AMSA Blog: Why the Government is gagging doctors – A closer look at the Border Force Act

8 Border Force Act

Marina Spajic, Alyssa Pradhan, Denise Braica, Monica Chen | The University of Adelaide

“Australia maintains one of the most restrictive immigration detention systems in the world”

(Australian Human Rights Commission, 2013) [1]

Since its inception, the 2015 bipartisan-supported Border Force Act has been embroiled in controversy. While the legislation has been endorsed as serving in the interest of national security and protection of information [2], many have questioned the intrinsic restriction on freedom of speech, and impacts on refugees and asylum seekers – Australia’s most vulnerable.

The Border Force Act: a summary

The new legislation serves to silence any “entrusted persons”, including doctors and other healthcare professionals, from speaking out about conditions in Australian immigration detention centres. Under the new Act, any “unauthorized disclosure of information, including personal information, will be punishable by imprisonment for two years” [2]. This includes reporting to the media as well as human rights bodies, such as the Australian Human Rights Commission [2]. Instead, reporting must first occur to the Minister of Immigration or Border Protection authorities; despite evidence that internal reporting mechanisms are often deeply flawed and elicit little change [3]. These concerns were recently raised in an open letter, signed by 40 former immigration detention workers, including 20 doctors [4].

Exemptions are included within the legislature, however the vague wording offers little insight into the possibility for legal ramifications following disclosure. Section 48(a) provides the following exemption: “the entrusted person reasonably believes that the disclosure is necessary to prevent or lessen a serious threat to the life or health of an individual” [2]. With the emphasis on ‘serious’, ‘threat to life’ and ‘individual’, many healthcare professionals are concerned about their rights to disclose information on non life-threatening concerns such as some mental health conditions, chronic diseases and systemic issues such as substandard living conditions or access to education and resources [5].

This legislation has particular ramifications for doctors, as it directly opposes the Medical Board of Australia’s Code of Conduct. The Code states that medical practice involves “supporting colleagues who raise concern about patient safety [and] taking all reasonable steps to address the issue if you have reason to think that patient safety may be compromised” [6]. Mandatory reporting is a core legal and ethical duty of medical practitioners, and failing to follow the Code of Conduct may result in the revoking of their medical license.

Although there have been no legal cases as a result of this legislation since its establishment in July of this year, there have been previous cases of social and humanitarian workers being made redundant after voicing concerns about the conditions in Nauru. In the words of one social worker: “I believe we were scapegoated to take the attention away from what was happening in the camp, which is the sexual exploitation of children, abuse, people’s human rights not being met and medical negligence — a boiling pot of despair” [7].

What about the whistleblower law?

The whistleblower law, as part of the Public Interest Disclosure Act (2013), was designed to allow public servants to publicly disclose any misconduct, dishonest or illegal activity within an organisation, provided internal reporting has been attempted and the disclosure is within public interest [8]. There is currently ongoing debate about whether this will afford sufficient protection to workers who speak out, as no one has yet been prosecuted under the Act. Regardless, this uncertainty produces a dangerous deterrent for individuals to report on conditions for fear of prosecution.

Why should we care?

Australia’s detention regime was designed to make asylum seekers suffer

(Dr Peter Young, 2015) [9]

As of June 30 2015, there were 2,013 people (127 children) in offshore immigration detention facilities, and 1,189 people (642 children) in community detention in Australia [10]. Of these, over 600 people had been in detention for over 18 months, with little or no knowledge as to if or when they would be granted asylum [10]. The offshore centres of Nauru, Christmas Island and Manus Island in particular have been repeatedly reported to have prevalent sexual abuse, child abuse, abhorrent living conditions and a systematic lack of adequate medical care [11] [12]. Mental health concerns are at critical proportions but medical support is rarely available. By two years in detention, 100% of adults were found to have depression, and 82% were diagnosed with PTSD despite rates on arrival in detention only being 21% and 50% respectively [13].

Asylum seekers may find themselves living in a single room with 112 others and only a few fans to relieve them from the suffocating heat and humidity, with a shortage of drinking water, toilets, shower facilities, clothing and shoes [14]. Despite the high frequency of preventable medical conditions such as heat stroke, skin infections, gastroenteritis and headaches, Amnesty International has reported that “medical advice given on Christmas Island and Manus Island to send asylum seekers for further tests or treatment in Australia has been ignored or refused” [14]. It is these inhumane conditions that may have contributed to the two preventable deaths in 2014 alone [14]. Nauru “does not provide safe and humane conditions of treatment in detention” and quality of life within the centre is non-existent and “akin to torture” [15]. With laws gagging the ability for visitors to publicly advocate against these human rights violations, the lack of internal regulation means the conditions, unbelievably, will not change.

Women and children are particularly vulnerable in detention. In an open letter to the Australian Government – a letter that would now in breach of the Border Force Act – former psychiatrists and social workers reveal that the Government was aware of the sexual abuse of women and children for 17 months, but no action was taken in this time and it remained shielded from media attention [16]. Detaining children causes immense and lasting damage and is in violation of several acts in the Convention of the Rights of the Child, and is against Australia’s international obligations [17]. By early 2014, 34% of children in detention were found to have severe mental health disorders, as compared to 2% of non-detained Australian children [17]. In detention, children are at risk of self-harming from as young as 12 years old, many regress to bedwetting or age-inappropriate behaviours such as the inability to form relationships, and are ten times more likely to develop a psychiatric disorder [17]. Families are expected to live in converted shipping containers the majority of which are 3 by 2.5 metres, with no play or educational facilities available to children in their most crucial stages of development [17]. For some children, their first spoken word is “officer” and they refer to themselves by their boat number and not their name [17] [18]. These devastating early years can impact the child for the rest of their life.

So where to from here?

The absence of media coverage and photographs of the deplorable conditions within these detention centres is testament to the tightly enforced secrecy, a secrecy that the Border Force Act aims to strengthen. The AMA and many other health bodies have continued to campaign for the Act to be repealed or amended to allow health professionals to adequately discharge their duty to their patients. While there may be some hope for change with a new Prime Minister, it is likely that it will take a doctor being charged for this issue to come to the forefront of public discourse. However, the hidden cost is the number of silent health professionals that have allowed unconscionable acts to occur without whistleblowing. As future clinicians, we should condemn this direct violation of human rights, and violation of our duty to act within the best interests of our patients. In the words of James Lawler, 2015 AMSA president:

To the Government, and to both major parties that passed this legislation, I say this:

How dare you tell me that I won’t be able to advocate on behalf of my patients.

How dare you pretend that this is in the interests of national security.

How dare you continue to treat refugees and asylum seekers, who have committed no crime, like substandard humans, and how dare you make out that doctors, teachers and other health workers are the enemies in all of this…

We will always fight for the best interests of people, and we will stand against you in any attempt to try and silence us.” [19]


As part of the National Inquiry into Children in Immigration Detention 2014, inquiry staff visited immigration detention facilities to speak to children in detention. During these visits, staff gave the children paper and pens and asked them to draw something about their life. Staff were given permission from these children to publish their photos, and they were given to the Australian Human Rights Commission.

3 1 2 4 5 8 7 6


[1] Australian Human Rights Commission 2013, Asylum seekers, refugees and human rights – snapshot report, Australia, viewed 21 September 2015, < >.

[2] Border Force Act 2015 (Cth), viewed 21 September 2015, <>.

[3] Bradley, M 2015 ‘Border Force Act: why do we need these laws?’, ABC The Drum, viewed 21 September 2015, <>.

[4] The Guardian 2015, ‘Open letter on the Border Force Act: ‘We challenge the department to prosecute’’, The Guardian, viewed 21 September 2015, < >.

[5] Butler, T 2015, ‘Talking about the border force legislation’, Terri Butler MP, viewed 21 September 2015, <http://www.terributlermpcom/talking_about_the_border_force_legislation >.

[6] Medical Board of Australia 2014, Good Medical Practice: A Code of Conduct for Doctors in Australia, Medical Board of Australia, viewed 21 September 2015.

[7] Lloyd, P 2015, ‘Nauru refugees ‘treated like animals’, subjected to ‘bride shopping’ by guards, social workers say’, ABC News, viewed 21 September 2015, <>.

[8] Public Disclosure Act 2013 (Cth), viewed 21 September 2015, < >.

[9] Farrell, P 2015, ‘Detention centre staff speak out in defiance of new asylum secrecy laws’, The Guardian, viewed 21 September 2015,<>.

[10] Australian Human Rights Commission 2015, Immigration detention statistics, Australian Human Rights Commission, viewed 21 September 2015, <>.

[11] Asylum Seeker Resource Centre 2015, Manus Island Detention Centre, Melbourne, viewed 21 September 2015,< >.

[12] Farrell, P 2015, ‘Detention centre staff speak out in defiance of new asylum secrecy laws’, The Guardian, viewed 21 September 2015, <>.

[13] Green, J, Eagar, K 2010, ‘The health of people in Australian immigration detention centres’, MJA, vol.192, pp.65-70.

[14] Amnesty International 2013, This is Breaking People: Human Rights Violations at Ausralia’s Asylum Seeker Processing Centre on Manus Island, Papua New Guinea, NSW, viewed 21 September 2015, < >.

[15] Metherell, L 2014, ‘Immigration detention psychiatrist Dr Peter Young says treatment of asylum seekers akin to torture’, ABC News, viewed 21 September 2015, <> .

[16] Asylum Seeker Resource Centre 2015, Children in Detention, Melbourne, viewed 21 September 2015, < >.

[17] Australian Human Rights Commission 2015, The Forgotten Children: National Inquiry into Children in Immigration Detention 2014 – Summary factsheet, Australia, viewed 21 September 2015, < >.

[18] Australian Nursing & Midwifery Federation (Victoria Branch) 2015, ‘ANMF resolves to campaign for asylum’, Australian Nursing & Midwifery Federation (Victorian Branch), viewed 21 September 2015, <>.

[19] Fernandes, B (AMSA Vice President (External)) 2015, AMSA continues protest over Border Force Act, media release, AMSA’s National Convention, Melbourne, 6 July, viewed 21 September 2015, < >.


Reference for images:

Australian Human Rights Commission, 2014 “Drawings by children in immigration detention” Flickr, viewed 22/09/2015 <>


AMSA Blog: Rural Health for the Non-rural Student

7 Rural Health

By Kate Wambeek | Monash University

I grew up in suburban Perth, have never lived in rural or regional Australia, and as a second year medical student have no experience providing rural healthcare… So how did I get involved in rural health? What sparked my interest? And why should my opinion on rural health be of any value?

There’s no single experience that precipitated my interest in rural health. Before medical school my involvement with rural health, or even rural Australia, was extremely limited. I had been very fortunate during school to visit a good friend who lived in the wheat belt in WA, and even more fortunate to have spent some time camping and travelling around WA with my family, however neither of these things can individually explain my interest in rural health today. It was instead my repeated exposure to rural health, especially during my first 2 years of medical school, that lead me to think of rural health as more than just a casual curiosity. These high school trips combined with lectures, conversing with rural friends and discussing rural issues with anyone who would listen, ultimately lead me to more actively pursue my rural interest.

I’m excited to think that there is still so much for me to learn and do in regards to rural health. Despite my clear interest in rural health I have, as of yet, been unable to gain any practical clinical experience – and not through lack of trying. I can read and postulate as much as I like, but passion and theory are no substitute for experience, something I have sorely missed. There’s something to be said about our medical education system when students want to experience rural health but don’t have the opportunity to. As part of a rural placement offered by my university I will finally be undertaking a two-week placement in Bairnsdale in the coming weeks. I am excited and curious to see how this experience will differ from my own expectations. Hopefully this will be the first of many more placements opportunities.

So what can I bring to the table as a non-rural student?

I’d like to think that my experience as a non-rural student engaging with the rural health sphere has given me an insight into how we can improve the participation of non-rural students in rural health conversations and hopefully encourage them to work rurally in the future.

I’d like to think that my experience is a gentle reminder that repeated exposure to rural health issues and conversations can encourage participation in these areas.

I’d like to think that in the future there will be a greater opportunity for practical rural experience as there is mounting research illustrating its influence on rural medical practice uptake.

To those interested in rural health, or indeed any area of health where they have little prior experience, I say go for it! Immerse yourself and further your curiosity into a passion. I have been overawed by how easy it is to find passionate people who are eager to share their own rural experience and knowledge with me. They don’t care about where I’m from, they are just excited to share their interests with anyone willing to listen. Where rural health is concerned, everyone is welcome and anyone can help make a difference.

Kate Wambeek is a second year medical student at Monash University. She currently sits on the AMSA Rural Health Committee, providing valuable perspective as a non-rural student.

AMSA’s Submission on Health Workforce Scholarships

Submission to Health Workforce Scholarship Program (HWSP) Consultation

The following proposals are generalised so that medicine, nursing and allied health students would be able to apply. The best known indicators to increase recruitment and retention in the rural workforce are students with a rural background and/or positive rural experiences during study. Therefore, the proposed scholarships should:

    • Support rural-background students in ongoing costs to study medicine; and/or
    • Support any student to undertake rural clinical placements.

Proposal #1: Rural Student Support Scholarship

This scholarship aims to address the inequities in access to medical education for students from regional, rural and remote backgrounds. The scholarship should not come with a bond, but should rather reinforce the scholar’s ties to rural and remote Australia through local mentorship and/or rural community activities.

Eligibility Criteria

  • Australian citizens and permanent residents;
  • Acceptance into an Australian undergraduate or postgraduate medical degree;
  • Rural background as defined by home address at application, time spent growing up in rural area, perceived connection to rural Australia, and rural identity;
  • Interest and/or intent to pursue a career in regional, rural or remote Australia; and
  • Not in receipt of any other scholarships totalling over $7 000.

Assessment criteria

1) Rural connection –

  • Rural residency and duration of time where primary home residence was at a rural address.
    • 5 years is when rural background starts to have a positive effect on rural intention. 8 years may provide the highest likelihood of rural intention.
  • Rural identity is a useful adjunct to rural background.
    • Essentials for developing a sense of belonging to a rural place are experiential place integration, identifying security, freedom, identity and meaning in place.

2) Financial need –

  • Assessed on taxable income over the previous 2 financial years and prediction of income for upcoming financial year.
  • Applications should provide detail of individual and partner income.
    • If dependant, parental income should be supplied.

3) Commitment to future rural practice –

  • Efforts displaying commitment to rural communities and rural health.
    • Requirement of students to maintain membership of their university’s Rural Health Club.

Student Obligations

  • Continue to be enrolled full-time in an Australian medical degree;
  • Have a rural doctor as a mentor;
  • Undertake rural activities with their mentor’s guidance;
  • Maintain membership of their local university’s Rural Health Club;
  • Engage with extra-curricular rural health activities; and
  • Sign a Scholar Agreement and provide reports and documents to confirm that you continue to be eligible for the scholarship.

Please note:

  • The scholarship should not be counted as taxable income.
  • Students should also be followed throughout their careers to evaluate the workforce outcomes of the scholarships.

Proposal #2: Rural Placement Support Scholarships

This scholarship will assist any student with an interest in rural and remote health to pursue a rural or remote placement.

Eligibility Criteria

  • Enrolled in an Australian undergraduate or postgraduate medical degree;
  • Interest and/or intent to pursue a career in regional, rural or remote Australia;
  • Undertaking a placement outside of the local university’s footprint;
  • Not in receipt of any other scholarships or funding for the same placement.

Assessment criteria

1) Rural connection –

  • Preference should be given to students of a rural background for greatest return, followed by domestic metropolitan and Australian international students who are interested in a career in rural Australia.

2) Commitment to future rural practice –

  • Efforts displaying commitment to rural communities and rural health.
    • Requirement of students to be members of their university’s Rural Health Club at the time of application.

3) Placement –

  • Students should be asked to describe what they hope to gain from the placement.
  • Length of placement should be considered.
  • Remoteness of placement should be considered.

Student Obligations

  • Complete a placement in rural or remote Australia (RA2-5) (MMM2-7);
  • Submit a 500-1000 word report on the experience following completion of the placement; and
  • Submit receipts for travel, accommodation and living costs while on the placement up to the value of the scholarship.

Please note:

  • The scholarship should not be counted as taxable income.
  • Students should also be followed throughout their careers to evaluate the workforce outcomes of the scholarships.

Answers to points from the consultation document

The courses that should warrant scholarships, both in terms of the profession they support and the type of support, such as undergraduate, graduate or continuing professional development. Which students should be prioritised for scholarship support.

The shortage of medical professionals in rural and remote Australia is well known. Lower rates of doctors per capita and full-time equivalent GPs in these areas contributes to a lower access to health services and a higher morbidity and mortality for rural and remote residents. It is therefore imperative that medical students continue to be supported to take up rural practice.

Medical programs in Australia are both undergraduate and postgraduate and there need not be a distinction in scholarship allocation based on this.

Continuing professional development (CPD) can be delivered at the student level via allowance to attend conferences and events to increase their interest and capacity to be a rural practitioner. Furthermore, participation in these activities will engage students with the wider rural health community. Cutchin (1997) highlights that individuals need to experience compatibility between themselves and the community for the retention of rural physicians.

Why medical degrees should be prioritised for scholarship support:

  • Higher student contribution band;
    • Medicine – Band 3 ~ $10 000/year
    • Allied health – Band 2 ~ $8 000/year
    • Nursing – Band 1 ~ $6 000/year
  • Longer degrees;
  • Limited capacity to study part-time to facilitate part-time work (particularly in clinical years);
  • Cannot be studied via distance (unlike nursing and some allied health degrees);
  • Most regional, rural and remote medical students must relocate to a capital city for all or part of their degree, while nursing and allied health students have greater access to regionally-based tertiary institutions (CSU, Southern Cross, La Trobe, TAFE).

The Australian Government Health Workforce Programs Review 2013 also found that “in some areas, particularly nursing and midwifery, Commonwealth scholarships are in competition with those offered by the states and territories” and that “this could represent a duplication of resources” (p.12).


“Available evidence suggests that a large number of nursing graduates leave the workforce within the first few years of practice. This could potentially mean that undergraduate scholarships, of up to $10,000 annually, are not heavily influencing the recipients’ future career choices and that the workforce is not greatly benefiting from this type of investment in terms of retention.” (p.106)

We hope that this will not be considered as a wish to petition for a reduction in scholarships for nursing or allied health students, but rather as perspective so that the Department can feel guaranteed of their current investment in medical students.

What might be an appropriate payment amount to participants and what outcomes could be expected for that payment?

Rural-background students need to be supported throughout their entire degree, and this necessitates a need for financial support scholarships. The value of $10 000pa is well supported by the Australian Government Health Workforce Programs Review 2013, whereby it was suggested MRBS funding for one individual ($26 000pa) could be better served supporting two RAMUS students ($10 000pa per student). The value of $10 000pa has also been supported during consultation with our members, reflecting the expenses rural-background medical students state they acquire from study.

Financial support programs such as RAMUS, that provide $10 000pa, concurrently maintain scholars’ ties to rural Australia through rural mentorship and rural activities. The outcome from this payment was ultimately a greater uptake of careers in rural and remote Australia.

Clinical placement scholarships should cover the costs of the placement so that there is not undue financial strain for students who wish to engage with rural health. The value would depend on the distance from the home university site and the duration of the placement. Values of $1 000-5 000 contribute greatly to reducing the higher cost of travel to rural and remote placements.

The outcome of rural placements are to provide positive rural experiences which add up to have a strong influence on an individual’s preference for a rural career.

Which criteria should be taken into account when awarding scholarships?

Given the evidence available, preference should be given to applicants with a rural background, strong rural intention, and financial need.

It should be noted that simply ranking income may not necessarily delineate financial need. For example, students who will be returning to study from full-time work and have dependants would be ranked higher due to their previous income but do not necessarily have lower financial need. In the case of RAMUS, an Appeals Panel assessed these applicants to ensure that this issue was taken into account.

The criteria are set in the proposals above.

Identify an evidence-based strategy for targeting scholarships.  The submissions must indicate areas of workforce shortage and demonstrate how scholarships could improve recruitment and retention in rural, regional and remote Australia.


Preliminary indicators suggest that RAMUS scholars are more engaged in rural health, more likely to take up rural clinical school placements, and more like likely to take up rural post-graduate positions.

Similarly, in a retrospective, national case control study on rural GPs, women meeting the RAMUS rural-background criterion were 3.2 times more likely to be currently working in a rural practice, and men meeting the criterion were 2.4 times more likely.

Because of this evidence base, we support the use of RAMUS and its criteria as a model for targeting future Health Workforce Scholarships.

Rural-Background Financial Support

There is a host of evidence that rural background students are more likely to take up rural health careers. This has been well recognised by the Commonwealth government who have offered to support rural-background students to study medicine. Without this support rural families (who have lower average incomes than metropolitan counterparts) would unlikely be able to support their children to attend university. Successful rural applicants are no longer forced to reject offers due to financial disadvantage and this has contributed to the increase in rural students in medical school and the diversity of medical cohorts. It would be a great disaster if these students were no longer prioritised.

Rural Placements

Placements in rural areas can be more expensive than in the town or city of a student’s home university. This is due to the cost of travel to rural areas and cost of living e.g. higher petrol and grocery prices. We are deeply grateful for programs such as John Flynn Placement Program (JFPP) and take note of the scholarships dispensed by SARRAH for our allied health friends. Selection of students with a rural interest and intention is a recommended strategy.

Rural placements have benefits for many students:

  • Rural-background students maintain the ties they have to rural health;
  • Metropolitan students develop greater perspective about rural health and rural patients;
  • Placements breakdown the lack of familiarity many students have with rural Australia, which is a barrier to them taking up rural careers.

We note that Australian international students are keen to become involved in rural health but are prevented from attending rural clinical schools. With the introduction of Commonwealth Medical Internships (CMI) Australian international are now beginning to participate in rural health following graduation and it would subsequently be advantageous for Australian international students to have rural experiences before their internship. The AMSA Rural Health Bursary is the only placement support available to these students, and we note that these students frequently submit very well-thought-out applications to AMSA Rural Health for the opportunity to go rural. Ultimately these students have trained in Australia, they understand our health system, and many show a great commitment to take up permanent residency to deliver health services to the Australian community – not fostering their desire for rural exposure and experience would represent a lost opportunity to improve and expand the rural health workforce.

Bonded Schemes

With regards to scholarship format, there is no evidence from Australia or around the world that bonded programs lead to the long term retention of health professionals. The Australian Government Health Workforce Programs Review (2013) recognised this and recommended investment to be redirected into non-bonded scholarships such as RAMUS (p.11-12, 107). RAMUS is both popular among rural communities and rural-background medical students, and lacks the element of stigma and coercion of bonding, resulting in a genuine community engagement (p.107).

International examples suggest bonded schemes are ineffective. One OECD (The Organisation for Economic Co-operation and Development) paper noted that many students enrolled in such schemes ultimately elect to buy their way out of the scheme or, if they do complete their return of service, leave areas of need upon completion. A systematic review of largely North American programs suggested bonded programs are considerably less effective than voluntary recruitment in long-term retention of rural doctors. According to a study by the World Health Organization in 2010, no other government requires a return of service obligation of up to 6 years through their respective compulsory service programs.

Despite significant evidence against Bonded Medical Schemes and scant evidence to the contrary, the 2015 Budget created more Bonded Medical Program (BMP) places and government health scholarships are now accompanied by a 1-year bond.

The most recent data regarding BMP and MRBS programs shows that they have been unsuccessful in creating long-term rural practitioners with an extraordinarily high withdrawal rate. The Australian Government Health Workforce Programs Review 2013 found that complicated contractual arrangements were expensive and administratively onerous and face questionable utility (p.106).

The 2013 review also stated that “many MRBS participants lack a positive connection to rural service and generally indicate an unwillingness to fully participate in rural life” (p.106). This highlights the importance of selecting students with a rural background and identity. However most frightening is that “the bonded element is experienced as stigmatising of rural practice” (p.106). In essence the MRBS may have an opposite effect on creating rural practitioners. We have received emails from current GPs completing their return of service who express how the program has made them resentful to the field of rural health, a field which they once loved.

Given the large taxpayer investment into MRBS, students they should still be expected to complete their return of service, however they should have the option to pay out their bond (~$250 000) back to the Department and should not be subjected to the 12 year Medicare ban. The time limit of 16 years to become a Fellow should be relaxed to enable a higher proportion of students to be retained.

In light of solid evidence that demonstrates that bonded schemes do not produce workforce outcomes we recommend that the new format of health workforce scholarships do not include a bond. This will cut the administrative costs to follow students and process the buy-outs which predictably have and will continue to occur. We implore the Department to embrace the evidence that supporting rural-background students and positive rural experiences will generate the workforce outcomes we all hope for.

What students are saying

The AMSA Rural Health Committee surveyed students about where they receive their income, expenses for studying, and what their preferences are for scholarships. Listed are common themes from the survey:

  • Relocation scholarships for rural-background students;
  • RAMUS model scholarship for rural-background students;
  • Focus on rural-background students;
  • Accommodation support for rural-background students;
  • Financial need to be a key selection criteria;
  • Extending scholarships to other health students;
  • Scholarships for rural clinical placements;
  • Continuation of JFPP to financially support rural experiences;
  • Increasing opportunities for students to undertake rural health placements;
  • Include positive rural experience in the program, e.g. rural clinical mentor;
  • Removing the bonding from all scholarships, or allowing bond to be return during training;
  • Current BMP student contracts to be reduced to 1 year return of service;
  • Supporting students and doctors who are currently bonded through the BMP and MRBS programs.

In addition, our consultation with AMSA members revealed that students benefit greatly from accompanying non-financial supports with scholarship programs such as having a rural clinical mentor and having access and support to engage with rural events and conferences.


Medical students welcome Surgeons’ report on Discrimination, Bullying and Harassment

Official AMSA Logo JPEG

The Australian Medical Students’ Association (AMSA) has welcomed the report of the Royal Australasian College of Surgeons (RACS) Expert Advisory Group’s (EAG) report on discrimination, bullying and harassment.

The independent report was commissioned by RACS earlier this year to recommend ways the College could improve its response to claims of bullying, harassment and discrimination in the profession.

AMSA President James Lawler, congratulated RACS on their response on this issue so far and welcomed the report.

“According to this report, 49% of fellows, trainees and international medical graduates report being subjected to discrimination, bullying or sexual harassment. This is damning of the culture of medical training and proof that the medical profession needs to do better.

“RACS should be congratulated on the process they have undertaken so far in commissioning this report.

“Senior leadership is the key to culture change in our hospitals. Culture change won’t ‘trickle up’ from the next generation – it needs to come from the top.

“All senior medical professionals, especially surgeons, should read this report and take heed of its recommendations.

“The recommendations from this report should be implemented by RACS in full.

Mr Lawler also called upon other medical colleges to take on the recommendations from the report.

“This report has highlighted the problems within Surgery, but similar problems still exist in other medical specialities.

“Every medical college should consider this report as a matter of priority and adopt its recommendations where possible.

Mr Lawler said that any doctor or surgeon who continued to defend the culture of bullying and harassment in hospitals should leave the profession

“Bullying and harassment don’t just lead to poor experiences with doctors in training. They lead to medical teams which communicate poorly, and ultimately patient care is jeopardised.

“Doctors who bully or harass their colleagues need to be reprimanded appropriately. Those who continue to defend this behaviour should leave the profession.

Next Monday 14 September, AMSA will be hosting a panel at its National Leadership Development Seminar in Canberra on Sexual Harassment from 10:50-11:50am at the Shine Dome in Canberra. Panelists include:

  • Dr Gabrielle McMullin – vascular surgeon
  • Mr James Lawler – AMSA President
  • Alice Matthews – ABC Journalist
  • Dr John Quinn – RACS Surgical Affairs Director

If any media are interested in attending, RSVP your attendance to

Media Contact
Brian Fernandes
AMSA Vice President(External)
0433 035 653

Bonded doctors bail on bush contracts

31 August, 2015 Tessa Hoffman. 

Originally published by Rural Doctor.  

Dozens of bonded doctors who signed up to work in the bush for six years in return for financial support for their medical degrees have backed out of the contracts.

But many who breached the terms of the controversial Medical Rural Bonded Scholarship Scheme have escaped without penalty, Rural Doctor can reveal.

The scheme, which offers $26,000 a year towards university fees in exchange for working in a rural or regional area once the doctor attains fellowship, has been widely panned since its launch in 2001.

Among the biggest concerns is that it ‘traps’ high school graduates, who — at 17 years old — are too young to fully grasp that they are making a commitment that will span 15 years.

Although the scheme — which is different from the Bonded Medical Places Scheme — was finally scrapped this year, there are still over 1400 doctors and students under the shadow of the contracts. 

Failure to provide return of service within a year of attaining fellowship can mean harsh penalities: a 12-year ban on claiming Medicare and a requirement to pay back the scholarship plus interest.

There is also a five-year ban on studying medicine for those who quit after starting the second year of their degree.

Despite the penalties, which have been described as draconian, people are quitting the program, with Department of Health figures showing 42 have now breached their contracts.

Of these, seven cases involved doctors failing to begin their return of service, but six escaped penalties owing to “exceptional circumstances”, such as health or personal reasons, while one person had a 12-year Medicare ban imposed and was required to repay the scholarship.

A further 35 quit their studies after a year — some had penalties waived while others agreed not to study medicine for five years — while 49 quit before second year, thus avoiding a penalty.

Meanwhile, 108 fellows have begun working in the bush, and 39 are yet to start.

A second bonded doctor, who did not wish to be named, told Australian Doctor that the scheme was “unethical”.

“The penalty is disproportionate to the crime. There needs to be some allowance for the fact that, over 15 years of a person’s life, circumstances change,” he said.

He said the government “should consider allowing the 1300 people still in it the option to buy out without incurring the draconian, harsh Medicare penalty”.

James Lawler, president of the Australian Medical Students’ Association, which described the scheme as exploitative, agreed.

He claimed that the number of doctors backing out of contracts was yet more evidence bonding was a policy disaster.

“A lot of people feel trapped after university, and there are so many implications for where they can train and what they can train in. The evidence internationally is that most who take part in the scheme will return to metropolitan area once bond is over.”

“I think if the government is going to scrap it because it’s a bad program, they need to review the contracts,” Mr Lawler said.

But ACRRM president Associate Professor Lucie Walters said the scheme had worked well for some communities and individuals, and the government’s decision to dump it was “premature” and made before there was enough evidence to show whether it had succeeded.

Two participants in the scheme told Australian Doctor that it had been a positive experience.

Dr Carolyn Siddell, a second-year resident planning to become a GP, said the program had been a positive experience because she “only ever wanted to be a country doctor”.

The program’s additional supports — such as free access to conferences and ACRRM’s support program as well as $25,000 a year – made it well worth the return-of-service commitment, she said.

Julie van der Clift, a postgraduate medical student and ICU nurse, said she never felt stigmatised for being in the program. 

“In fact, sometimes students are envious of all the extra support we had access to,” she said.

Transcript: 2016 Executive-elect Presentation

Origin story

We all have a story to tell. Mine is set on top of an old volcano, in a town called Toowoomba. It’s a regional area about an hour and a half outside of Brisbane. For most of my life I was a part of a community there, and my community’s world was of a certain size. It spanned from Bridge Street in the North to Spring Street in the South, and I could drive across my world in 12 minutes and 20 seconds. My mother is a nurse, my father is a nurse, as are my nan, aunty, and as of this November, my little brother. My family, and my community, and my self, were a self-contained world.

When I started medicine, the limits on my world very quickly expanded. I got voted on to my MedSoc Exec as First Year Rep in my first month in medicine, and that introduced me to the concept of advocating for issues in a world wider than just your own.

My time on my MedSoc introduced me to a number of other valuable skills. It taught me to barbeque for a hundred and twenty hungry medical students at a time, it exposed me to the power of free food in engaging medical students above all else, and it forced me to master the art of “lecture bashing” to a captive audience. It also introduced me to AMSA.

While I was on my MedSoc, I started spending time with a more senior member of the Executive. They taught me to think critically about policy, advised me to enlist a team of family, friends and acquaintances to help me register for AMSA’s National Convention, and took me along to my first Council. That MedSoc Executive was Chloe Boateng.

A year and a bid team later, Chloe and I were standing in front of AMSA Council hoping to be a part of the 2015 AMSA Executive. When we practiced our speech as a team the night before, I was incredibly nervous. Time after time, we practiced our speech and when it came to me, I forgot what I’d invested months of preparation and a flight to Hobart to say. I went to bed that night thinking, if I couldn’t get the words out surrounded by my team, how could I possibly get through this speech standing in front of a room as intimidating as AMSA Council. The next morning we ran over our speech again, and I fought my nerves all the way to the front of the room. When we stood up in front of Council, and I met the eyes of the AMSA Reps and Presidents, a thought struck me that made me calm. “They’re medical students. They’re just here trying to make AMSA better. They’re just like me.”

We won that election and we started 2015 with a joy that I’m incredibly proud to say has never left our team. There have been moments, of course, when the requirements of being on the AMSA Executive have challenged each of us.

When it comes to logistics, even the best laid plans go awry. At First Council, 2015, the Sunday afternoon session was running long and dinner wasn’t going to plan. Everyone Chloe planned to ask for help was busy and turned her away with the same refrain “ask Matt Lennon”. Matt just has that reputation within AMSA as the guy who will never say no to lending someone a helping hand. So, she did ask Matt, and he said yes, to helping her carry over 100 burritos in the rain and missing a solid Council session as a result, because that’s the kind of guy Matt is. Off they went on an hour long travesty of a dinner run, they got lost for half an hour, the payment system at the burrito place was down, it rained so much that they came back looking like drowned rats and yet they came back with huge smiles on their faces. When I asked her about that story, Chloe said, “honestly, Matt being there just made it fun!”.

And it was Matt that brought us to Brad. Matt and Brad are old mates, becoming friends while working together in event management. They have a strong working relationship, spanning managing animals, to managing people and back again. It’s very obvious that they’re on the same wavelength, often rocking up to our team meetings in cute matching outfits. Brad has a great personality, and as many of you have said to me, a nice face. He has quickly become a friend, someone’s who’s able to make you laugh one moment and be a great sounding board for your ideas the next, he’s a much loved member of our team.

Standing in front of AMSA Council, presenting our bid in 2014 I saw just how intimidating AMSA can be, and I saw a way for AMSA to move past it. I stand here before you today because Chloe Boateng had faith in a very small, very loud first year from Toowoomba and took me under her wing. Matt’s here because he braved the rain so Chloe didn’t have to carry 100 burritos on her own. Brad’s in front of you because Matt saw an opportunity to engage someone who hadn’t even started medicine yet. That’s how I know that this is the team to lead an AMSA that finds a place for every medical student, whether they’re looking for an opportunity, for an advocate, or for a hand of support. The culture of AMSA will be made and broken in these small moments.

Earlier this year, AMSA set it’s sights on another cultural change. In May, I watched James Lawler stand up in front of the AMA National Conference and speak against bullying and harassment in medicine. The medical hierarchy is so entrenched that it would be easy to believe that one speech could not make a difference. But even single actions can have an effect down the line.

In the time since that speech, one of the MedSoc’s came across a situation where some of their students came to them, feeling that they had been treated with disrespect by a member of staff. When I spoke to the MedSoc about it, they told me about the way AMSA was able to contribute to their response. It filled me with confidence in AMSA’s ability to support students and to bring about change, and I hope it will do the same for you.

They told me that in isolation, they wouldn’t have felt strong enough to act, and in the past, they would have copped it on the chin. But with media attention focused on bullying and harassment in medicine, it felt like time to change. They told me that they found confidence to respond as a united student body in a way that wouldn’t have been possible without the momentum generated by AMSA.

When they spoke up, they were listened to, and were able to sit down in a room with the staff member in question, discuss what had happened with them and receive an apology.

Change in the culture of bullying and harassment in medicine will take sustained work from all of us in AMSA and from many others working in this space. That change in the culture of medicine will come about in individual victories just like these. The change in the internal culture within AMSA can be brought about in just the same way.


We’ve all seen AMSA’s ability to rise up when faced with an external threat. But what about when the threat comes from within? Too many people don’t share our origin story. Too many people enter and leave AMSA without feeling like anyone went the extra mile for them. In an organisation run entirely on the backs of volunteers, this is one of our greatest risks.

We all want to work for an organisation that supports the needs of individual medical students, and the individual needs of each state. An organisation with a culture of integrity, one that turns a critical eye to it’s own structures and resolves to make itself stronger. We know that AMSA can be that organisation, and there are four areas of change that we want to focus on to do it.

AMSA for All

We know that to sustain AMSA, and to fulfil its mission, we must create an AMSA that welcomes the unskilled and the eager, and gives them something back in return for their efforts. We must create an AMSA for All.

No state left behind

When it comes to supporting the states, AMSA knows it can do better. We’ve got an idea for a National Advocacy Committee, comprised of one representative from each state, that can inform and direct the work of the Executive on state based needs. We won’t attempt to replace or replicate the work of the state based MSCs. We’ll work with them to find out where AMSA can better support them to achieve their advocacy aims.


AMSA holds this country’s governing institutions to the highest standard of integrity. This is an area where AMSA does well, and an area of which I am proud. Fighting for transparency is a part of AMSA’s legacy. Let us be clear, however: in order to maintain that standing we know we must not make an exception of ourselves. Transparency must always start from within. A focus of our work as the 2016 Executive would be improving lines of communication and accountability within the organisation. We’re not saying we won’t make mistakes. We’re saying we will readily own up to them and engage in a dialogue to understand why they happened and to ensure they don’t happen again.

Taking stock

Just as AMSA is supported by the hands of hundreds of volunteers, AMSA too must strengthen itself in order to support them. 2016 is a year to challenge the assumptions underlying AMSA’s structure and function. It’s a year to make clear what the core functions of AMSA are, and how we will do them better. It’s a year to make sure that everything we’ve built can be sustained. A year to go back to the medical students of Australia and ask their honest opinion on just how well we’re doing, and how we can improve.

We want to see AMSA engaging and upskilling a generation of advocates, problem solvers and critical thinkers. Brad’s here to start to tell you how we’d like to do it.


Engaging the members

Over the last few months, I’ve been introduced to the structure of AMSA and the workings of AMSA Council. There’s a lot of information to digest. When we sat down as a team and talked through ways to make AMSA more approachable, providing Councillors and guests with an easy guide to understanding AMSA Council was an obvious obstacle to tackle.

We’d like to expand on existing Pre Council Training, creating internal training that provides a brief overview of each of a number of areas relevant to Council. This could include the nuts and bolts of AMSA, the structure of its membership, its committees and its external relationships. There’d be information on the separate functions of the board and the Executive, the role and legal responsibilities of the board, and clear pathways to give feedback to both groups. There’d be further clarification of the standing orders in order to make it easier for first time Council attendees to speak up. This way, Councilors start the year with an understanding of their position in the organisation, empowering them to ask the right questions and make informed decisions from the beginning of their term.

Empowering the volunteers

We know it’s in individual conversations that change comes about. AMSA, as an organisation of part time student volunteers, should be a place where having a conversation with anyone at any level should be as easy as picking up the phone.

There’s still work to be done in flattening the organisational hierarchy to make that happen. We’d like to trial a weekly open meeting time for any volunteer to jump online and discuss their thoughts or concerns. Each meeting would be run on a broad topic, with volunteers encouraged to submit them. The entire volunteer base will be invited, to open the floor for anyone in the organisation to be heard.

We’d like to organise state based meet ups of AMSA volunteers, and promote it as a place that welcomes those who are keen to get involved. In this way, we can break down more barriers to engagement and encourage more conversations.

The known unknowns

Human resources are AMSA’s most precious resource. To sustain our HR needs, we need to increase our engagement with medical students across the board. We’d like to put together a survey of AMSA’s volunteers, collecting both demographic and qualitative information to help direct our efforts to engage. From there, we can begin to develop a strategy to increase the depth of engagement of those that connect to AMSA.

The unknown unknowns

A challenge for us as a representative organisation is engaging those without ties to AMSA. We want to reach these people, because we stand to represent them. We want the message to be: we are your voice. Tell us what what you believe and let us take it forward on your behalf.

To reach those that don’t connect with AMSA, we’d like members of our Exec to work with AMSA Reps to trial focus groups at medical schools. We’ll be looking to find out what people know about AMSA, and what they’d like to see from the national body that represents them. From there we can develop our strategy to build an AMSA for All.


“Lets talk advocacy”

If Brian has taught me one thing this year it is that everything and anything is possible as long as you ask for things with a ginormous smile on your face and are willing to send up to 26 emails without reply. With several internship review findings being discussed, CMI coming to a close and a federal election year, AMSA advocacy in 2016 will be busier than a cobra at a mongoose convention.

A National Advocacy Team

The most radical component of AMSAs advocacy restructuring will be our national advocacy committee. The structure of the advocacy committee will be as follows:


Comprised of the President, Vice President (External), Policy Officer and Public Relations Officer.


Comprised of a representative of AMSA Global Health, AMSA Rural Health, AIDA and the International Students’ Network.


The State Advocacy Component will be comprised of one representative from each state and territory. We see a State Advocacy Committee as crucial in our effort to address state specific issues, streamlining advocacy nationally while engaging with media and politicians locally. The national team will facilitate upskilling of AMSA members nationally and cross pollination of ideas and issues of advocacy between states. This the whole team on a regular basis for ongoing consultation on state based advocacy issues, as well as reactively in order to meet the fast turnaround required to advocate on topical issues. We’ll be working with the various committees, state MSCs and MedSocs to nominate and elect individuals for the team.

Because we’re upgrading to a national advocacy team – transport will now be exclusively by helicopter. Its the latest and greatest way to travel.

An AMSA of Advocates

With the issues of CMI closing, medical student numbers increasing and an election year we will need to be clear and we will need to be loud. To do this we hope to start “workload blocking” – that is dividing big advocacy strategies into small, discrete, specific tasks usually taking a couple of hours of work and offering them to our base of advocates to be taken up by individuals and teams. Increasing delegation of tasks will mean that AMSA will be able to advocate both broadly, developing our voice on things like youth public health, and deeply, focussing on our core priorities.


And finally our focus for next year will be on consultation, we say in every policy that we represent the 17,000 medical students in Australia, for this the core of our focus will be on speaking to our constituents from the least involved to the most involved and ensuring that what we do is genuinely representative.


I came to my first AMSA Council and I sat there in awe, impressed by the sheer breadth of this organisation and the passion of its volunteers, but also very intimidated. I’ll never forget how terrifying I found it all at first, I didn’t speak for the entirety of my first Council and for months I was very unsure of myself. My story is probably very similar to most of yours, but this isn’t a story we want future AMSA volunteers to be telling. We want them to come to this organisation and feel welcomed and empowered from the get go, we want them to know where to go for support and to feel comfortable doing so. We want to create a better volunteer culture and now I’m going to tell you how we are going to do that: better induction, streamlined communication and support.

Handover and Induction

Taking office in AMSA is like stepping on to the stage of “Thank God You’re Here”, having no idea what’s behind each and every door. But it doesn’t have to be like that, we want to ensure all of us have a strong handover for our individual roles AND induction into the organisation as a whole.

We’ll create more specific handover guides for office bearers in various arms of the organisation. And by using rolling handover documents, our handovers will both improve over time and ease the burden on individual volunteers.

We’ll build on the current Welcome to AMSA Guide, ensuring that induction information is more digestible and widely distributed. We’ll carry on Matt Rubic’s existing HR strategy and supplement induction information with further optional education throughout the year. In this way, volunteers will be in control of how much they’d like to learn about AMSA.


Despite the fact that we are all medical students, new and old volunteers alike often see different groups ingm AMSA as unapproachable. We’ll work to flatten this view of organisational hierarchy. We’ll ensure everyone is aware of their individual liaison pathways, so they feel well supported and all parts of the organisation are made accessible.

Burnout and support

The risk of burnout is inherent in an organisation where we are expected to be both full time medical students and volunteers. We’ll support our volunteers, promote dialogue about burnout to reduce the stigma, encourage healthy workloads and use burnout plans to both catch burnout early and recover from it.

Wider use of burnout plans will start at the beginning of volunteer terms. We’ll ask volunteers to name their personal signs of burnout and how they’ll tackle it, if it does happen. These plans will be shared amongst teams and each volunteer will be asked to name people they’ll seek support from if they are burnt out. In this way, we’ll be able to see signs of burnout early in both ourselves and each other and we’ll engender a more open dialogue and supportive culture.

A more welcoming AMSA

We want to create an inclusive and healthy volunteer culture. We want every AMSA volunteer to finish their terms glad they said yes to AMSA and eager to return.


And finally, in finance, I’ll strike a balance between ensuring the day to day operational success of the organisation and working within an overarching strategic framework. Prior to deciding to apply for medicine, I spent my down time getting an undergraduate degree in Financial mathematics and statistics, and followed it up this year with a Masters of Commerce, specialising in finance and business analytics. It would be a privilege to be able to contribute this financial background to the development of a financial strategic plan, which Tom Morrison currently has well underway. My emphasis in the role of treasurer will be on upholding transparency, on implementing merit based funding, and on ensuring that allocation of resources provides a sustainable foundation for AMSA moving forward.


And there you have it. AMSA’s story is a choose your own adventure. You speak, we act, and AMSA moves forward in the direction you choose.

We want to hear the stories of as many medical students as possible. We want to hear about their experiences of AMSA so that we can make this the place they keep coming back to. We want to hear what they needed most in medical school so that AMSA can work in that space. We want to hear what they believe so that we can be their voice at the highest level.

Now you know who we are, why we’re here, and where we want to go. So that’s our story. Our question becomes; would you tell us yours?

Thank you.

Annual General Meeting 23rd August

On 23rd August, AMSA will hold the third Annual General Meeting in Sydney to elect the 2016 senior leadership team.

There are three Bid Teams from: QLD2016, NSW2016 and WA2016.

You can find the agenda here.

Who to Contact?

If you have any questions regarding the meeting and the election, please contact the following people;

Election Information – Danielle Panaccio (

Meeting Information – Alex Hanson (

Board Process/Voting Information – Alex Robinson (

Logistics of the Meeting – Matt Rubic (

Plan to overhaul rural training plan

By Flynn Murphy | First published in the Medical Observer, 29 July 2015

STUDENTS fear the popular John Flynn Placement Program (JFPP) is doomed, with funding only guaranteed until December and the Department of Health consulting on its future.

Medical Observer can reveal a secret government plan that would strip the program from ACRRM and divide it between Australia’s 17 university-run Rural Clinical Schools as part of a larger rural training consolidation push.

The plan has been criticised by students, rural doctors and now the schools themselves.

Splitting the JFPP and giving it to universities would defeat its purpose and undo nearly two decades of work forging connections with remote mentors, they say.

The Australian Medical Students’ Association’s Sophie Alpen says the program, which students rate highly, would be made less effective at attracting and retaining rural doctors.

Though the health department has told stakeholders that consolidating rural training programs will be a “cost-neutral administrative change”, Ms Alpen suspects a cost-cutting exercise.

“I think they think if they move [the JFPP] to Rural Clinical Schools, no-one will actually apply for it, because it doesn’t have the same sort of appeal. Therefore they’ll have a massive underspend and say the program doesn’t work and cut it.”

About 1500 students a year register for the competitive program, which selects 300 for placement in settings as diverse as remote NT Indigenous communities, the Australian Antarctic Division, the Pilbara and Christmas Island.

Successful registrants are matched with a long-term mentor and live in the community, returning for a minimum of two weeks each year over the four-year life of the placement — often during holidays.

Placements include general practice, hospitals and Aboriginal Medical Services. Travel and accommodation are covered and students are given a stipend.

In a statement, ACRRM president Associate Professor Lucie Walters said students who complete their full JFPP show a significant increase in their intention to practice rural or remote medicine.

ACRRM figures show that of the 2010—14 cohort, the number “moderately to very interested” in rural practice, increased from 55% at commencement to 93% at completion of the program. The JFPP had positively influenced the decisions of 87%.

Rural Clinical Schools have rejected a government plan for them to take on the program, saying they don’t have the resources.

Rev Dr Helen Malcolm, who represents rural medical educators and rural medical schools on the JFPP national advisory committee, says the plan could also mean the most remote practices “miss out”.

“I don’t think it’s in the best interests of the universities or the students or the practices,” Dr Malcolm said of the plan.

RDAA president Professor Dennis Pashen, who was initially sceptical the JFPP was an “education tourism project”, said it had been hugely successful in retaining medical practitioners in rural and remote areas long term.

“It’s created a cohort of enthusiastic young students who have been distributed all over rural Australia. These kids have formed bonds and affinities with numerous rural communities. You can’t buy this kind of stuff,” he told MO.

A health department spokeswoman said “no decisions have been made yet” and consultation continues.



Med School is filled with people who do wonderful, odd and/or funky things outside the mundane tutorial-, lecture-, teaching- and learning-filled life of medicine. Our team is proud to present our latest Edition of Panacea, which is filled with stories about these wonderful, odd and/or funky things that medical students do.

Apart from being a fun edition to showcase the talents of Australian Medical Students, this edition of Panacea also aimed to highlight the importance of a life outside medicine and how this has an important effect on our health and wellbeing.

We sincerely hope that you have a good read and a laugh or two from this edition of Panacea! If you are interested in writing an article for future Panaceas, or have any questions about AMSA’s publications, feel free to email



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