Medical Rural Bonded Scholarship Scheme

The Medical Rural Bonded Scholarship Scheme is an Australian government program the Government says is to increase the availability of rural doctors.
Others take the view it is a concerted effort to ban access to Medicare, thus hiding a blow out in Medicare costs and lack of services. Government documents obtained by Freedom of information indicate the Government is actually placing work restriction, on Dr's ^[1]

Government policy is to move population from areas of low work, generally rural to areas of high opportunity generally metropolitan centres.^[2][3][4]

Scheme and Contract Operation, termination of Medical Students

There is a contract between the government and medical students. How a person enters the contract, as a student or applicant to Medicine and if it is voluntarily is very unclear.

Contract breach is the mechanism of formal contract between a person and the Commonwealth that triggers loss of a provider number and repayments. However the scheme consists of arrangements between the Government and Universities on how to get the contracts signed and terminate students who do not breach the contracts. The current (2011) Contract gives a one year period within which the contract will not be breached if finalised.

However the Contract and supporting material claims a students place is some how 'linked' or 'funded' under the contract/scheme while at the same time each student is required to be eligible of HECS/CPS. There has been no change to HECS/CPS legislation to reflect this 'link' assertion. Rather HECS/CPS legislation requires all students to be treated equally ^[5]. The Department of Health and Ageing rather asks Universites to terminate Students, and pays amounts of money to Universities on the basis they follow this request.

Value of Payments and Debts under the Contract

The scheme has a net value of around $5000 per annum, or a net detriment of $10,100 if the contract is breached to a student

While the Contract the student enters pays medical students a yearly indexed rate, currently around $24,000 the Contract also makes you ineligible for

[1] Austudy worth about $10,100 per annum, because of the payments under the contract ^[6] and the

[2] HECS Reimbursement Scheme, which is worth around $8859 per annum based on area of service. ^[7]

Accordingly the net value of scheme scholarship is around $5000 per annum.

Further if a person breaches by not practising in a 'rural' area after speciality training they must pay all the money back with interest and the $10,100 per annum of Austudy is un-recoverable.

Over a 5 year degree this amounts to a $25000, or about $100 per week, and if breached a loss of $50,500 in addition to all repayments of $125,000

Loss of Medicare Rebate for 12 Years

Most importantly if the contract is breached the student is prohibited access to Medicare provider numbers for up to 12 years after completing specialty training (the time does not being running from the time of graduating from medical school, but completion of specialty training). This limits the ability of student, now a Dr's to practice if they refuse to honour their contract.

Some have criticised the scholarships, stating that they limit the ability of medical students to specialise in their chosen field.

Contrast With Bonded Medical Places

the MRBS scheme is different to bonded medical places. Some Universities offered MRBSS to students who already have a place in medicine. These scholarships are therefore voluntary, and students are not pressured into accepting them with the promise of a medical placement. However some Universities do not. They require a person to sign a MRBSS contract before having a place.

In the former case the main benefit of the MRBS scheme is not the promise of a medical education but rather the monetary compensation provided by the government. In the latter case the medical school education is the main benefit, and civil conscription issues arise. The Civil Conscription issue may still arisen the former case as the enforcement of the contract when a person changes their mind about where they wish to serve, faces the fact that such enforcement is against the current choice of the individual. The free choice of the individual at any time is enshrined in the Constitution. Any instrument that fetters that choice at any time is thus invalid at the time that instrument fetters a persons choice.

Unlike the MRBS scheme, students who take bonded medical places must work in an 'area of need'. This could include a speciality in the city that is experiencing a shortage, or an outer suburb of a large metropolitan city. MRBS students must work in a rural area.

Constitutional Issues

Members of the Australian parliament have raised concerns over the constitutionality of the scheme, as section 51(xxxiiiA) of the Australian Constitution prohibits legislation introducing any form of civil conscription for medical services.^[8] Speaking in the House of Representatives, Michelle O'Byrne said

On 10 September 1998, in a press release, the minister stated: The scholarships are probably unconstitutional due to the limitation in section 51 preventing civil conscription of doctors."[1]

Countering the view that the scheme constitutes civil conscription is the argument that the scheme is entered into voluntarily. Government minister Ian Macfarlane said,

If the people who are considering taking these scholarships are not prepared to take the conditions, the answer is simple: don't sign them. This is not a compulsory scheme; this is a voluntary scheme."[2]

As of 2010 a legal constitutional challenge has been filed in the Federal Court to the MRBS scheme. Edwards v Commonwealth, Secretary Department of Health And Ageing and Ors.

Criticism

Some have criticised this program, stating that it preys on students who cannot support themselves during university. Many students may not realise the length of their obligations or fully understand the ramification of their decision to accept the scholarship. Often studying in a rural area limits the choice of speciality for new doctors, since some smaller specialities don't operate in rural areas. Speaking in parliament Mr. Dick Adams (Lyons) stated:

As I said, this bill is really about bashing people to achieve a goal. It sets out conscription on people which might be a contractual arrangement for 17 years and then you take away the Medicare ticket so they cannot get payment. Therefore, working as a doctor would be pretty difficult because you would probably work for nothing. I do not think that is the solution. ...[this is] a bill to bash people about the head with and make them stay somewhere where they probably do not want to be.'[3]

See also

• Medicare (Australia)
• Medicare card
• Medicare Australia
• Department of Health and Ageing

References

1. ^ http://www.wikileaks.ch/wiki/Too_sneaky_by_half:_plan_to_keep_local_Australian_doctor_numbers_low,_assorted_documents,_2000-2009
2. ^ http://www.fahcsia.gov.au/guides_acts/ssg/ssguide-3/ssguide-3.2/ssguide-3.2.1/ssguide-3.2.1.35.html
3. ^ http://www.austlii.edu.au/au/legis/cth/consol_act/ssa1991186/s553b.html
4. ^ http://www.centrelink.gov.au/internet/internet.nsf/payments/newstart_waiting_periods.htm#moving
5. ^ http://www.austlii.edu.au/au/legis/cth/consol_act/hesa2003271/s19.35.html
6. ^ http://www.centrelink.gov.au/internet/internet.nsf/payments/austudy_rates.htm
7. ^ http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/Content/program-hrs
8. ^ Parliamentary paper for the Health Insurance Amendment (Rural and Remote Area Medical Practitioners) Bill 2000

External links

• Department of health and Ageing Scheme information
• Commentary

• Action group/resources against bonding[4]