Medical students in cities and large regional centres are using government rural placement schemes to get low rate university loans with no intention of going bush.
That's what a Senate committee enquiry into health services in rural areas has been told.
The Department of Health told the committee that of the 13,521 participants since 2001, just 597 had completed their return of service obligation and 779 participants had withdrawn from the program.
Of the remaining 12,145 active participants, 6904 are still studying and yet to complete their RoSO, while the other 5421 are unknowns.
Since 2001, students have been able to apply for various Bonded Medical Program schemes, which provide them with a Commonwealth supported place at an Australian university in return for a commitment to work in eligible regional, rural, and remote areas for three years after course completion - known as the return of service obligation.
Medical students have 18 years to fulfil their promise.
Ochre Health co-founder Dr Hamish Meldrum told the enquiry that when he had asked rurally bonded students what made them want to go rural, they laughed.
"... they laugh at me and say, 'No. Nobody wants to go rural. We just put down that we want to be rurally bonded students so that we can get into medical school'," Dr Meldrum said.
"They think the question I asked them is quite hilarious ..."
In March this year, a committee chair said they had heard from submitters that the scheme was failing.
"Basically, we were told this morning that the bonded medical placements aren't working and that there are very few people who accept a bonded medical place who actually end up working as a medical practitioner in a rural or regional area," the chair said.
"There are large numbers who, rather than doing that, basically pay back the money that they were loaned."
Asked what evaluation there had been of the success or otherwise of BMPs, Department of Health health financing deputy secretary Penny Shakespeare said there had not been a specific review since the Mason Review nine years ago.
The chair then went on to question the validity of the program.
"If you haven't done any evaluation for nine years and there have been various versions of it done in the last nine years, how do you know whether it's providing value for money or being successful in addressing the shortage of GPs in rural and regional areas? Out of the 13,521 we've only had 597 who have actually completed their placement."
Ms Shakespeare said the BMPs were long term programs.
"In many cases there is no obligation to complete a return of service until training has been completed through the fellowship, and, as you would have heard from many witnesses, that can be quite a long process," she said.
"There's been no external evaluation since 2013, but we have certainly done a lot of work internally, within the department and within government, reviewing and reforming this program."
The committee interim report then went on to say that the committee had received evidence that bonded medical programs were "ineffective", had low participation rates, and were associated with lower retention after the period of service.
"Inquiry participants also suggested that those who sign up to bonded medical programs do not intend to practice rurally and use it as a mechanism to secure a position in medical school," the report said.
The report then touched on the 2013 Mason Review.
"It found that there was a lack of evidence that the Medical Rural Bonded Scholarship Scheme resulted in longer term positive connections to rural life and provided 'questionable utility' for a program that was expensive and administratively burdensome," the interim report said.
"For the Bonded Medical Places scheme ... it also noted that the Department of Health was not currently able to adequately monitor and report on completion of return to service obligation requirements while graduates are undertaking vocational training."
Kennedy MP Bob Katter said medical students in the bonded medical place scheme should be required to complete their rural service in the immediate three years after they graduate.
"The government and health department did excellent work in establishing this scheme but having 18 years to complete the requirement to go rural is just unrealistic and is resulting in undesirable outcomes," Mr Katter said.
"No doctor, after living in Brisbane on a much higher wage for a few years, is going to cart their family back to the boondocks. It's never going to happen, and the stats show that.
"They should go out in the first three years, or they'll receive no incentive at all.
"There are chronic shortages of GPs through North Queensland, which is curious because we've trained 2000 doctors through James Cook University, but we've still got no doctors in country areas and no GPs."
Mr Katter has written to Health Minister Greg Hunt and urged him to act immediately by reducing the time given to complete rural service.
"If the Health Minister cuts down the time given to complete rural service under a bonded medical place scheme from 18 years to the first three years, then I think we'll see a noticeable change."
KAP leader and Traeger MP Robbie Katter said the federal government had a responsibility to ensure its policies were effective and fit-for-purpose, and that the current scheme requiring doctors completed rural service over a period of 18 years was "failing abysmally".
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