National Rural Health Alliance response to questions in the Health Consult Paper: Review of Section 19AB and District of Workforce Shortage (DWS) Classification System Discussion Paper

08 April 2024

1. What impact has Section 19AB and DWS had on the distribution of the medical workforce to areas of workforce need? 

Section 19AB and District of Workforce Shortage (DWS) are part of a suite of distribution levers that have been in place, in the most part, to support building a rural health workforce, in particular the medical workforce. These policy levers have supported rural health in Australia, have been important measures, and it is timely that they are being reviewed, as they are no longer fit for purpose indeed, sometimes, misused. 

Access to health care services would be even worse if Australia did not have the professional expertise of overseas trained health professionals. Rural Australia relies heavily on, and benefits from, the services and care provided by health professionals who have come from, studied and/or trained in other countries. In many cases, if it were not for overseas trained and qualified health professionals, rural communities would not have access to essential care at all. However, international medical and health graduates, whether generalists or specialists, were never meant to fill the long-term gap to the scale they are currently filling in rural Australia. More than 30 years later, they are still not the long-term solution to solving the doctors’ shortage and rural communities are tired of the forever revolving door of doctors. “Growing our own” for rural Australia, as we know from research has demonstrated that rural students are much more likely to stay or go back to rural areas, as are Aboriginal and Torres Strait Islander practitioners who wish to be close to family and country.

Levers need to be placed in the context of population health and the whole of clinician journey (from secondary school to university, to post graduate training and along the career journey) and the broader policy environment. Hence, it is essential that the Australian health and education sectors are focussed on improving recruitment of rural origin students into rural medicine, general practice, and rural generalist training programs to generate a larger pool of medical practitioners for the whole country to draw on. 

Accordingly, recruitment of rural students into medical and healthcare degrees and the provision of end-to-end training in rural Australia, is just as vital to workforce planning and management, as the distribution levers to meet population health needs. On their own the levers tweak around the edges, but as part of a broader suite of policies and focus on population health need, we make an enormous difference to the likelihood that a person will stay rural to deliver care to the communities which make up thirty per cent of the population. 

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