Rural doctor shortage needs action now
CHRONIC shortages of local doctors is a problem rural and regional communities know all too well. When Australia faced the crisis of a national doctor shortage 20 years ago, it embarked on a sustained drive and policy ambition of national self-sufficiency.
With 10 new medical schools established over the intervening years, metropolitan and capital city Australia now enjoys a reliable supply of locally educated, locally trained doctors.
But the story is very different in rural and regional communities across the country.
Nine of those 10 new medical schools were located in metropolitan areas, and over this period our rural and regional communities have continued to suffer doctor shortages and reduced access to necessary care, which has resulted in increased rates of chronic disease and lower life expectancy.
Yet this policy of national self-sufficiency was meant to increase rural and regional doctor supply. The medical schools were funded to deliver rural outreach programs. This included a set of ‘targeted’ rural student places and programs to expose medical students to rural life.
When devised, the policy was envisaged as the foundation of a reliable pipeline of new doctors for rural and regional practice.
However, a recent report by the Department of Health demonstrated that 20 years after the national self-sufficiency policies (that continue to this day) were introduced, the most notable result has been an oversupply of doctors in our cities.
At the time these policies were developed, we understood very little about the factors that influenced medical students to make the decision to work rurally. The research suggested that recruiting more ‘rural’ students, and exposure to rural practice, would be enough to solve shortages. We now know this is not the case. Rather the solution is complex and requires complimentary ‘end-to-end’ solutions.
Selecting students from rural and regional Australia, who also intend to practice in rural and Australia is one.
Educating and training students in rural and regional Australia, with a medical curriculum specifically designed for the work they will encounter, and the opportunities they will have, is another.
But with the exception James Cook University, the one and only rural medical school in Australia, this is not what happens.
In a major recent study, approximately 60 per cent of rural medical students sent to a metropolitan medical school expressed a preference for rural practice when they started their study. By their final year, this number stood at just 10 per cent. In sharp contrast, at James Cook University, this intention to practice in rural areas actually increased during the same period: from 68 per cent to 76 per cent.
The experiences of Charles Sturt University have reinforced this.
Seventy-five per cent of our students studying health-related disciplines are from rural areas. By educating them in rural and regional Australia, 85 per cent of our graduates subsequently live, work and make their life in a rural or regional community. The same is true of La Trobe University.
Our two universities have been advocating on behalf of our communities for a rural medical school for the Murray Darling Basin for several years now. Under our proposal, four out of five students will come from a rural, regional or Indigenous background. They will learn and train in rural communities. This means more opportunities for students from Orange, Wagga Wagga, Bathurst, Dubbo, Albury-wodonga and Bendigo to become doctors.
Yet the New South Wales Medical Students’ Council opposes this new school. Why? Because even if they were initially interested in rural or regional practice, the medical school's’ own statistics show that the current system will have switched the majority of them off.
Our school reflects the model of selfsufficiency championed 20 years ago to help create more doctors for the bush.
We’re hopeful that the medical school places assessment announced by the Federal Government will provide the foundation for a rural medical school to be established in our communities and deliver more doctors for inland rural Australia.
Though we eagerly await assessment findings, due next year, we believe the evidence supporting the MDMS solution is clear and incontrovertible.
It’s time for the city elites – the medical deans and students – to start listening to rural and regional communities.
Then, it’s simply a case of political courage to take bold action and implement the policy solution that will deliver for rural and regional Australia.