National reforms aim to grow rural workforce and lift cost transparency.
Australia’s specialist medical colleges have committed to a major overhaul of how and where doctors are trained, pledging to shift specialist training out of metropolitan hospitals and embed it in regional Australia as the default pathway for future specialists.
At a two-day summit at Parliament House, the country’s 16 specialist medical colleges committed to redesigning trainee selection, curricula, supervision and assessment so that regional training becomes the foundation of specialist education rather than a short-term placement.
Council of Presidents of Medical Colleges chair Associate Professor Kerin Fielding told The Medical Republic training programs have been set up very metro-centrically.
“We are already training in rural but they are small bits of time when the trainees come to us and learn and work with us, and then they go back to the city,” she said.
“So we need to flip that model – so that they start here, they get to work with us, and then they pop into the city to do some extra training on a special area that we don’t have, but we actually do cover most of the curriculum for generalist training in pretty much all specialties.”
Professor Fielding said shifting specialist training out of metropolitan hospitals into regional centres would allow a redesign of how trainees were selected, as well as how they were trained and supervised.
“Rural training hubs, which have already been developed by the federal government, with the medical schools, will become the centre of training so people that are born in rural and grew up in rural, can actually access this training where they live, and they can then stay where, where they’ve trained,” she said.
“We’ve got very good evidence that that works.”
Led by the CPMC at the Canberra summit, the colleges also agreed to work with state and federal governments to redesign training systems and establish new national standards on ethical billing and fee transparency.
As reported in The Medical Republic this week, the new national Professionalism Framework on specialist billing and financial consent, establishes shared standards for ethical billing, fee transparency and informed financial consent – making clear that patients are entitled to clear, upfront information about the cost of their care.
The CPMC has committed to working with the Commonwealth to ensure the Medical Costs Finder website delivered better transparency for patients seeking specialist medical care.
The council represents The Australasian College of Dermatologists, the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine, the Royal Australasian College of Surgeons, the Royal Australasian College of Physicians, the Royal Australian and New Zealand College of Ophthalmologists, the Royal College of Pathologists of Australia, the College of Intensive Care Medicine of Australia and New Zealand, the Australasian College for Emergency Medicine, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal Australasian College of Medical Administrators, the Australasian College of Sport and Exercise Physicians, the Royal Australian and New Zealand College of Radiologists, the Royal Australian & New Zealand College of Psychiatrists, the Australian and New Zealand College of Anaesthetists and the Royal Australasian College of Dental Surgeons.
Professor Fielding, a practising orthopaedic surgeon who has served the Wagga Wagga community for more than 30 years, said the colleges were stepping up alongside state and federal governments to deliver change.
“We are committed to working with state and federal governments to ensure all Australians receive the specialist care they deserve – because patients in regional Australia don’t care whose responsibility it is. They just need an appointment,” she said.
Under the reforms, colleges will restructure trainee selection, curriculum design, supervision and assessment so that regional training becomes a core part of specialist education rather than a short-term placement.
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The move aims to address persistent workforce maldistribution, with more than 80% of Australia’s specialists currently practising in metropolitan areas despite nearly a third of Australians living outside the cities.
The workforce imbalance has long been reflected in poorer health outcomes for rural communities. Potentially preventable hospitalisations are around 30% higher in outer regional areas and up to 70% higher in remote communities.
The training shift builds on Rural Selection Guidelines adopted by all colleges in 2025, which prioritise applicants with rural backgrounds and a demonstrated intention to work in regional and remote settings. The Australian Medical Council is also introducing strengthened rural accreditation standards for specialist training programs from mid-2026.
The summit was attended by ministers Mark Butler and Emma McBride, National Rural Health Commissioner Jenny May, as well as officials from the Department of Health, Disability and Ageing, and the Australian Medical Council.
Professor Fielding said the colleges had already been working hard to address issues of workforce, particularly around shortages and maldistribution.
“We had some wonderful presentations from several of the colleges of the models of training that they’re doing including dermatology, ophthalmology, psychiatry, general medicine,” she said.
“There’s quite a number of small projects running out there that we can now expand right out to the whole country. It’s that sharing and collaboration that’s really important for the other colleges that perhaps haven’t done it, to see that other people are doing it and that they can too.”
Professor Fielding told TMR that having all of the colleges on board with the reforms was a massive achievement.
“We’ve been working really hard to get all 16 specialist colleges together. Every one of them have signed on to the new national framework, setting the minimum expectations,” she said.
“That’s a huge, huge effort and it’s really positive message to everybody that we’re serious about the future of healthcare in this country.
“There are so many issues in the system, and they’re not all issues about specialists. They’re issues about the system and how the system needs reform. And I think finally, everybody has realised that we’re much better with one voice.”
Professor Fielding said the colleges all agreed that transparency around cost was important in building trust.
“Many of us, we’re all clinicians, and all the presidents of the colleges work in the system, and when we see egregious billing, it’s just not on and where the law is broken, misleading patients, failing to get proper financial consent, or even illegal billing. We support enforcement, and we do know it happens.
“It’s always second-hand information and the system isn’t capturing that as it should. So we agree with transparency, absolutely.”
In its pre-budget submission, CPMC has called on the Commonwealth to match the colleges’ commitments with expanded funding for specialist training outside metropolitan centres, national scaling of the FATES training innovation program and investment in multi-specialty rural training hubs. The organisation said improving access and affordability would require sustained collaboration and long-term investment across the health system.
“On behalf of the 16 specialist medical colleges, CPMC proposes an additional $45.6 million per year in ongoing Commonwealth funding, plus $980,000 in one-off funding, to deliver a coordinated package of reforms that will strengthen specialist training, retention and workforce planning nationally, improving access to high-quality care where it is most needed,” Professor Fielding said in the council’s budget submission.
The proposal recommends several investments to improve specialist healthcare access, particularly in rural and regional areas. It includes increasing funding by $9 million per year to expand the Flexible Approach to Training in Expanded Settings program so successful training models can be implemented nationally.
It also proposes an additional $35.4 million per year for the Specialist Training Program to expand training capacity in priority specialties and locations outside major cities.
To help keep experienced doctors in rural and remote areas, the plan suggests increasing funding for the Support for Rural Specialists in Australia program by $1.2 million annually.
Finally, it recommends creating a national specialist workforce planning mechanism to better coordinate funding, training capacity, and workforce needs to improve access to care and reduce duplication.
“Together, these investments focus on fixing system design rather than managing the consequences of workforce shortages. They build on existing Commonwealth programs that are already delivering results, but lack the scale and coordination needed to shift access at a national level,” Professor Fielding wrote.
“These solutions will improve access to specialist care closer to home for people in rural and regional areas, reduce avoidable hospitalisations due to delays as well as patient transfers, strengthen value for money from existing training investment, and support a more sustainable and predictable specialist workforce over the long term.”
