Rural Classification Reform - Frequently Asked Questions

District of Workforce Shortage (DWS) - Questions and Answers

Q: When will the 2016 update to the District of Workforce Shortage system occur?
A: The February 2016 update to the District of Workforce Shortage system came into effect 10 February 2016.

Q: What is a District of Workforce Shortage (DWS)?
A: A DWS is an area identified as having below average access to doctors. This is determined using population data and Medicare billing information to get a GP to population ratio.

Q: Why do we have DWS?
A: DWS is a mechanism to identify and address the maldistribution of the medical workforce in Australia.

Q: How does DWS work?
A: Some doctors, such as overseas trained doctors; foreign graduates of Australian medical schools; and Australian trained bonded doctors with return of service obligations are restricted from being eligible for a Medicare provider number unless they work in a DWS.

Q: Why is DWS being amended?
A: The current system relies on outdated population data. This means that the DWS system is not accurately assessing the medical workforce in towns that have experienced population growth over the past decade.

Q: What will the amended system include?
A: The new system will use the latest Australian Bureau of Statistics (ABS) geography and population data and the most recent medical workforce statistics (derived from Medicare billing data).

To provide a more accurate measure, further analysis will occur for towns that are determined to be only slightly above (within 10 per cent of) the national average. DWS status could be considered if doctors are providing more than 30 per cent above the normal full-time level of medical services to meet local needs of the community. This new process will ensure that towns are still considered DWS if they are only achieving an above-average level of Medicare services because of a small number of doctors working extremely long hours – this sometimes happens in small rural towns. Doctors will not have to apply for special consideration as this process will occur automatically.

Updates for general practice will take place annually to provide greater stability and assurance to practices and other employers seeking to recruit doctors.

Non-DWS status for general practice is automatically applied to inner metropolitan areas of all capital cities, except Darwin, to reflect that they have better access to primary care, public and allied health services compared to other parts of Australia. Darwin will continue to be exempt due to ongoing doctor shortages and its remoteness.

Q: Will the new DWS disadvantage communities?
A: The new system will give an accurate assessment of areas where there is a shortage of doctors and will provide stability by having an annual update.

Overseas trained and bonded doctors (for the Bonded Medical Places (BMP) Scheme) who are already working in a DWS location are NOT required to move if that location subsequently becomes non-DWS – this is currently the case, and this will continue under the new system.

Often an area will stop being a DWS because it has managed to attract an overseas trained doctor or a bonded doctor. This is the whole point of the DWS system – to direct doctors to areas of workforce shortage – and it would defeat the point of the system to then make those doctors move somewhere else.

Q: I am an advanced user who needs to do analysis on a larger scale. Can I get a complete dataset?
A: Datasets that provide DWS classifications at the ASGS SA1 level are available as a CSV, or at the DWS Assessment Area as an ESRI shapefile on the Downloads page.

Q: Where can I find more information?
A: Information about the DWS amendments will be available on the DoctorConnect website at www.doctorconnect.gov.au in the near future. Email queries can be directed to Doctorconnect@health.gov.au

Modified Monash Model - Questions and Answers


Q: What is the Modified Monash Model?
A: The Modified Monash Model is a new classification system that better categorises metropolitan, regional, rural and remote areas according to both geographical remoteness and town size. The system was developed to recognise the challenges in attracting health workers to more remote and smaller communities.

Q: How can I find the classification of my location under the Modified Monash Model?
A: You can find the classification of your location by using the Modified Monash Model locator.

Q: How are the categories different to the current model?
A: The previous model was the Australian Bureau of Statistics (ABS) remoteness classification system, the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA 2006), which was based on residential data from the 2006 Census. The ABS has now updated their remoteness classification system to the Australian Statistical Geography Standard - Remoteness Areas (ASGS-RA), which uses the latest residential population data from the 2011 Census to determine the five remoteness categories. The Modified Monash Model uses the ASGS-RA as a base, and further differentiates areas in Inner and Outer Regional Australia based on local town size.

A summary of the current classification and the new classification can be found below.

ASGC-RA (2006)
RA1 – Major cities
RA2 – Inner Regional
RA3 – Outer Regional
RA4 – Remote
RA5 – Very remote

Modified Monash Category
Inclusions
MM 1
All areas categorised ASGS-RA1.
MM 2
Areas categorised ASGS-RA 2 and ASGS-RA 3 that are in, or within 20km road distance, of a town with population >50,000.
MM 3
Areas categorised ASGS-RA 2 and ASGS-RA 3 that are not in MM 2 and are in, or within 15km road distance, of a town with population between 15,000 and 50,000.
MM 4
Areas categorised ASGS-RA 2 and ASGS-RA 3 that are not in MM 2 or MM 3, and are in, or within 10km road distance, of a town with population between 5,000 and 15,000.
MM 5
All other areas in ASGS-RA 2 and 3.
MM 6
All areas categorised ASGS-RA 4 that are not on a populated island that is separated from the mainland in the ABS geography and is more than 5km offshore.
MM 7
All other areas – that being ASGS-RA 5 and areas on a populated island that is separated from the mainland in the ABS geography and is more than 5km offshore.

Q: Does the Modified Monash match the DWS?
A: No. The Modified Monash model is about towns and remoteness, whereas the DWS is an area identified as having below average access to doctors. So, an individual town in RA 2 might now be Modified Monash class 4 as it has less than 15,000 people, but is not a DWS, as its level of Medicare services per person is above the national average.

Q: Why is the change required?
A: There has been much criticism from rural doctors and rural communities that the ASGC-RA (2006) system implemented in 2010, which is used to determine eligibility and incentives under a range of health workforce programs for doctors working and training in rural areas, was creating perverse incentives for doctors to move to large, coastal towns, and did not recognise the challenges of recruiting doctors to small rural towns.

For example, doctors would receive the same incentives to move to Townsville, a coastal town with a population of approximately 172,000, as they did to move to Charters Towers, an inland town with a population of approximately 8,000.


Q: Why choose the Modified Monash model?
A: The Modified Monash model was developed by eminent rural academics at Monash University and was modified following consultation with key stakeholders. It is a consistent and well-understood system supported by the best available evidence.

Q: How will small towns in close proximity to larger towns be classified?
A:The Rural Classification Technical Working Group (RCTWG), established to consider the implementation of the Modified Monash Model, provided recommendations on the size of the buffer zones around larger regional towns to ensure equity at a local level. The buffer zones themselves are based on road-distance calculations provided by the Australian Population and Migration Centre.

Q: When will programmes start using the Modified Monash Model
A: One of the first programmes to transition to the Modified Monash Model was the General Practice Rural Incentives Programme (GPRIP).

Over time, the Government will consider the transition of other health workforce programmes.

Some examples of how towns are placed in the new structure

Modified Monash Incentive Structure
RA2 (current system)
RA3 (current system)
MM2: population 50,000+Hobart, TAS
Ballarat, VIC
Bundaberg, QLD
Cairns, QLD
Townsville, QLD
Darwin, NT
MM3: population 15,000 to 50,000Coffs Harbour, NSW
Maryborough, QLD
Warrnambool, VIC
Kalgoorlie-Boulder, WA
Geraldton, WA
MM4: population 5,000 to 15,000Lithgow, NSW
Dalby, VIC
Sale, VIC
Margaret River, WA
Charters Towers, QLD
Port Pirie, SA
MM5: population <5,000Gundagai, NSW
York, WA
Port Fairy, VIC
Hay, NSW
Bega, NSW
Mossman, QLD

Q: I am an advanced user who needs to do analysis on a larger scale. Can I get a complete dataset?
A: Datasets that provide MMM classifications at the ASGS SA1 level are available as a CSV or an ESRI shapefile on the Downloads page.


General Practice Rural Incentives Programme - Questions and Answers


Q: What is the General Practice Rural Incentives Programme?
A: The GPRIP provides incentives for doctors to move to, and remain working in, regional, rural and remote areas. The more remote the location according to the ASGC-RA (2006), the greater the incentive the doctor receives.

Q: Why has the classification system changed?
A: The GPRIP is based on the ASGC-RA (2006) classification system which was implemented by the previous government. This system has been widely criticised by rural stakeholders as creating inequities between rural and regional locations and further exacerbating the issue of maldistribution of doctors.

Q: How was the redesign of GPRIP considered?
A:An independent expert panel, announced by the Assistant Minister for Health, Senator Fiona Nash, provided advice to Government on how the Modified Monash Model (MMM) might be applied to GPRIP.

The members of the expert panel consisted of:
  • Dr Steve Hambleton - immediate past President of the Australian Medical Association
  • Dr Paul Mara - former President of the Rural Doctors Association of Australia
  • Professor John Humphreys - Emeritus Professor of Rural Health Research at Monash University, who led the design of an improved classification system for rural areas, which is the basis of the Government’s preferred new Modified Monash Model.
The panel consulted with key stakeholders and received public submissions about how GPRIP could be better targeted. The Final Report was provided to the Government on 20 January 2015.

The Government has adopted a number of the Independent Expert Panel’s recommendations in its redesign of GPRIP. For further information on these changes, go to: http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/General_Practice_Rural_Incentives_Program