006COAG Health Workforce ReformsResponse to productivity commission report - NRAS, 605 additional medical places and guaranteed internship places for CSP students.
2006Medical Training and Review PanelSubcommittee formed to take on role monitoring clinical training
2006-07COAG2006 - Expanded specialist training program. 2007 Additional PGPPP, specialist and GP places.
2008Report on the Audit of Health Workforce in Rural and Regional AustraliaThe main findings of the report were that there is a persistent workforce shortage in rural and regional areas leading to resources being allocated in the subsequent budget.
2008National Clinical Training Review reports provided to MTRPReports supported COAG 2008 health workforce reforms in relation to improving clinical training capacity.
2008Bradley reviewHigher education reform, retained cap on medical places but recommended uncapping nursing and allied health.
2008-09National Health and Hospitals Reform Commission
2009Response to the Bradley review of Higher EducationStudent centred funding, removal of caps, increased indexation.

A demand-driven funding system commenced in 2012, with exception of medicine.

2009-102009-10 Rural Health Workforce Strategy BudgetAdoption of ASGC-RA classification, replacing RRMA. General Practice Rural Incentive Program. New scaling initiatives for bonded medical students and retention and relocation grant programs. Pathology and diagnostic imaging workforce training places and support for rural pathologists.
2010COAG 2008Health Workforce Australia established
2010Health reformIncreased specialist and GP training places
2010COAG 2006 - NRASMedical Board of Australia commences
2011Knight - Strategic Review of Student Visa ProgramTemporary student visa class easier to obtain
2011COAGAugust – COAG National health reform agreement
2012Health Workforce Australia 2025 Vol 1-3Contains detailed supply and demand projection results for the medical and nursing and midwifery workforces.

219 Joyce et al. (2007). Riding the wave: current and emerging trends in graduates from Australian university medical schools. Medical Journal of Australia, 197(6):374-5

220 Medical Training Review Panel, 15th Report 2012

221 Joyce et al, loc cit.

222 COAG Communique July 2006. accessed at http://www.health.gov.au/internet/main/publishing.nsf/Content/6F61F2FB891D83D6CA25726B0003893D/$File/mstapd.pdf

223 AIHW (2011). Medical labour force 2009. AIHW bulletin no. 89 Cat.no. AUS 138. Canberra

224 Health Workforce Australia 2025: Doctors, Nurses and Midwives Vol. 1, 2012

225 Australian Health Ministers’ Conference, 2004

226 Health Workforce Australia 2025: Doctors, Nurses and Midwives Vol. 1, 2012

227 Audit of Health Workforce in Rural and Regional Australia, 2008

228 Department of Health and Aged Care Occasional Paper New Series No. 12 The Australian Medical Workforce. August 2001

229 Department of Health and Ageing. Section 19AA of the Health Insurance Act 1973: Factsheet http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/section19AA

230 Australian Government Department of Health and Ageing (2008). Report on the Audit of Health Workforce in Rural and Regional Australia, April 2008. Commonwealth of Australia, Canberra.