[2020 entry and beyond] Guide to Bonded Medical Places

[chinaski]

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?

Basically you're asking if it's a disadvantage to lose time in a competitive market. It is. Doesn't matter what reason you do it for: bond, family, bad luck, travel - the net effect is the same: you lose ground (and it might also be noted that some of those choices are within one's control, whereas the timing of repaying a bond after fellowship is dictated to you). You can make that time up, sure, but in a setting wherein you want to get out in front, it is counter-intuitive to choose a situation that will place you behind the pack.

And all of this doesn't mitigate the earlier point about portability of a specialty. In order to pay a bond off in a regional area, your specialty must be supported and have sufficient need to exist in that regional area.

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.

And those gems are usually reasonably well-serviced and not in need of extra hands on deck. Doctors don't avoid rural work because they like going to night clubs and sipping lattes in the city - if there's a well-supported, attractive regional town you're likely to find doctors there already.

 

[Sokka]

From my understanding we need to complete 3 years of service in an under represented area within 18 years of completing our training. Would it be possible to start a career as an urban doctor and after around 14/15 years work in a rural area for the bond?

I probably sound super naive rn but that’s why I’m asking

 

[dotwingz]

Yeah sure its possible, but what (im pretty sure) chinaski's saying is that the world moves on without you. During the time that you are working rural, your peers have made connections, have experiences, done research, completed fellowships, etc... and you fall a bit behind. Obviously, they had to start somewhere aswell, but you have to make that time up.

EDIT: Oh i misread you, yeah sure its possible, but your career is still delayed. As it would be whenever you take it

 

[Sokka]

Yeah sure its possible, but what (im pretty sure) chinaski's saying is that the world moves on without you. During the time that you are working rural, your peers have made connections, have experiences, done research, completed fellowships, etc... and you fall a bit behind. Obviously, they had to start somewhere aswell, but you have to make that time up.

Ohh okay yep makes sense. Thanks for the super helpful clarifications!!
On another note, does working with the royal flying doctor service count towards the BMP contract? It seems pretty cool (atm haha I still need to do more research on it)

 

[DrDrLMG!]

From my understanding we need to complete 3 years of service in an under represented area within 18 years of completing our training. Would it be possible to start a career as an urban doctor and after around 14/15 years work in a rural area for the bond?

I probably sound super naive rn but that’s why I’m asking

Definitely not my area of expertise, but I’ll give it a go! Yes, it would likely be possible to some degree, however...

Project yourself forward 14/15 years plus the length of your degree (so ~20 years). Are you married? Does your spouse work? Do you have kids? Are they entrenched in schools with established school friends? Do they want to up and move?

And that’s just the immediate family-based difficulties I can foresee.

ETA: I definitely don’t say this to discourage people, just to facilitate thorough consideration of the myriad factors at play.

 

[dotwingz]

Ohh okay yep makes sense. Thanks for the super helpful clarifications!!
On another note, does working with the royal flying doctor service count towards the BMP contract? It seems pretty cool (atm haha I still need to do more research on it)

Well if you read the legislation behind the agreement

Health Insurance (Bonded Medical Program) Rule 2020 - Federal Register of Legislation

www.legislation.gov.au

8.3.(d) [eligible work means] aeromedical evacuation and retrieval services to patients in an eligible location

So i assume RFDS would count under this

 

[Sokka]

Definitely not my area of expertise, but I’ll give it a go! Yes, it would likely be possible to some degree, however...

Project yourself forward 14/15 years plus the length of your degree (so ~20 years). Are you married? Does your spouse work? Do you have kids? Are they entrenched in schools with established school friends? Do they want to up and move?

And that’s just the immediate family-based difficulties I can foresee.

ETA: I definitely don’t say this to discourage people, just to facilitate thorough consideration of the myriad factors at play.

Yeah thank you for being realistic (that’s what helps more).

Well if you read the legislation behind the agreement

Health Insurance (Bonded Medical Program) Rule 2020 - Federal Register of Legislation

www.legislation.gov.au

8.3.(d) [eligible work means] aeromedical evacuation and retrieval services to patients in an eligible location

So i assume RFDS would count under this

ahh awesome awesome!

 

[chinaski]

From my understanding we need to complete 3 years of service in an under represented area within 18 years of completing our training. Would it be possible to start a career as an urban doctor and after around 14/15 years work in a rural area for the bond?

I probably sound super naive rn but that’s why I’m asking

After 14 or 15 years of work in a rural area, your expertise and experience would be fairly well-honed to that environment. As such, it might make you a very competitive and sought-after applicant for another similar job in another rural community, but it's not necessarily going to make you competitive in an urban area, particularly within specialties that sub-specialise (increasingly so these days).

 

[JL538]

After 14 or 15 years of work in a rural area, your expertise and experience would be fairly well-honed to that environment. As such, it might make you a very competitive and sought-after applicant for another similar job in another rural community, but it's not necessarily going to make you competitive in an urban area, particularly within specialties that sub-specialise (increasingly so these days).

I think they meant the other way around? As in 14/15 years in an urban environment (basically ignore your bond during this time) then hop to a rural area for 3 years before coming back. With 14/15 years of experience would you have enough time for all your networking and professional development needs so that you can comfortably come back to an urban area?

 

[Deleted member 42871]

I think they meant the other way around? As in 14/15 years in an urban environment (basically ignore your bond during this time) then hop to a rural area for 3 years before coming back. With 14/15 years of experience would you have enough time for all your networking and professional development needs so that you can comfortably come back to an urban area?

It is not possible. If you want to do specialisation you must have to spend 18 months before and after specialisation in rural area. If you dont do specialisation then it sounds okay but I have doubt about this. Only GP specialisation is perfect for this scnerio in my opinion, not an expert though

 

[JL538]

It is not possible. If you want to do specialisation you must have to spend 18 months before and after specialisation. If you dont do specialisation then it sounds okay but I have doubt about this. Only GP specialisation is perfect for this sender in my opinion, not an expert though

Oh so when training for a speciality you have to do it in a rural area? Which would reduce the number of specialities available to you?

 

[dotwingz]

It is not possible. If you want to do specialisation you must have to spend 18 months before and after specialisation. If you dont do specialisation then it sounds okay but I have doubt about this. Only GP specialisation is perfect for this sender in my opinion, not an expert though

You can do max 18 months before specialisation. You can also do 0 if you please. This is absolutely possible, and GPs are also specialists.

I would think working in an urban area then a rural effect would really be the same effect as the opposite. You’re skills that help you make it in a urban area, are not typically applicable 100% to a rural area

 

[JL538]

You can do max 18 months before specialisation. You can also do 0 if you please. This is absolutely possible, and GPs are also specialists.

I would think working in an urban area then a rural effect would really be the same effect as the opposite. You’re skills that help you make it in a urban area, are not typically applicable 100% to a rural area

On the second point, since there is a shortage in rural areas it would make it easier than the other way around no? Even though your experience is not completely applicable since they are looking for people to fill those places rather than selecting the absolute most elite candidates like they do in an urban area

 

[dotwingz]

Yes but say for example, an orthopaedic surgeon that has done nothing but ankle reconstruction for the last 15 years will have trouble finding enough ankles in a rural area to keep themselves busy. If you have spent the last decade or so specialising in very specific area, not many people would be confident working outside that too much.

 

[JL538]

Yes but say for example, an orthopaedic surgeon that has done nothing but ankle reconstruction for the last 15 years will have trouble finding enough ankles in a rural area to keep themselves busy. If you have spent the last decade or so specialising in very specific area, not many people would be confident working outside that too much.

Oh I see, I didn't think you can specialize to the point of a single procedure!

 

[dotwingz]

Oh I see, I didn't think you can specialize to the point of a single procedure!

Well its a bit of an over exaggeration but the point stands. There would be ankle surgeons, maybe not those who do the same procedure only for 15 years (life would get a bit boring, i imagine)

 

[chinaski]

On the second point, since there is a shortage in rural areas it would make it easier than the other way around no? Even though your experience is not completely applicable since they are looking for people to fill those places rather than selecting the absolute most elite candidates like they do in an urban area

As per above - being a sub-specialist who sees patients in a hospital with adequate infrastructure is completely different to being a rural generalist. This is the whole point of the discussion - the roads diverge greatly between urban and rural practice in Australia - they require different skillsets and encounter a wider or narrower case mix.

I think they meant the other way around? As in 14/15 years in an urban environment (basically ignore your bond during this time) then hop to a rural area for 3 years before coming back. With 14/15 years of experience would you have enough time for all your networking and professional development needs so that you can comfortably come back to an urban area?

D'oh - you're right - long day; didn't read clearly. But to answer your question: not only impossible as per the bond repayment rules and the lack of easy transportability of urban-to-country practice, you'd also be giving up your job in the city to "hop" to a rural area for 3 years. After relinquishing the security of an urban position, it would be a gamble to assume you would be appointed to a similar position after taking a hiatus away.

 

[Sokka]

I’ve heard of doctors splitting their week between rural and urban hospitals. Is this applicable for those on BMP?

 

[A1]

I’ve heard of doctors splitting their week between rural and urban hospitals. Is this applicable for those on BMP?

Previously not iirc, the new BMP does allow FIFO.

 

[Hulk123]

Hey after reading these thread I have a question. So in the bonded contract we can choose where we want to practice as long as it’s a MMM 2-7 area / has a shortage of health professionals. So let’s say I do one year of the bond contract as part of my internship year, can I do the rest two years after my fellowship?

also let’s say I get a bonded contract in Monash, does that mean I’m bound to do the bonded contract in Victoria or can I practice in a rural area in another state?