Agreed x1000. It’s not serving its purpose at all currently.
No point adding an extra 30% of medical school places in the country only for none of them to actually go towards the reason they were created in the first place.
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[2020 entry and beyond] Guide to Bonded Medical Places
- Thread starter Crow
- Start date
No point adding an extra 30% of medical school places in the country only for none of them to actually go towards the reason they were created in the first place.
But think of all the votes that PR and spin can buy!
What and instead create a two tiered system between those who are unbonded and those who are bonded? Or a two tiered system between those in the highest socioeconomic groups who can afford more comprehensive education, or extra ucat/interview prep? or just generally more extracurricular activites that look good in applying/interviewing for medical school? or those who can take a gap year to reapply for a non bonded spot? the list goes in...
The bonded system is inherently two tiered, you cant create two streams of medical students, with two different work conditions, and not somehow make it not two tiered in a way that will NOT disadvantage those in lower socioeconomic groups. At least currently doctors have 10+ years to earn and save the money to pay the price of breaking off a contract, a somewhat mitigating factor in the inherent socioeconomic divide these kind of agreements cause.
This is a report from 2003 talking about the bonded medical school, and it talks about it to a great detail... obviously there is some support and some saying its horse crap. But heres some interesting bits
Ultimately, youre right. The bonded agreement isnt serving its purpose... but there is a reason why previous agreements with more conditions, more punishments, and more rigid RoS's were scrapped, its because bond agreements like this rarely work... they should make it workable. Or at least give people the contract to sign when they are old enough to know its implications, not when they are 18...
To be fair, the general advice for all these bonded contracts is that the person signing should seek legal advice (and additionally, most school leavers are probably getting guidance and advice from their parents also). The problem is more that these contracts have implications on your career that kick in so far down the track that it's impossible to know what kind of situation you're going to be in when the time comes to repay your service. Even if you sign the contract when you're in your twenties, you still don't know what kind of specialty you're going to want to work in, and it's also quite likely your personal relationships will change a great deal between starting med school and the time you are obliged to return service.
Giving people the contract to sign when they know it's implications, as far as I see it, and providing there is a link between understanding the implications and the age of the student involved, would involve either
1. waiting till late in the medical degree to sign it -> which makes no sense, as who would voluntarily sign it then - there would be no functional difference between signing it in year 1 and in final year if they are *forced* to sign it to continue their progress
2. having a minimum age to sign the contract (i.e. making there a minimum age to start medicine, which would be a fair bit older than 18 - one potential method of doing this would be to make all the BMPs the grad entry and/or non-standard positions, although the ethics of such a decision remain)
Neither really is satisfactory for me but certainly I would prefer the second method - having grad entry (and thus older applicants) take the BMPs ensures that they would be at least an older age and therefore more understanding of the implications. However, this is akin to discrimination based on age, of which there would be many ethical questions to answer for.
Personally, I think it would just make sense to scrap the whole BMP system and just use the internship allocation plus the centralised state job matching algorithm to allocate junior staff to positions and the supply/demand equilibrium (i.e. salary) to allocate senior staff. If a position is less desirable/less conducive to other parts of life, then it should come with more pay, simple as that, and eventually supply will meet demand.
1. waiting till late in the medical degree to sign it -> which makes no sense, as who would voluntarily sign it then - there would be no functional difference between signing it in year 1 and in final year if they are *forced* to sign it to continue their progress
2. having a minimum age to sign the contract (i.e. making there a minimum age to start medicine, which would be a fair bit older than 18 - one potential method of doing this would be to make all the BMPs the grad entry and/or non-standard positions, although the ethics of such a decision remain)
Neither really is satisfactory for me but certainly I would prefer the second method - having grad entry (and thus older applicants) take the BMPs ensures that they would be at least an older age and therefore more understanding of the implications. However, this is akin to discrimination based on age, of which there would be many ethical questions to answer for.
Personally, I think it would just make sense to scrap the whole BMP system and just use the internship allocation plus the centralised state job matching algorithm to allocate junior staff to positions and the supply/demand equilibrium (i.e. salary) to allocate senior staff. If a position is less desirable/less conducive to other parts of life, then it should come with more pay, simple as that, and eventually supply will meet demand.
Financial incentives don't work. The government has been offering huge incentives to get people to work remotely for decades already.
Yeah exactly. Which is why i find the whole BMP Agreement irredeemable in the first place, I honestly see no way around this issue.
Sinking money into the problem doesnt fix it, theyve been doing that for ages and look where we are. The best bet imo is to make people want to go regional - which will help rural with time, allow people to do extended parts of medical school, internships, or training in regional areas by removing hospital nepotism (maybe through a national RMO selection?) is where I would start.
Ultimately doctors make enough money to be comfortable in many places, so the dimishing returns of medical salaries appear fast. I would be suprised if there is a massive uptake of rural positions that may pay more per year, but involve tearing up your entire family and personal situation to move to an isolated part of the country.
Heres a funny little part from that report I linked above
How large are we talking here? I have seen some things in the press in years gone by for $500k and upwards in addition to salary for a few years service, and even then I think that would be inadequate for losing access to many other things.
A thought experiment: If you paid a doctor $100m to work in a rural town for 5 years, do you think they would do it? $50m? $25m?
At some point supply and demand meet equilibrium, I just don't think we've reached it.
Edit to add: One way you could balance this equilibrium with the BMP scheme would be to increase the price of buying it out to the relative price of hiring someone to work in your position to fill those three years. If it costs $200k per year to hire someone to perform the RoS, then the cost would be $600k to buy out the contract.
At some point supply and demand meet equilibrium, I just don't think we've reached it.
Edit to add: One way you could balance this equilibrium with the BMP scheme would be to increase the price of buying it out to the relative price of hiring someone to work in your position to fill those three years. If it costs $200k per year to hire someone to perform the RoS, then the cost would be $600k to buy out the contract.
I dont think sinking 1000% of a small towns GDP into hiring one person is particularly efficient...
Also if we want to talk economics, rural medicine is a market failure
solved by microeconomic intervention (e.g. reform) not just lifting the price roof on what people would pay for healthcare. No amount of pumping in cash will come with a socially acceptable solution, instead just causing issues elsewhere in the community with underfunding of other crucial services.
Also if we want to talk economics, rural medicine is a market failure
solved by microeconomic intervention (e.g. reform) not just lifting the price roof on what people would pay for healthcare. No amount of pumping in cash will come with a socially acceptable solution, instead just causing issues elsewhere in the community with underfunding of other crucial services.
I dont think sinking 1000% of a small towns GDP into hiring one person is particularly efficient...
Also if we want to talk economics, rural medicine is a market failure
Agree, and yet, look what Australia pays its banking CEOs...
I'm not sure if people have asked this before, if so I do apologise. I've heard people talking about rejecting their preferred universities in preference for much less desirable ones (in their preference) just because of a BMP offer, as they often say that having a BMP significantly reduces a person's chances of getting into/completing specialist training (or at least, makes this process longer by a few years). Is this fax?
People do choose to do this. Essentially it boils down to this: would you rather go to a medical school that wasn't your first choice, but then graduate with absolutely no ties or obligations on your potential career trajectory, or would you choose your number 1 med school with the cost of having to repay a bond and work in an area you may not want to work in, potentially affecting your career trajectory?
IMO, all the med schools have their pros and cons, but you come out with pretty much the same degree at the end of all of them. I'd value a clear run through my career higher, frankly.
IMO, all the med schools have their pros and cons, but you come out with pretty much the same degree at the end of all of them. I'd value a clear run through my career higher, frankly.
About half of this thread is dedicated to discussing that exact question. I suggest that instead of apologising, just give the thread a read?
Forgive me plz
I now understand the chastisement, as you were the very person who asked more or less the exact same question. Happy to inform you that i've done my due diligence like a good lad, and gave the whole thing a read. I've also learnt that the UCAT VR skills are useful after all.
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I feel like I've read through your coming of age journey from naivety to approaching wisdom through this almost 3 year cycle.
You love to see it xD
I'm not sure if there is a specific BMP (Bonded Medical Place) thread already in place, but I had a question regarding it. So if you are given one, I understand (from the thread --> [2020 entry and beyond] Guide to Bonded Medical Places), that it is a 3 year RoS which you have to complete within 5 years of attaining fellowship.
1) What exactly is a 'fellowship', and when does that commence after graduating from medical school?
2) I believe that you can 'pay off' a BMP offer if you wish not to fulfill it, but I wanted to know if that's considered as 'unethical' or not?
Thanks in advance
1) What exactly is a 'fellowship', and when does that commence after graduating from medical school?
2) I believe that you can 'pay off' a BMP offer if you wish not to fulfill it, but I wanted to know if that's considered as 'unethical' or not?
Thanks in advance