[2020 entry and beyond] Guide to Bonded Medical Places

[hmall11]

I

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

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...

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

From this I am guessing you are not from or were not raised in a rural area? Your assumptions about lack of schooling opportunities and work almost come across classist. Bonded students are not being sent to the most rural and remote areas in Australia. Some areas, such as Port Macquarie, Wagga and Albury have the highest qualities of life. These aren’t towns with 500 people, these are regional areas that are thriving communities with a myriad of specialty departments. I for one am so incredibly grateful to have been raised in regional Australia, mentalities like these are hurtful to rural communities and for doctors who can and will have flourishing careers in these areas.

 

[RuralDr]

Hi Guys
Just for the record in case someone in the future would like to know. I have spoken with JCU today and a BMP offer can be deferred on reasonable grounds.

 

[JL538]

It's the reason that 95%+ of people break the bond for a financial cost.

Is that a hyperbole or do literally so many people decide to pay like 300k or whatever it is just to avoid working in a rural area

 

[dotwingz]

From this I am guessing you are not from or we’re not raised in a rural area? Your assumptions about lack of schooling opportunities and work almost come across classist. Bonded students are not being sent to the most rural and remote areas in Australia. Some areas, such as Port Macquarie, Wagga and Albury have the highest qualities of life. These aren’t towns with 500 people, these are regional areas that are thriving communities with a myriad of specialty departments. I for one am so incredibly grateful to have been raised in regional Australia, mentalities like these are hurtful to rural communities and for doctors who can and will have flourishing careers in these areas.

Except I was... and I can personally see the effects of this in my own very life. I went to the best school in my area, and it was ranked well in the 200s in the HSC school list - theres a reason why boarding school and home shares exist. I know personally how the high suicide and drug addiction affects these communities, and seeing dozens of my friends and over half my cohort leave my school when the coal mines shut down, or watching young girls leaving school early to care for their teen pregnancies of which rural teens are more than 8 times more likely to have, or how it may take police 90 minutes to respond to a domestic violence call...

Pointing out that rural areas are hard to live in is not classist. It's not hurting regional Australia. Im just don't buy these idea that rural Australia is all sunshine and lollipops of which everyone knows each other and has a jolly gay time. There is a reason why these areas are maldistrubuted, and its not just because city slickers have a myopic view of these areas - and locking them into a contract where they have to personally put hold on their life is not the way to answer

And not all of these areas are DPA's for Bonded Medical Places. Port Mac, Coffs, etc dont count.

Is that a hyperbole or do literally so many people decide to pay like 300k or whatever it is just to avoid working in a rural area

From an article published in 2015 - 12 years after the BMP scheme was introduced:

DoH advises that 413 original BMP participants have withdrawn or breached, significantly greater in number than the 9 who have completed their ROS, and the 135 who are undertaking their ROS.

So 2% of participants actually completed it within 12 years - i believe out of the 15 years before they have to pay it out. Its about 20-25k per year of medical school, a link to the costs is somewhere on this thread.

 

[hmall11]

Except I was... and I can personally see the effects of this in my own very life. I went to the best school in my area, and it was ranked well in the 200s in the HSC school list - theres a reason why boarding school and home shares exist. I know personally how the high suicide and drug addiction affects these communities, and seeing dozens of my friends and over half my cohort leave my school when the coal mines shut down, or watching young girls leaving school early to care for their teen pregnancies of which rural teens are more than 8 times more likely to have, or how it may take police 90 minutes to respond to a domestic violence call...

Pointing out that rural areas are hard to live in is not classist. It's not hurting regional Australia. Im just don't buy these idea that rural Australia is all sunshine and lollipops of which everyone knows each other and has a jolly gay time. There is a reason why these areas are maldistrubuted, and its not just because city slickers have a myopic view of these areas - and locking them into a contract where they have to personally put hold on their life is not the way to answer

And not all of these areas are DPA's for Bonded Medical Places. Port Mac, Coffs, etc dont count.

From an article published in 2015 - 12 years after the BMP scheme was introduced:

So 2% of participants actually completed it within 12 years - i believe out of the 15 years before they have to pay it out. Its about 20-25k per year of medical school, a link to the costs is somewhere on this thread.

The new bonded scheme includes areas of MMM 2-7, such including those areas I mentioned

 

[hmall11]

Except I was... and I can personally see the effects of this in my own very life. I went to the best school in my area, and it was ranked well in the 200s in the HSC school list - theres a reason why boarding school and home shares exist. I know personally how the high suicide and drug addiction affects these communities, and seeing dozens of my friends and over half my cohort leave my school when the coal mines shut down, or watching young girls leaving school early to care for their teen pregnancies of which rural teens are more than 8 times more likely to have, or how it may take police 90 minutes to respond to a domestic violence call...

Pointing out that rural areas are hard to live in is not classist. It's not hurting regional Australia. Im just don't buy these idea that rural Australia is all sunshine and lollipops of which everyone knows each other and has a jolly gay time. There is a reason why these areas are maldistrubuted, and its not just because city slickers have a myopic view of these areas - and locking them into a contract where they have to personally put hold on their life is not the way to answer

And not all of these areas are DPA's for Bonded Medical Places. Port Mac, Coffs, etc dont count.

From an article published in 2015 - 12 years after the BMP scheme was introduced:

So 2% of participants actually completed it within 12 years - i believe out of the 15 years before they have to pay it out. Its about 20-25k per year of medical school, a link to the costs is somewhere on this thread.

However, as you mentioned you are bonded I would assume you’d be under the older scheme which doesn’t use the MMM model, but I do believe the new scheme can be opted into

 

[dotwingz]

I am a part of the new scheme, its alot more flexible and is a welcome change... but it still suffers the inherent flaw in the idea. Youre right, these places are MMM2-7 for now... its only a matter of time before these places go up a few ranks and will no longer count (although we will probably be fine).

 

[botselenium]

Btw I’ve heard there is also a “Medicare ban” for breaking the BMP contract (along with having to pay back the cost of the degree).

 

[JL538]

So 2% of participants actually completed it within 12 years - i believe out of the 15 years before they have to pay it out. Its about 20-25k per year of medical school, a link to the costs is somewhere on this thread.

Wow ok so would the drop out rate have increased? Since the ROS period is now 3 years instead of 1 and people were already willing to pay 100k just to avoid only 1 year of working in a rural area. Damn this whole scheme seems like a scam

Also what is the link for that map thing? Looks interesting
Edit: Nvm I found it

 

[dotwingz]

Btw I’ve heard there is also a “Medicare ban” for breaking the BMP contract (along with having to pay back the cost of the degree).

This is for the old Medical Rural Bonded Scheme - the government obviously realised this was a terrible idea (oh yeah the best way of fixing a rural doctor shortage is to not let doctors practice)

Wow ok so would the drop out rate have increased? Since the ROS period is now 3 years instead of 1 and people were already willing to pay 100k just to avoid only 1 year of working in a rural area. Damn this whole scheme seems like a scam

Also what is the link for that map thing? Looks interesting

I believe the original scheme was 3 years - then changed to 1 - then changed back to a flexible 3 years. I would say the drop out rates havent changed too much, because its not so much about the duration, but the pain of getting moving around, and the lack of professional development.

 

[DrDrLMG!]

I believe the original scheme was 3 years - then changed to 1 - then changed back to a flexible 3 years. I would say the drop out rates havent changed too much, because its not so much about the duration, but the pain of getting moving around, and the lack of professional development.

There was an early period when the RoS was 6 years, from memory. I can definitely see there’d have been a super high breach rate for that.

 

[Stapedius]

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

Sorry for the long post, but I think I may have something to add to discussion here (maybe). I think I made this point a while back, but in my opinion the whole issue with BMPs now is they're forced onto some people who clearly have no interest in working rurally and they're subsequently going to the wrong people. People apply for both BMPs and CSPs as if they're one and the same and will take a BMP if it means studying Medicine. They then go and finish their degree, get turned off by the prospect of some of the negatives of working rurally and thus buy it out because as is the reality of studying Medicine, most of us are of a higher SES than the rest of the population, and are more likely in a position to afford to do so. The government benefits from this buyback cost, but as was made as an initial counter to this point - surely the economic cost of worker shortages and failing primary healthcare leading to increased hospitalisation in rural areas as a result of poor BMP compliance outweigh this from a government fiscal perspective?

My position is honestly that they should bring back the Medicare billing ban and get rid of the pay-back clause. I know there are some on here that finds this measure draconian but I believe that all this encourages is the largely non-rural cohort who would otherwise not have any intention of going rurally and completing the BMP to instead only apply for the CSP positions. Yes, it increases competition for the CSPs, but we already know there's enough doctors working in metro locations; time for some serious measures to help solve the rural workforce maldistribution shortage (not to be confused with workforce shortage). Leave the BMP positions to those students (rural or non-rural; it doesn't matter imo) who actually care about working rurally and will stay there, fully aware that they will have to stay there for (3) years (or whatever) at least due to the new provisions. Obviously with lots of flexibility as to where they can go. If students are adequately informed about their options with the BMP and what it means from the get go, I don't think it is fair to say it is a "human rights breach" or that "they are working without freedom of choice". The only people who will be upset by this change are the people who are directly contributing to the maldistribution problem by buying out of these schemes and not fulfilling their obligations.

While I agree with most of what you're saying dotwingz, I do think there are a number of regional (I'm not talking RA5) areas which are perfectly acceptable to train up in such that the impacts on progression are negligible. For example, Townsville and Cairns are deemed RA3 (mainly due their sheer raw distance from Brisbane) and offer most specialist training (Townsville even offers a neurosurgery pathway) that you would see in the city. The places themselves are definitely not ultra-urbanised but for what they are, you're not missing out on too much in terms of schooling and other stuff. I think the lifestyle, working hours and other stuff you mentioned definitely applies for the more remote areas, particularly in Queensland which is so spread out and so it's not easy to transfer patients meaning the responsibility and working conditions of the doctors becomes much more lucrative and by the very nature of where it is there just aren't any specialty pathways there. I definitely saw this on my rural placement in a RA5 region and it's so true about the difficulties and stresses of raising a family whereby there's one school in the region and 4 doctors sharing the load of a whole mini hospital. Having a patient walk in 20 weeks pregnant with severe uncontrolled bleeding when your only OBG/GYN specialised rural generalist is on leave is just horrifying to deal with. I can say though with almost complete confidence (having spoken to many JCU graduates who have gone down this path, one of whom is now an orthopaedic surgeon) that spending your intern and PGY2/PGY3 years in a place like Townsville or Cairns will not affect your career progression for the vast majority of specialties compared to those who have gone down the path in the SEQ metro regions. I'm personally not aware of the situation in other states though, however I'm sure there's at least some overlap. I think it's important to make a clear distinction that a lot of the issues which are used to describe the difficulties of rural life exist on a continuum and it's certainly not as severe is some places than others.

So in summary; I agree the BMP scheme in its current form is a joke and the rules need to be tightened so the right people are actually taking them and completing them. I also think the government needs to foster more rural training hubs to encourage more specialty training outside of the major tertiary centers where possible (I'm fully aware of the limitations regional areas pose to certain specialties at meeting accreditation requirements). I think those signing onto BMPs definitely need to be aware of the arrangements of taking a BMP, and while I disagree with the current arrangement of it, I think it is extremely unethical to breach the BMP without any serious reason and I think any encouragement of this should be condemned. I think though that if you're not adept to possibly having to delay your training at worst for 3 years for some specialties, you shouldn't immediately dismiss a BMP as being the worst thing possible. Remember you can always spread it out and find a place that you like working. I think this all comes down to how much you want to study Medicine. Not all regional areas are doom and gloom.

Sorry for the painfully long post. Hope I wasn't completely incoherent.

 

[chinaski]

Having a patient walk in with menstrual bleeding when your only OBG/GYN specialised rural generalist is on leave is just horrifying to deal with.

It is? Menstrual bleeding tends to occur with predictable regularity for most women of child-bearing years.

I can say though with almost complete confidence (having spoken to many JCU graduates who have gone down this path, one of whom is now an orthopaedic surgeon) that spending your intern and PGY2/PGY3 years in a place like Townsville or Cairns will not affect your career progression for the vast majority of specialties compared to those who have gone down the path in the SEQ metro regions. I

Firstly (and again): remember the bond is not completely repaid during your training period. You must also consider the ramifications of having to return service at the point of fellowship.

 

[Stapedius]

It is? Menstrual bleeding tends to occur with predictable regularity for most women of child-bearing years.

Sorry, I'm a complete idiot lol... meant to say excess bleeding while 20 weeks pregnant. Not menstrual bleeding, my bad. That case was quickly flown to Cairns anyway.

Firstly (and again): remember the bond is not completely repaid during your training period. You must also consider the ramifications of having to return service at the point of fellowship.

That's true - I believe they only changed it recently (2020?) to needing to do half before and half after. But... I think you can always to the DWS criteria for a specialty that perhaps would not exist in a really remote area right? Or are you saying that should you have a BMP, train up as a cardiothoracic surgeon and say there were no positions in a regional area, you'd be stuck? I'm genuinely curious -is that a possibility, or would there always be a DWS place you could go to?

As always, thanks for your input as a doctor who has seen all of this first hand chinaski.

 

[A1]

I believe the original scheme was 3 years

The original BMP scheme was the length of your med course, so varied from 4 years (graduate entry) to 6 years.

 

[chinaski]

. But... I think you can always to the DWS criteria for a specialty that perhaps would not exist in a really remote area right? Or are you saying that should you have a BMP, train up as a cardiothoracic surgeon and say there were no positions in a regional area, you'd be stuck? I'm genuinely curious -is that a possibility, or would there always be a DWS place you could go to?

Basically, you need to consider about the portability of your specialty. If you have your heart set on training in a reasonably specialised area, say, paediatric cardiothoracic surgery, then you're not going to find too many consultant positions (if any) open in rural or remote communities simply because they don't have the demand for that specialty to keep you employed (ie there will always be some specialties that are centred in urban areas due to the way our population is dispersed). There may be DWS places crop up from time to time in urban areas for such specialties, but you can't guarantee they will arise when and where you need them. In the setting of niche specialties, when those positions are filled, it could be months to years before another one is advertised. You also must bear in mind that it's a really competitive market out there so the likelihood of being unsuccessful in multiple consultant job applications before you actually land a post is quite high. You won't get a job given to you in a certain area just because you have a bond to repay.

This can lead to you being forced into applying for and taking a job because it's the only one available at the time and you have a bond to pay off, rather than your wanting the job per se. People without a bond to repay have freedom of choice: they can choose to not apply for a position if it has a bad reputation, or happens to be in a part of the country they don't want to live.

Secondly, bear in mind that people don't tend to get jobs in urban public practice straight after finishing their training. In order to become competitive for those jobs, one must do a lot of leg work - largely in large urban centres or academic institutions (eg overseas fellowships, research, higher degrees, sub-specialty focus, provision of leave cover etc etc). This takes years of work before you're even considered for an urban job. As such, if you take yourself away to the country to work as a consultant straight after getting your letters, you take yourself out of that competitive pool. What's more, it takes your career and CV in a completely different direction: you're now working as a consultant in a regional or rural area, rather than someone who is looking at entry into urban practice who is building their CV in far more niche and academic areas.

 

[Sokka]

Basically, you need to consider about the portability of your specialty. If you have your heart set on training in a reasonably specialised area, say, paediatric cardiothoracic surgery, then you're not going to find too many consultant positions (if any) open in rural or remote communities simply because they don't have the demand for that specialty to keep you employed (ie there will always be some specialties that are centred in urban areas due to the way our population is dispersed). There may be DWS places crop up from time to time in urban areas for such specialties, but you can't guarantee they will arise when and where you need them. In the setting of niche specialties, when those positions are filled, it could be months to years before another one is advertised. You also must bear in mind that it's a really competitive market out there so the likelihood of being unsuccessful in multiple consultant job applications before you actually land a post is quite high. You won't get a job given to you in a certain area just because you have a bond to repay.

This can lead to you being forced into applying for and taking a job because it's the only one available at the time and you have a bond to pay off, rather than your wanting the job per se. People without a bond to repay have freedom of choice: they can choose to not apply for a position if it has a bad reputation, or happens to be in a part of the country they don't want to live.

Secondly, bear in mind that people don't tend to get jobs in urban public practice straight after finishing their training. In order to become competitive for those jobs, one must do a lot of leg work - largely in large urban centres or academic institutions (eg overseas fellowships, research, higher degrees, sub-specialty focus, provision of leave cover etc etc). This takes years of work before you're even considered for an urban job. As such, if you take yourself away to the country to work as a consultant straight after getting your letters, you take yourself out of that competitive pool. What's more, it takes your career and CV in a completely different direction: you're now working as a consultant in a regional or rural area, rather than someone who is looking at entry into urban practice who is building their CV in far more niche and academic areas.

Would it still be possible then to enter the workforce in an urban area after completing your bond in a rural/remote area?

 

[chinaski]

Would it still be possible then to enter the workforce in an urban area after completing your bond in a rural/remote area?

Possible, sure - but think realistically. You're literally years behind your contemporaries who have all been busy doing the right things to get noticed for those few jobs in the city. You won't be seen as being on an even par with them, and meanwhile, there are new fellows being minted every year coming up through the ranks too. The time you spend out of sight serves as a disadvantage in what is an incredibly tight, competitive market.

 

[Stapedius]

Possible, sure - but think realistically. You're literally years behind your contemporaries who have all been busy doing the right things to get noticed for those few jobs in the city. You won't be seen as being on an even par with them, and meanwhile, there are new fellows being minted every year coming up through the ranks too. The time you spend out of sight serves as a disadvantage in what is an incredibly tight, competitive market.

But surely simply doing some rural work post fellowship doesn't disadvantage you by itself? Surely there are some unbonded "super subspecialists" who have done some years overseas volunteering in disadvantaged countries for whatever reason or for that matter taken a 1-2 year hiatus to start up a family that would be in a similar position on paper. Some metro docs also opt to do rural training without any bonds for some rural experience - are you suggesting that this is at a disadvantage to themselves? Or are you saying all of these examples come from docs who have already established themselves in metro areas first?

Regardless, (and please correct me if I'm wrong) wouldn't the worst case scenario be the person with a 3 year bonded position (assuming they did 1/2 pre-fellowship) be that they're 1.5 years "behind" the metro trained fellow in that subspecialty? Or are you saying that those hiring in metro positions discriminate against that 1.5 years spent rurally, even if the bonded person spent an additional 1.5 years training in a metro location to "catch up" with all the metro "niche and academic areas" so to speak?

 

[dotwingz]

Great Post Stapedius you bring up alot of great points.

or example, Townsville and Cairns are deemed RA3 (mainly due their sheer raw distance from Brisbane) and offer most specialist training (Townsville even offers a neurosurgery pathway) that you would see in the city. The places themselves are definitely not ultra-urbanised but for what they are, you're not missing out on too much in terms of schooling and other stuff.

Townsville is a great example imho of what rural training done right looks like. Townsville hospital is a large tertiary hospital! Of course its going to have a great ability to teach a wide variety of specialties. But this is somewhat unique due to the unique geography of North Queensland as you mentioned. Which is really important for career progression, especially in competitive specialties

From comments i've read on this forum and what I've seen in person, is that hospitals are nepostistic to their own. They'd much rather higher a resident or registrar from their own hospital rather than out reach. Benjamin said in this thread that

My example is the ENT resident and PHO job at the hospital system I currently work at - they have not employed anyone to the non-rotational PGY2 or PGY3 resident jobs for the last 3 years (the time I've been here) that has not done an internship ENT rotation with them. Similarly, 4/5 of the ENT PHO jobs have been allocated this last year and the upcoming year to previous PGY2 / PGY3 residents who did an internship rotation followed by ENT resident jobs at the same hospital.

and Mana has said to me before things along the same line about hospital nepotism over voice chat on Discord.

Now, back to the BMP Scheme. Doctors have to choose to pay it out in one of two ways, before or after finishing training.

So lets see why doing it before is a bad idea

Looking at this this, the only Principial Referral Hospitals outside of Major Cities are

1. The Royal Darwin (29 interns),
2. Royal Hobart (41 interns), and
3. Townsville (71 interns).

These 141 intern jobs make up 4% of the total 3515 amount accross the country.

Comparing this to the ones in Major cities

1. Austin (62)
2. Canberra (95)
3. Concord (46)
4. Flinders (69)
5. Geelong (42)
6. Gold Coast (90)
7. JHH (125)
8. Liverpool (69)
9. Monash (107)
10. Nepean (59)
11. Prince of Wales (51)
12. Princess Alexandria (95)
13. Royal Adelaide (130)
14. Royal Brisbane (93)
15. Royal Melbourne (78)
16. Royal North Shore (71)
17. Royal Perth (85)
18. Royal Prince Alfred (61)
19. Sir Charles Gardinar (113)
20. St George (77)
21. St Vincents Darlinghurst (51)
22. St Vincents Fitzroy (65)
23. The Alfred (57)
24. Prince Charles (25)
25. Westmead (116)
26. Wollongong (65)

Which is 1997 if my UCAT QR skills dont fail me, or 57% of all internships positions.

So if the 28.5% of newly minted bonded junior doctors in this country want to pursue an internship that will help pay off their bond in a hospital that will give them a leg up in competitive specialties, they are restricted to such a small minority thats its not even funny. Which could be disastrous for the ENT gunner as described above, and a significant dent in their career. Obviously, there are more in need specialties and regions in mind, but its an issue nontheless.

Ok so why not delay this until after training?

Well my understanding of the medicine Job Market is not great to say the least, Chinaski is much much better than me for that. But my general impression is a few things

• There seems to be an increasing trend of subspecialisation, which is hard to play off in rural areas
• Metropolitan medicine communities can be insular... e.g. if you dont have a history of work in Melbourne, good luck trying to break into that. (this one is not so much an issue if you want to rurally - which should be the goal) youre years behind in experience and connection against your peers.

So bonded junior doctors are stuck between a rock and hard place here. Which is why the overwhelming majority of them end up breaking the contract (with a clause that has been implemented and used heavily in at least the last two agreements - so its hardly a loophole)

My position is honestly that they should bring back the Medicare billing ban and get rid of the pay-back clause. I know there are some on here that finds this measure draconian but I believe that all this encourages is the largely non-rural cohort who would otherwise not have any intention of going rurally and completing the BMP to instead only apply for the CSP positions.

Personally, I think there is more too this argument then - either go rural or don't be a doctor - even if they had taken a BMP. Life situations change, and from an efficiacy point of view, it makes no sense spending hundreds of thousands of dollars educating people just to bar them from working. The time frame from someone accepting this place and seeing the implications is very long, and having teenagers sign contracts with that much obligation on it is unethical no matter how much they 'intend' to go rural in the first place.

I don't agree that breaking the bonded contract is morally incomprehensible... you can't blame people for taking opportunities thats best for them. Nobody kicks up a storm when a rent contract is broken and the break lease fee is paid off if I get a job in a new city... if the government is not going to work on providing opportunities to people who want to work and live in rural areas, I see no reason why people should stay. Especially not in a predatory contract like the BMP.

Also: you're right, rural isnt rural isnt rural. It's not all doom and gloom, there are some real gems out there, with some great areas of living. Realistically, the government needs to do more to split workload between smaller and larger hospital (i like NSW's network design for internships for one), provide more opportunities for more of a registrar term to be done rurally, and more to support those in rural regions. Rather than locking them into a contract as a teenager and holding their career ransom for 100k

EDIT: Also sorry for the long post - this is probably longer than the page that describes the BMP on the health website