Evaluation of the University Departments of Rural Health Program and the Rural Clinical Schools Program

6.6 - Health system capacity to absorb increased training requirements

Page last updated: 2009

The ability of both Programs to deliver their stated objectives is heavily dependent upon the capacity of the health system to absorb the projected increase in the number of medical students, as well as nursing and allied health students. This in turn is dependent upon the ability of Federal and State/Territory health services to recruit and retain high-quality clinicians.

In the long term, the sustainability of both Programs will rely on an interdependent relationship with Federal and State/Territory-funded health services in which the Programs nurture potential rural clinicians and support existing ones, while the health services provide the environment in which those clinicians (both potential and existing) can flourish.

'It's all very well turning out graduates, but it's no good if there are no postgraduate intern positions. We need a better vision for a rural pathway.' (clinician)
Success for the RCSs could be measured in the number of rural interns and registrars; however it is not possible to measure success with these parameters when the placements for those segments of medical training are not available in rural areas. In addition, a significant factor in the RCS Program's potential to impact on workforce is the development of vertically integrated rural pathways. Medical students spend another 5-7 years in postgraduate training programs following their RCS experience, before they become qualified to practise in their own right; these are years where significant life choices are made, wedding vows are exchanged, mortgages are signed and families are started. The more that postgraduate and vocational training requires extended metropolitan placements, the greater risk that rural intentions fostered by the RCS Program may be eroded and replaced by metropolitan intentions. The Australian General Practice Training Program has already been regionalised (by the same Minister for Health who oversaw the launch of the RCS and UDRH Programs); the same progress has not yet been made for surgical or physician training.

Recent calls to re-examine the number of Commonwealth-funded medical student places (Wallace 2008), to increase the number of rural hospital intern placements and to restore the PGPPP funding for general practice intern placements (RDAA 2008), and to consider a market-based approach to the determination of workforce levels (Schwartz 2008), are symptomatic of a heightened awareness that the lack of integration across all levels of medical training will potentially limit the intended benefits of many of the Australian Government’s rural health workforce strategies, including the RCS and UDRH Programs.

The need for integration across training levels will require collaboration across training providers, as well as across State/Territory and Federal health systems in providing clinical placements within hospitals and other service delivery environments. As the ability of the RCS and UDRH Programs to deliver their workforce outcomes will be hampered by the lack of availability of placements for students within community or hospital settings, as well as the lack of capacity of rural health professionals to take on preceptor responsibilities, it seems essential for both Programs to be represented in national and State/Territory-based discussions on resolution of a vertically integrated rural training pathway. In addition, the development of clear clinical academic pathways, so that clinicians could be supported to develop from clinical supervisor to clinical educator over a career, could be an additional contribution to the recruitment and retention of GPs as well as specialists.

Recommendation 13:

That the Department, in collaboration with State/Territory-funded health services, explore alternative partnership arrangements with State/Territory health systems, such as joint appointments, sharing of clinical training facilities, and creation of new clinical training places, to provide stability in training systems for both Programs.

Recommendation 14:

That at national and State/Territory levels the Department encourages vertical integration opportunities to link more closely RCS, postgraduate and vocational training systems, including the implementation of a rural medical career pathway, in close collaboration with universities, professional colleges, workforce agencies, State/Territory governments, and FRAME.

Recommendation 15:

That the Department, in collaboration with State/Territory-funded health services, assist both Programs to develop additional incentives, training and support mechanisms for clinical supervisors and trainers, including exploration of alternative remuneration structures.