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    Note for forwarding Shannon Nott please:

    Shannon, there is a large untapped group travelling round the country, namely the grey nomads, who would willingly (I hope) give of their time and professional competence to assist in the bush. I suspect that all that has to be done is to provide them with facilities to volunteer their services (maybe in exchange for board and lodging). Ad mittedly they would cover only 6 months of the year but, in terms of a major preventive effort, that may be adequate.

  2. 2

    Raymond Bange

    Shannon Nott is absolutely correct about the fixation on hospitals and medical practitioners in the reform debate, and I’m pleased to see him raise the issue of interprofessional practice in rural and remote Australia.

    Readers of Croakey may recall my own observations on health care reform last June 2009 (Paramedics forgotten in our health care debate and the concern I expressed about a too narrowly-focussed view of health care.

    As for incentives being offered, the allied health professions and nursing at least get something in the way of scholarships and clinical training support.

    Paramedic students get virtually nothing and are excluded from the eligibility list of the various Scholarship Schemes managed by Services for Australian Rural and Remote Allied Health (SARRAH) To verify this inexplicable situation, just look at the eligibility criteria for ARRHPS ( or for RAHUS ( or
    ACHPSS (

    It is well past time that governments recognised the benefits that could be gained by properly integrating paramedic practice with the primary health care system and better utilising the skills of these qualified practitioners to provide a true interprofessional approach to care.

    But that will only happen if EMS is funded nationally with paramedics registered under an independent national regulatory scheme. That cannot come too soon for the sake of everyone, and particularly those living in rural and remote Australia.

  3. 3


    Speaking of registration, @ Raymond, it is interesting to see who gets included in registration in the next round – occupational therapists, Chinese medicine practitioners, and podiatrists I believe are in there, while speech pathologists are not – interesting given to money sent our way with the Helping Children with Autism package… Just not deadly enough, I suppose. Because there’s no risk in having to decide whether a patient is safe to eat and drink.

  4. 4

    Raymond Bange

    Fiona, I appreciate the point you are making and the priorities that seem at times a little awry.
    When it comes to registration, the question of risk is one of the criteria listed under the 1995 AHMAC guidelines for assessing the regulatory requirements of currently unregulated health occupations.

    However, one might question the generality of application of these guidelines and the extent to which the various criteria (such as risk) are weighted in any assessment, as well as the objectivity and appropriatness of other regulatory controls.

    In some cases, such as EMS, the risks are demonstrably high, with patients receiving interventions and powerful medications that would qualify for a Medicare rebate if performed in a clinic or hospital by a registered practitioner with a provider number. The fact that intubation and other invasive procedures are often performed under emergency and adverse physical conditions only adds to the risks and underscores the high level of professional skill and judgement required of the attending paramedic.

    Unfortunately, as Shannon has outlined, the importance of interprofessional practice has not been fully recognised in health care and the established silos of practice still hold great sway within the policy arena.

  5. 5


    Whilst I agree with you I would like to clarify one point you made.
    You wrote”As for incentives being offered, the allied health professions and nursing at least get something in the way of scholarships and clinical training support”.

    I was part of a delegation invited to Parliment House last year by Warren Snowden MP to discuss the inequities that exist with scholarships and opportunities between medical, nursing and allied health students.

    Whilst there are scholarships available for Allied Health through SARRAH, there is not a national scholarship scheme for nursing students to undertake a rural or remote placement.

    There is some money available through some of the states and territories but only approx $500 per placement. These are not available in all states and territories though.
    Many nursing students are not even offered a rural or remote placement, most students have to organise the placements themselves – that is find the placment location, arrange accommodation, and travel etc etc and usually nursing students have to fund these placements themselves.

    CRANAplus (Council of Remote Area Nurses + Allied Health) offer three scholarships of $1000 each on an annual basis for students who have undertaken a remote placement and they also administer another three scholarships for a S.A. based nursing agency.

    This is – as far as we know – just about all that is available for rural and remote placements for nursing students. If anyone knows of any more I would love to hear about it.

    I think it is really important though that we work as a team and not single out one profession as being more hard done by than the other. A multidisciplinary approach is what is needed if we want to get things changed.

    Stephanie Jeremy
    Senior Nursing Representative
    National Rural Health Student Network

  6. 6

    Raymond Bange

    Thank you for highlighting yet another anomalous situation regarding support for rural and remote health education and placements.

    I agree that interprofessional practice and interprofessional education are goals to be sought and a much more holistic approach needs to be taken in developing policies that will provide support across areas of need. I feel that some are worthy of special attention because of the nature and depth of that need – such as indigenous health workers – nand to a degree I discern some affirmative actio in those areas.

    It’s clear that nursing, medical and allied health students are at least recognised as belonging to discrete health care professional groups when it comes to discussing policy initiatives. Nursing stands apart as a strong profession and special arrangements do apply even if not specifically covering rural and remote aspects.

    My reason for nominating paramedics is that they are not even recognised by government (and thus administrative organisations such as SARRAH) as health professionals or allied health professionals, despite their obvious health care functions and critical clinical interventions. So unless one mentions them specifically by name, how will the situation ever change? It’s a catch 22 situation.

    For example, health care really begins with the patient and not at the hospital door. Effective triaging by paramedics and referral to suitable avenues of care during the initial atages of crisis care could have a substantial impact on the Emergency Department loads of hospitals and help allieviate overcrowding and other demands.

    To me as a policy and systems analyst, recognising paramedics as part of the interprofessional team, alongside other health professionals, would facilitate the provision of a seamless continuum of care with significant outcome benefits..

    But the evidence from my reading of several hundred submissions produced during the current health care reform debate is that EMS and paramedics simply haven’t registered to any significant degree on the policy radar. They fall between the policy cracks despite the public perception of them as Australia’s most trusted professionals.

    I certainly support any moves to have a more balanced view of health care reform with consideration of rural and remote incentives across the full range of major health care disciplines. I hope that others will do likewise.

    Ray Bange
    Principal, Probity Consultants International


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