[2020 entry and beyond] Guide to Bonded Medical Places

[chinaski]

There are so many things that can affect one's career progression, it's not linear for every single person and its silly to think that a return of service would be the only thing (if it even does) that affects career progression. I hope everyone on this forum starts to slowly get this.

That's true, though I would counter that by saying do you really want to add a compulsory element that has a great potential affect your progression or freedom to pursue avenues or opportunities when you will already have a lot of other mitigating factors already on your plate? In a competitive market, willingly taking on an extra disability can make a big difference.

And frankly, you should be thinking about a specialist career if you are thinking about medicine as a degree... that's exactly what you're studying to become after all! It's a bit like saying it's silly to think about being a teacher when you apply to do a Bachelor of Education.

 

[bigyikes]

That's true, though I would counter that by saying do you really want to add a compulsory element that has a great potential affect your progression or freedom to pursue avenues or opportunities when you will already have a lot of other mitigating factors already on your plate? In a competitive market, willingly taking on an extra disability can make a big difference.

Again, I don't disagree that it's something that needs to be thought out, I'm just saying it that instead of focusing on how it might affect your career progression, maybe focus on how it might affect more immediate things such as cost of living, transport, family etc. rather than focusing purely on career progression

I dont think its too preposterous to consider what factors would affect a career trajectory. I think a bonded agreement is damaging to a career (as does the AMA and just about every article ever published about the scheme) and its an important consider literally worth more than 100k.

Care to share your source on the AMA calling the bonded scheme damaging to a career?

 

[DrDrLMG!]

maybe focus on how it might affect more immediate things such as cost of living, transport, family etc. rather than focusing purely on career progression

These are literally always factors we very strongly encourage people to consider. Are your comments directed towards those asking the questions, or those providing the advice, because they're a little hard to follow.

 

[bigyikes]

These are literally always factors we very strongly encourage people to consider. Are your comments directed towards those asking the questions, or those providing the advice, because they're a little hard to follow.

Those asking the questions, and specifically botselenium

 

[dotwingz]

Care to share your source on the AMA calling the bonded scheme damaging to a career?

I can't find the exact fantastic presentation i read before about it (i believe it may of been UOW - i will report back on a later date) but here is an article from the AMA president calling for the scheme to be scrapped Australian Medicine - President's message: Bonded Medical Places Scheme should be scrapped (APAFT) - Informit


https://www.ruralhealth.org.au/sites/default/files/position-papers/position-paper-03-11-23.pdf heres a (very old) white paper when the scheme was first introduced.

In sum, therefore, the bonded medical scholars are likely to be faced with greater professional and commercial risks, as well as opportunities, than people who (like teachers “in the old days”) were bonded to guaranteed positions in the public service.

But essentially the vibe of it, is that hospitals are nepotistic. Those who intern and resident in hospitals with registrar positions, have better opportunities. Medicine, like everything else in this country, is a game of mates.

 

[chinaski]

Again, I don't disagree that it's something that needs to be thought out, I'm just saying it that instead of focusing on how it might affect your career progression, maybe focus on how it might affect more immediate things such as cost of living, transport, family etc. rather than focusing purely on career progression

Porque no los dos?
I would suggest that thinking about the long game is far more critical before you commit to both the degree and a legally-binding bond. But yes, obviously one must weigh up primary issues such as "can I afford to study medicine?" as a matter of course. But not to the exclusion of the bigger picture ie being a specialist.

 

[DrDrLMG!]

Those asking the questions, and specifically botselenium

This is the BMP CSP thread, though. So asking about other things here would be off topic. We have a whole other thread dedicated to helping people decide between offers on the basis of all the factors (accommodation, cost, scholarships, internship location, etc), but this thread is for specifically asking about the implications of the bonded medical places scheme.

 

[bigyikes]

I can't find the exact fantastic presentation i read before about it (i believe it may of been UOW - i will report back on a later date) but here is an article from the AMA president calling for the scheme to be scrapped Australian Medicine - President's message: Bonded Medical Places Scheme should be scrapped (APAFT) - Informit


https://www.ruralhealth.org.au/sites/default/files/position-papers/position-paper-03-11-23.pdf heres a (very old) white paper when the scheme was first introduced.


But essentially the vibe of it, is that hospitals are nepotistic. Those who intern and resident in hospitals with registrar positions, have better opportunities. Medicine, like everything else in this country, is a game of mates.

That study you linked is beyond outdated, it was written before the first bonded students were even out of medical school, not to mention the limitations of working in RRMA3-7 (I didn't even know there was a bonded scheme in 2003). If we're going to ignore the fact the bonded scheme has been reformed not once but twice, and that the AMA was heavily involved in the newest reform and the previous president (Tony Bartone) was fully in support of it, I still don't think that conclusion is still applicable the same way it was in 2003, and the conclusion you reached is not even what that quote from the study is saying. I'm not saying hospitals aren't nepotistic and favour their own people, but it seems you've gotten to that conclusion purely from anecdotal evidence rather than actual evidence, and there's also no guarantee that as a non-bonded doctor, you're going to be working in the same hospital your entire career, rather its the opposite most doctors I know shift around

This is the BMP CSP thread, though. So asking about other things here would be off topic. We have a whole other thread dedicated to helping people decide between offers on the basis of all the factors (accommodation, cost, scholarships, internship location, etc), but this thread is for specifically asking about the implications of the bonded medical places scheme.

That's what I meant re cost of living, transport and family, the impacts the BMP has on these - the fact that you will have to either commute to a rural location, or live there while completing your RoS and the impacts this can have you and your family, not about the offers themselves

 

[chinaski]

I'm not saying hospitals aren't nepotistic and favour their own people, but it seems you've gotten to that conclusion purely from anecdotal evidence rather than actual evidence, and there's also no guarantee that as a non-bonded doctor, you're going to be working in the same hospital your entire career, rather its the opposite most doctors I know shift around

They might shift around during training by contractual necessity, but like salmon to the spawning ground, they invariably circle back to the mother ship. This phenomenon is really, really apparent and a recurring theme in the big nepotistic hospitals. Someone might do a long spell of training at a competitive hospital during which time they kiss the right backsides and do the right things to get a foot in the door and a favourable reputation, then go away overseas for a while on fellowship, only to be embraced back by the competitive hospital on their return.

 

[dotwingz]

That study you linked is beyond outdated, it was written before the first bonded students were even out of medical school, not to mention the limitations of working in RRMA3-7 (I didn't even know there was a bonded scheme in 2003). If we're going to ignore the fact the bonded scheme has been reformed not once but twice, and that the AMA was heavily involved in the newest reform and the previous president (Tony Bartone) was fully in support of it, I still don't think that conclusion is still applicable the same way it was in 2003, and the conclusion you reached is not even what that quote from the study is saying. I'm not saying hospitals aren't nepotistic and favour their own people, but it seems you've gotten to that conclusion purely from anecdotal evidence rather than actual evidence, and there's also no guarantee that as a non-bonded doctor, you're going to be working in the same hospital your entire career, rather its the opposite most doctors I know shift around


That's what I meant re cost of living, transport and family, the impacts the BMP has on these - the fact that you will have to either commute to a rural location, or live there while completing your RoS and the impacts this can have you and your family, not about the offers themselves

If you ACTUALLY READ the first article you can see in no uncertain terms that the AMA president

was then shocked to learn that, despite this evidence, the Government is actively considering increasing the ROS for future BMP graduates (dotwingz adds: this is regarding the policy for students starting 2020 of which they later applied), and sought advice on this policy at a recent Rural Roundtable Meeting.

I told Assistant Minister Gillespie that putting more emphasis on a scheme that has not delivered any meaningful results for rural Australia – a policy that is not supported by international evidence, or even his own Department – represents a significant policy failure.

also that the BMP has "poor reputation", is seen as "coercive".

And in the second article just because it was in 2003, doesnt mean its any less valuable. They say, just like other bonded agreements in other profession, legally binding people to rural communities where it is hard to train people is not helpful to their career in any sense.

If there is a health workforce shortage in a rural area, explain to me how they could possibly train someone in that area? or how they could possible give people enough experience to be valuable for a registrar position?

The AMA has used words like 'shackles' to describe the program because thats what it is. Sure it may be getting better and a little more flexible, but at the end of the day theyre tying you into an area where they cant supply medical services for their own population, and expecting you to somehow gain valuable experience from this as a junior doctor.

 

[bigyikes]

If you ACTUALLY READ the first article you can see in no uncertain terms that the AMA president


also that the BMP has "poor reputation", is seen as "coercive".

And in the second article just because it was in 2003, doesnt mean its any less valuable. They say, just like other bonded agreements in other profession, legally binding people to rural communities where it is hard to train people is not helpful to their career in any sense.

If there is a health workforce shortage in a rural area, explain to me how they could possibly train someone in that area? or how they could possible give people enough experience to be valuable for a registrar position?

The AMA has used words like 'shackles' to describe the program because thats what it is. Sure it may be getting better and a little more flexible, but at the end of the day theyre tying you into an area where they cant supply medical services for their own population, and expecting you to somehow gain valuable experience from this as a junior doctor.

Ironic that you quoted the AMA using 'shackles' to describe the program when they used it to describe the OLDER program, and used it specifically to emphasise the importance of the reforms they did that debuted in 2020.

Sign in

ama.com.au

Also ironic given that despite the AMA's 'shock' to learn the RoS increased, they 'welcome' the changes made, including the increased RoS.

And arguing about the training opportunities in rural areas is a whole different conversation about the state of healthcare in rural Australia, not about the bonded medical program.

 

[dotwingz]

And arguing about the training opportunities in rural areas is a whole different conversation about the state of healthcare in rural Australia, not about the bonded medical program.

It really isn't though. Medicine is largely taught by doing. If you can't do it, you can't learn it.

The concepts of being forced to work and live rurally, and the lack of opportunities of working and living rurally, are in no way separate.

 

[DrDrLMG!]

And arguing about the training opportunities in rural areas is a whole different conversation about the state of healthcare in rural Australia, not about the bonded medical program.

I must admit to not having done a heap of research on the ins and outs of the BMP as I'm fortunate enough not to have one, but I'd honestly think this is a huge and very relevant consideration. If the "state of healthcare in rural Australia" is worthy of a whole topic on its own, then I'd think it's a key component of considering signing up to a scheme that would bond you to serving in those locations. At least, it would be a factor for me to further research.

 

[bigyikes]

It really isn't though. Medicine is largely taught by doing. If you can't do it, you can't learn it.

The concepts of being forced to work and live rurally, and the lack of opportunities of working and living rurally, are in no way separate.

You're basically saying there's no way to learn medicine properly in rural areas because of workforce shortages. Obviously there's no way to confirm this, but everyone I've spoken to who's worked in a rural area have explicitly said that they learned more BECAUSE it was a rural area and that a lot of things that they normally wouldn't be responsible for in a metropolitan area, they were there. This isn't to say that its better to learn in a rural area, but you're acting like its an impediment whereas many would argue its an advantage in some senses

 

[chinaski]

The bond isn't just over your training period. Conscription out to rural areas once fellowed puts you on a different trajectory compared to colleagues who have the freedom of choice.

 

[botselenium]

Those asking the questions, and specifically botselenium

Apologies bigyikes I did not mean to irk you or anyone else. I have a lot of respect for this community.

 

[hmall11]

I’m really shocked about this thread! The discourse around the bonded scheme seems to be in a negative light and reflective of self interest, not mentioning the reason why bonded medical places exist - to better provide for areas that have shortages. My experience of the reality is very different to what has been said here. Many UNSW alumni choose to do their internship and residency at rural hospitals (MANY CSP students also choose this) due to the quality of teaching. This is especially the case for Wagga and Albury which are fantastic hospitals with extremely strong training programs (as well as considerably higher pay 78k Albury and overtime vs 59k POW no overtime internship salary). I truly believe that a bonded medical scheme does not need to restrict ones medical career and arguably could put you in a very strong position for fellowship prospects. Of course there are exceptions, but on the whole there is a great appreciation for rural doctors and the bonded medical scheme is not a means of restriction, but rather built to diversify, both in experience and patient base.

 

[chinaski]

I truly believe that a bonded medical scheme does not need to restrict ones medical career and arguably could put you in a very strong position for fellowship prospects.

Based on what evidence, exactly?

 

[villanelle35]

So I have just been through the entire thread and kind of following from above ^^.

I know multiple people have already asked this but does doing a bonded degree really close you off to various specialties [one of my main concern besides the working environment and teaching quality]? I currently have a bonded 5 year, bonded 6 year and an unbonded 7 year course all requiring me to move out [though the 5 year course is in my state]

Would you say the extra 1/2 years of the UNbonded program is ultimately more worth it since I will apparently be getting a career with more freedom?

Thank you! - in the mood where I'm more worried about my future than excited

 

[dotwingz]

If training in rural areas really made people better doctors and more attractive candidates for specialty training positions, then we wouldn't have these workforce distribution issues.

Living and working is hard in rural areas, there is no way around this. Suicide rates are high, drug addictions are high, there are antisocial elements from being so disconnected, they're hard to get around, lack of schooling opportunities for children, lack of work opportunities outside of primary industries, the list goes on... and for this, junior doctors who are often start postgraduate training around the time they settle down with a partner, or have some kids, it is very hard to justify to live in these rural areas.

For young junior doctors, its hard to move to a rural area with a spouse and kid for intern or residency year, just to throw it all up again to move to somewhere you can actually train as a registrar. Take a look at this quote from an article published in the AMA about the factors that lead to doctors deciding where to practice

Postgraduate education occurs at a crucial time in a trainee's personal and professional life. For most specialties, this training is currently based in large urban centres, and trainees spend very little time in rural settings. Thus mentor–trainee relationships, life partnerships, work opportunities for partners, purchases of homes, and stable child care or schooling arrangements become established in urban centres.

This is the entire idea behind the rural training pipeline the government is funding. To allocate extended terms during a registrar to essentially spend a large amount of their time, training in a regional training hub... same with opening medical schools in Orange, Rockhampton, Shepparton, Wagga, Bendigo, Midlura, Dubbo, etc... It's to help people get settled in rural areas so they can train there... if the training opportunities were equal in the first place, they wouldn't need schemes like this.

Knowing about the limitations of a BMP is not self serving, or self interest. It's reality. It's the reason that 95%+ of people break the bond for a financial cost, because despite earning more in a rural area, or getting more work, or more 'hands on experience', it is a harder lifestyle that can hurt your future.

villanelle35 - I wouldn't be too worried, personally I would take the 5 year one. A bonded agreement is not the end of the world, mostly due to its ability to be broken and payed off (lets be realistic here: is the primary motivator behind the scheme for the government), and you will 100% change with what speciality you want to be before you graduate

ETA: I might add that I am a bonded student and interested in rural practice... and am in no way acting in 'self interest' with pointing out the flaws in the the scheme, by preying on teenagers who dont fully understand the career or personal affects a bonded career may have.