Rural Generalist Training: Beyond Employment

Greatest contribution of Murrumbidgee SEM model was never the employment contract. It was the place-based codesign process. RG training must remain strategically distinctive over standard pathways

The fourth Single Employment Model (SEM) summit in Tasmania and the conversations around it, triggered me to write an opinion piece. I have fond memories of being involved in the first SEM Summit held in Wagga Wagga in 2022. It is remarkable to see how a small SEM pilot in Murrumbidgee has grown into a national initiative, delivering wide-ranging impact across many fronts. The SEM have largely focused on employment arrangements, trainee entitlements, workforce numbers and program growth. These are important measures. They are easy to count, easy to report and easy to compare. But after being involved in the development of the Murrumbidgee Rural Generalist Training Program in 2020, I increasingly wonder whether our focus on the mechanism has caused us to lose sight of the REAL innovation itself.

The greatest contribution of the Murrumbidgee model was never the employment contract. It was the relationship – the place-based codesign process.

When the program was first conceived, general practice training faced significant challenges. Junior doctors moving from hospital employment into general practice often experienced a reduction in income, loss of employment entitlements and increased uncertainty. Rural communities were already feeling the effects of workforce shortages, and there was growing concern about the future pipeline of Rural Generalists.

The Single Employer Model addressed many of these issues. Employment continuity through the Local Health District reduced financial disincentives and provided greater stability for trainees. That story is now well known. What receives far less attention is the codesign process behind the scenes. For perhaps the first time in many rural communities, Local Health Districts and general practices were required to sit at the same table and jointly plan their workforce future. Historically, hospitals and general practices have often operated in parallel systems. They are funded differently, governed differently and frequently measured against different objectives.

The Murrumbidgee model created a reason for these sectors to work together. Hospital executives gained a greater understanding of the realities facing community GP practices. General practitioners gained greater insight into hospital workforce challenges. Workforce planning became a shared responsibility rather than a negotiation between separate organisations. This may seem like a subtle change. In reality, it was profound.

The most sustainable rural workforce solutions are rarely created through policy directives alone. They emerge when local organisations develop trust, understand each other’s constraints and commit to solving problems together.

That is why I believe the most important outcome of the Murrumbidgee model was not administrative. It was relational. This is also why I have some reservations about how we evaluate these programs. The Commonwealth evaluation undertaken in 2025 appropriately examined trainee experience, supervision quality and employment arrangements. These are essential aspects of any training program. However, they are also the minimum expectations of an accredited training pathway. What makes programs such as Murrumbidgee different is not simply that trainees are satisfied. It is that they create new forms of collaboration between institutions that have traditionally worked in isolation.

Did relationships between Local Health Districts and general practices strengthen?

Did trust improve?

Did governance arrangements mature?

Did communities become better equipped to solve future workforce challenges?

These questions are more important in determining long-term success. As the model expanded beyond its pilot phase, another challenge emerged.

Scale brings bureaucracy, that could dilute local decision making.

This is neither surprising nor entirely negative. Large-scale programs require coordination, accountability and oversight. However, there is always a risk that as programs grow, the focus shifts towards metrics rather than relationships.

How many registrars?

How many sites?

How many participating districts?

How much annual growth?

These are useful metrics, but they do not tell us whether local ownership is strengthening or weakening. The success of the Murrumbidgee model was built upon local enthusiasm, local leadership and local collaboration. It was fundamentally a place-based solution. Its strength came from the fact that it was designed by people who understood the communities they served. Not every region starts from the same place. Not every Local Health District has the same relationship with general practice. Not every community requires the same workforce solution.

The challenge for the next phase of Rural Generalist training is preserving that flexibility while continuing to scale successful initiatives.

The GP training landscape nationally has also changed considerably since the model was first introduced. Many of the concerns that originally drove the creation of the SEM program have now been addressed through broader reforms. Employment entitlements have improved. Additional incentives (State and Federal) have been introduced. Colleges have strengthened their regional training presence. More resources are being directed towards attracting doctors into general practice. These developments are welcome. However, they also mean that what was once SEM’s distinctive advantage is increasingly becoming standard practice.

If Rural Generalist pathways are to continue attracting doctors into rural communities, they must remain strategically distinctive over the standard pathways.

Not because rural doctors deserve special treatment, but because rural communities have fewer alternatives when workforce shortages emerge. Rural Generalist training must continue to offer something that cannot easily be replicated elsewhere.

In my view, that “something” is not the employment contract. It is the partnership.

The future of rural workforce development will be secured through durable relationships between hospitals, general practices and communities. It will be secured through shared accountability, local leadership and genuine collaboration.

The original success of the Murrumbidgee model was that it encouraged organisations to see workforce development as a collective responsibility. That lesson remains as relevant today as it was when the pilot first began in 2020. As we look towards the future of Rural Generalist training, we should continue to measure trainee outcomes, employment conditions and workforce growth. But we should also remember to measure the things that matter most.

Trust.

Partnership.

Local ownership.