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[2020 entry and beyond] Guide to Bonded Medical Places

ucatboy

Monash MD I
Valued Member
A question I've been meaning to ask for a long time but keep forgetting:

On SATAC I've preferenced 1. Adelaide CSP, 2. Flinders, 3. Adelaide BMP, understandably so because the BMP ROS does seem quite inhibiting.

That being said, I've heard numerous reports of Adelaide BMPs being upgraded to CSPs down the road. If I initially qualified for an Adelaide BMP but not CSP, I would get my second pref, Flinders. That's great and all, but I would essentially be locked out of Adelaide and a CSP upgrade possibility.

If I instead preference 1. UAdel CSP and 2. UAdel BMP, and get chosen for a BMP first-round, my question is, will I essentially be guaranteed an upgrade? In other words, will ~35 interstate students/any student for that matter reject their CSP offers, meaning my upgrade is inevitable? Doesn't seem that out of the ordinary in my opinion - surely some Victorian or NSW students, upon receiving a home state offer, will reject their Adelaide one? It seems too good to be true i.e. qualifying for a first-round BMP will inevitably lead to a CSP. Hopefully that makes sense.
 

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LMG!

Moderator
Staff Member of the Year 2019
A question I've been meaning to ask for a long time but keep forgetting:

On SATAC I've preferenced 1. Adelaide CSP, 2. Flinders, 3. Adelaide BMP, understandably so because the BMP ROS does seem quite inhibiting.

That being said, I've heard numerous reports of Adelaide BMPs being upgraded to CSPs down the road. If I initially qualified for an Adelaide BMP but not CSP, I would get my second pref, Flinders. That's great and all, but I would essentially be locked out of Adelaide and a CSP upgrade possibility.

If I instead preference 1. UAdel CSP and 2. UAdel BMP, and get chosen for a BMP first-round, my question is, will I essentially be guaranteed an upgrade? In other words, will ~35 interstate students/any student for that matter reject their CSP offers, meaning my upgrade is inevitable? Doesn't seem that out of the ordinary in my opinion - surely some Victorian or NSW students, upon receiving a home state offer, will reject their Adelaide one? It seems too good to be true i.e. qualifying for a first-round BMP will inevitably lead to a CSP. Hopefully that makes sense.
It does make sense and it definitely happens, no doubt at some unis more frequently than others. This is grad Med, but the example still stands, my friend was initially waitlisted for USyd (so no offer at all), but by the time rejections had happened (they don’t participate in GEMSAS so people can get multiple offers if they apply to USyd), she ended up jumping from waitlist straight to CSP.

It’s definitely not guaranteed though, so you’d need to factor in the possibility that you remain bonded, and whether that’s something you’d be prepared to accept.
 

Misa

Member
You're also (a) breaching a contract you signed in good faith, (b) wasting the government's money, and (c) robbing the rural community of a desperately needed healthcare professional (i.e. someone who would have actually completed the RoS if they had been able to have your bonded place). Doesn't sound like such a great option to me.
To you it might not, but a prospective medical student who maybe didn't get the best marks and has the Bank of Mum and Dad.. it might. Especially since that the government doesn't specify any specific punishments/penalties. Don't get me wrong here, I'm not advocating to abuse the system and definitely would not be doing so myself, I'm saying there's a high chance of abuse when a system is simply pay out your HECS forget the contract
 

alexlipton

JCU MBBS II
Valued Member
Maybe this isn't the right forum to discuss this, but the recent discussions on this forum highlight the immediate need to review the BMP system as it currently stands. Can I also preface this by saying that I currently hold a 2019 BMP, and I do intend to fulfill my requirements. In my view, there are a number of issues with the methods in which the government is trying to get more medical graduates to work rurally, and I believe the current and new amendments to the BMP scheme are at the centre of this.

Firstly, there is assumption that those who are from rural areas are more likely to work in rural locations. While there is certainly a correlation here and it would be erroneous of me to dismiss this view outright, I would argue there is no proven causation here, and (albeit anecdotal) I've certainly spoken to many people at various medical schools around Australia who came from rural backgrounds, got in via the rural entry and began to enjoy the city life and stayed. This is not an uncommon occurrence. I would quite ardently argue that simply increasing numbers of rural students into medical programs under the mere "hopeful" expectation that they will work rurally is not the solution to solving the rural medical workforce shortages, particularly when BMPs are not generally allocated according to rurality (as far as I know; some of you Mods can chip in here I'm sure) and so many rural students have no actual contractual obligation to work rurally anyway. In fact, even AMSA (I'll see if I can find a link) challenges the government's current view that opening up more Medical schools (like CQU and Macquarie) will solve the problem. What you find (and the start of this can already be seen today) is you get an oversaturation of interns that wish to be metro, and people who had no interest in working rurally are forced into rural areas "against their will".

It's clear that offering large financial incentives and lures of a good work-life balance isn't addressing the crisis, and if the government really wants to help address the serious workforce shortage in rural areas I see no other option but to increase the BMPs to something much more feasible to 5 years, and tighten the rules it so you can't pay it back and avoid it; like a 10 year Medicare billing ban. That being said, there still should be significant flexibility of where you can do placement of course, but that goes without saying. In my mind, the only reason the government doesn't add the 10 year Medicare billing ban is because it's in the government's economic interests to have another avenue for income, however I don't think this is really acting in the interests of what the BMPs are really all about. Particularly when you look at the demographic of those who enter Medicine which are more likely (statistically speaking) to be better off SES wise, who are much more likely to be able to afford paying it all back. To me, the government is quite malignantly exploiting this.

Your immediate reaction might be that that is a ridiculous burden to put on someone essentially forcing someone to work in a rural location for such a long time, but that's from the perspective of someone who really does not want to work rurally; and if that's the case they should not be taking the BMP positions. Let all those people fight for the CSP positions, and then only let the people that really do have an interest in working rurally take the BMPs. That way, you not only increase compliance to the scheme by people who are genuinely interested in it, but you also prevent someone from taking away a BMP position from someone who actually was planning on fulfilling the requirements for it. To me, that's a win-win.

I'm curious to see what other people think.

Edit: I am not advocating for the removal of rural entry pathways at all - in fact there is sufficient argument that those students end up in rural areas, just that there needs to be tighter provisions put in place to help deal with the workforce shortages, as the current system is grossly insufficent.
 
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mnms

Lurker
If you had a CSP vs a BMP at an arguably better university - would it really matter what university you completed your MD at? Wouldn't people in the new scheme prefer the flexibility of a CSP rather than a BMP, given the BMP could limit their options for fellowship?
 

Crow

Moderator Band 🦧
Moderator
If you had a CSP vs a BMP at an arguably better university - would it really matter what university you completed your MD at? Wouldn't people in the new scheme prefer the flexibility of a CSP rather than a BMP, given the BMP could limit their options for fellowship?
If location and length of the degree wasn't a factor in the decision, then taking the CSP over the BMP would be a much more logical choice, yes.
 
L

Logic

Guest
Hi! Just wondering, when we do our Return of Service, can we choose which location we work in? Or will we be allocated one?
You choose which "area of workplace shortage" you work in, you are not allocated one. Quote from the BMP website: "As a BMP Scheme doctor you can choose where you work, and for whom you work, when undertaking your return of service period. The only requirement is that you work in an eligible District of Workforce Shortage (DWS) for your specialty, including General Practice."

Source: https://www1.health.gov.au/internet/main/publishing.nsf/Content/work-bonded-medical-places-scheme-frequently-asked-questions#faq-4

Hope that made sense!
 

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A1

Admissions Speculator
Moderator
Firstly, there is assumption that those who are from rural areas are more likely to work in rural locations. While there is certainly a correlation here and it would be erroneous of me to dismiss this view outright, I would argue there is no proven causation here, and (albeit anecdotal) I've certainly spoken to many people at various medical schools around Australia who came from rural backgrounds, got in via the rural entry and began to enjoy the city life and stayed.
IMO even correlation is sufficient to justify continuing the rural-entry method. JCU conduted a study on 700 graduates, 4-9 years after their graduation:

- 50 to 70% of RA3-5 were practising in rural areas
- only 35% of BMP, 25% of RA1-2

Rural-Doctors.JPG
 

alexlipton

JCU MBBS II
Valued Member
IMO even correlation is sufficient to justify continuing the rural-entry method. JCU conduted a study on 700 graduates, 4-9 years after their graduation:

- 50 to 70% of RA3-5 were practising in rural areas
- only 35% of BMP, 25% of RA1-2

View attachment 2992
I have read that study (I think the one I've got my hands on is slightly different to yours but I think the conclusions are similar) and I certainly am not advocating for a removal of the rural-entry pathway as there is clear merit to JCU's program in getting people to work rurally, but I think more needs to be done. In that report, one of the key conclusions was that increased exposure to rural placements throughout the course was one of the key influences in guiding career pathways, alongside initial rurality. Considering JCU has (I think) the highest proportion of rural placements, it's hard to eliminate confounders here as to what is actually the key in getting students to work rurally, and in fact I think it's fair to say that it can not be attributed to one factor. In this study, the conclusions for the increase in JCU students working in rural locations was attributed largely to initial interest and "was influenced by undergraduate and early career experiences in smaller rural and regional hospitals and health centres" rather than solely whether they were rural or not. I would be curious to see if studies of other universities' graduate pathways revealed similar results to those from rural backgrounds working rurally or not. If more were found to be staying in metro areas, then it would seem that the university and its course design has a significant influence in this.

It might also be worth noting that the survey that was used to gauge this data was from exit surveys which were optional to be completed, and had only a 66% answer rate. I don't at all wish to dismiss the report's findings, however I imagine (again; speculative) there would be a number of students working in metro locations who would have intentionally not answered as to "disappoint the college" given JCU's extensive focus on trying to get graduates ready to work in rural locations. I think it's fair to say more studies ought to be done, but yes - I do agree with you that the correlation still supports rural entry as a start. In particular, I think more research should go into specifically whether amount of rural placements at medical school actually increases numbers of people working rurally. I still however don't see how else to solve the issue without tighter BMPs implemented?

1572673914665.png
 
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chinaski

Regular Member
It's clear that offering large financial incentives and lures of a good work-life balance isn't addressing the crisis...
You make some great points in your post, but I had to comment on this one. The jobs being advertised with huge financial incentives more often than not DON'T have a great life-work balance, hence the reason why there is a poor rate of uptake from doctors. Working in remote and rural communities often means a life of being the sole doctor or one of only a handful, meaning you are never off-call, and you are practicing in isolation, away from colleagues and necessary infrastructure. Further to this, socially this means locating one's family (ie children, partner) away from extended family in communities where employment for one's partner may be non-existent, and educational options limited or considered sub-standard to what is available in the city. If you accept the financial incentives, you also accept the lifestyle and working conditions - and it's not a contract many doctors are willing to sign off on.

You choose which "area of workplace shortage" you work in, you are not allocated one.
...Provided there are jobs available in said area. It is advisable to have a look at what kind of jobs are being advertised as an illustrative point (any state-based health recruitment site will list all jobs currently available) - even if an area is statistically recognised as an "area of shortage", this doesn't mean there are salaries available for doctors to start work in the public system.
 

A1

Admissions Speculator
Moderator
It might also be worth noting that the survey that was used to gauge this data was from exit surveys
This is the report I snipped that chart from > https://pdfs.semanticscholar.org/6d70/a387f5d71d7a756e177f3c68f84fb581ea49.pdf?_ga=2.195752108.1217253956.1572671009-765029006.1572671009

The exit surveys were only used to obtain their consent for further follow-up. For their actual practice location:

"Postgraduate practice location
Practice location data were obtained from several sources. Initial contact was made via a JCU School of Medicine Facebook page. Further contact was made by email and telephone communication.

Additional data on practice location data were sourced from the Australian Health Practitioner Regulation Authority (AHPRA) website, the validity of which was checked by a comparison of twenty practice locations obtained via direct contact, showing agreement for 18/20 (90%) of cases; a similar percentage to a more in-depth study comparing the accuracy of AHPRA to personal contact19. These four strategies provided practice location data for 744 out of a total of 766 graduates (97%) from 2005 to 2013.
"
 

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alexlipton

JCU MBBS II
Valued Member
This is the report I snipped that chart from > https://pdfs.semanticscholar.org/6d70/a387f5d71d7a756e177f3c68f84fb581ea49.pdf?_ga=2.195752108.1217253956.1572671009-765029006.1572671009

The exit surveys were only used to obtain their consent for further follow-up. For their actual practice location:

"Postgraduate practice location
Practice location data were obtained from several sources. Initial contact was made via a JCU School of Medicine Facebook page. Further contact was made by email and telephone communication.

Additional data on practice location data were sourced from the Australian Health Practitioner Regulation Authority (AHPRA) website, the validity of which was checked by a comparison of twenty practice locations obtained via direct contact, showing agreement for 18/20 (90%) of cases; a similar percentage to a more in-depth study comparing the accuracy of AHPRA to personal contact19. These four strategies provided practice location data for 744 out of a total of 766 graduates (97%) from 2005 to 2013.
"
Okay thanks for sourcing that. I certainly see your point, however I would still be curious to see if that trend is also seen to the same degree at other medical schools. JCU's Townsville medical school is set in a relatively rural location, and as I mentioned has extensive exposure to rural placements that may all be involved in confounding that data. As I wrote above;

In this study, the conclusions for the increase in JCU students working in rural locations was attributed largely to initial interest and "was influenced by undergraduate and early career experiences in smaller rural and regional hospitals and health centres" rather than solely whether they were rural or not. I would be curious to see if studies of other universities' graduate pathways revealed similar results to those from rural backgrounds working rurally or not. If more were found to be staying in metro areas, then it would seem that the university and its course design has a significant influence in this.
 
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Totolier

Member
I've applied for BMP places for my medical coursed. I am seriously considering breaching the contract and paying the full amount to not complete the three years of service. Can someone give me a rough guide of how much to pay. I am assuming it is anwhere from 60k-100k???? A1
 

A1

Admissions Speculator
Moderator
I've applied for BMP places for my medical coursed. I am seriously considering breaching the contract and paying the full amount to not complete the three years of service. Can someone give me a rough guide of how much to pay. I am assuming it is anwhere from 60k-100k???? A1
I have seen from multiple sources the gov contribution/subsidy for medicine is around 25K/year. Multiply that by your med course's number of years plus 2-3% interest per year.
 

ucatboy

Monash MD I
Valued Member
I've applied for BMP places for my medical coursed. I am seriously considering breaching the contract and paying the full amount to not complete the three years of service. Can someone give me a rough guide of how much to pay. I am assuming it is anwhere from 60k-100k???? A1
If we assume an average inflation rate of 2.5% and 25k/year, here is how much you should be expecting to pay:

5-year medical courses: $131,408
6-year medical courses: $159,693
7-year medical courses: $188,686

This is in addition to your roughly 10k/year HECS-HELP to begin with. That's a pretty hefty sum - I assume you'll be treating BMPs as your "last resort"?
 

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A1

Admissions Speculator
Moderator
7-year medical courses: $188,686
There's no 7-year med course in Aus. Grad-entry MD counts as 4-year.

Also don't forget the interest from graduation to when you repay, assuming you are not in a finance position to repay at graduation.
 

ucatboy

Monash MD I
Valued Member
There's no 7-year med course in Aus. Grad-entry MD counts as 4-year.

Also don't forget the interest from graduation to when you repay, assuming you are not in a finance position to repay at graduation.
Wait so if you forfeit your ROS contract with UQ bonded you only pay 25k for the last four years of the seven year course?
 

A1

Admissions Speculator
Moderator
Wait so if you forfeit your ROS contract with UQ bonded you only pay 25k for the last four years of the seven year course?
Yes because your UQ undergrad degree is all CSP by default.
Apparently you don't sign the BMP contract until the year you start the MD.
 

ucatboy

Monash MD I
Valued Member
Yes because your UQ undergrad degree is all CSP by default.
Apparently you don't sign the BMP contract until the year you start the MD.
In that case, if you're gonna forfeit a BMP contract, you might as well go for a provisional med course to ease the financial burden - comes to ~100k in fines then. Griffith immediately comes to mind as one of them.
 

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