The national program supporting specialist medical training positions in rural and regional areas has not done enough to increase the number of First Nations specialists despite this being one of its core aims, an independent review found.

Australia’s approach to non-GP specialty training outside of major metropolitan areas was under the microscope after the federal health department commissioned external advisors Proximity to evaluate the performance of the Specialist Training Program (STP) in 2024.

The program, established in 2010, is administered by the medical colleges and helps cover the salaries of trainees outside of metro teaching hospitals, including in rural, remote and private facilities. The Commonwealth invested close to $710 million in the program between 2022 and 2025, funding 1080 full-time equivalent trainees per year.

The review was delivered in February and published by the department last month [link here]. It outlined seven recommendations for improving performance, including drawing on the expertise of indigenous governance committees to inform the future direction of the program.

The current funding arrangements for the scheme expire at the end of February, 2026.

One of the three aims of the STP is to enhance indigenous health outcomes through increasing training experiences for Aboriginal and Torres Strait Islander people, but the review rated the program as “poor” in its attempts to boost numbers of First Nations specialists.

“It rarely funds posts in the community-controlled sector and does not collect data regarding the populations served by settings where posts are based,” the report observed.

While individual medical colleges had been focused on improving their cultural competency in recent years, the sector overall “remains immature in its engagement with Indigenous ways of knowing and being”, the review found.

The authors said active engagement with indigenous leaders was now needed to to make sure the program was fit for purpose.

CEO of the Council of Presidents of Medical Colleges, Jodie Long, told the limbic the council “takes the ‘poor’ rating on First Nations performance seriously”.

But she said member colleges had made significant strides in targeted initiatives to support First Nations specialists throughout their training in recent times.

“We welcome this review as a chance to refine the program, enhance data collection, and ensure even greater flexibility for training in Indigenous communities,” she said.

The report acknowledged the collaboration between the colleges and the Australian Indigenous Doctors Association (AIDA) to establish indigenous governance committees and recommended these committees could help guide the program on a number of issues including supporting the cultural safety of trainees.

Program must look at workforce need

The program’s other major aims are to broaden the experience of Australian trainees and to improve the distribution of the specialist medical workforce, yet the report also points to significant room for improvement on these issues.

“In its current form the STP does not respond to the changes in the evolving national non-GP specialist medical workforce,” it found.

“[Program] targets generally remain static over time, based on historic funding levels and largely determined by Colleges, and the program does not draw on data and modelling around workforce need.”

The reviewers recommended a tripartite governance group be set up including members of the commonwealth, the states and the colleges to take a national view on where future funding would be best placed to respond to Australia’s specialist workforce needs.

Current minimum placement lengths in the program are just three months and there are no incentives for specialists to stay in rural and regional postings long term.

“This does not support the long-term aim of the program to encourage specialists to relocate away from metropolitan areas and support a correction of the workforce maldistribution across Australia,” the report found.

The limbic asked the Department of Health and Disability and Ageing whether it had responded to the review’s recommendations, and what the next steps were on possible reforms.

The department did not provide comment on specifically on these points. In response to questions, a departmental spokesperson said: “The Specialist Training Program aims to improve the specialist workforce by providing quality training posts in different settings, as well as increasing the number of specialists working in regional, rural, and remote areas.” 

“The Department of Health, Disability and Ageing welcomes findings issued in the STP Final Report.”