I believe medical schools are getting the balance right
Of the 202 first year students offered places at Otago University’s medical school last year, 120 were chosen from special categories including Ma¯ori, Pasifika and rural, creating such intense competition for the remaining 84 general places that students
Iread the article last weekend asking whether the medical schools had the balance of entry right, and wanted to say, as someone working in the New Zealand public health system, ‘‘Yes!’’
A chunk of the article, Medical School: who gets in and why, refers to Harry, a white student with great grades and a good UCAT who didn’t get in, and suggests this is unfair to him. I agree with Professor Crampton, who argued the role of the university is to produce the doctors the health workforce needs. The New Zealand public pays for the majority of any individual’s medical training – hundreds of thousands for each doctor, and New Zealand patients allow medical students to learn on them for the benefit of their community. No individual has a right to a medical education.
The statistics in this article could have been written as a good news story. When I graduated from the University of Otago with a medical degree, Ma¯ ori and Pacific Island representation was well below the population. So when I see the university has reversed this in less than two decades and is starting to right the wrongs of many years of underrepresentation, I’m impressed.
We idolise grades in New Zealand. Why? Effort? Ability? Numerical superiority?
The marks that come in firstyear university in part reflect preparation at high school. They reflect privilege. Students who have gone to rural or low-decile schools that teach to pass, not to excel, come in with a disadvantage. They also come with less confidence, and confidence helps when chasing limited entry spots.
The international data has shown that entry to med school is so competitive that, if you select on grades, the grades required are well above what you ‘‘need’’ to understand academic medicine. So we should look at the attributes other than grades needed to make the doctors our community needs.
We know there are many ways to be a good doctor. Who is a good doctor for any given patient will vary.
For some people, the white, highly intelligent doctor who speaks a good middle-class lingo is perfect. But for many Kiwis, no matter how good that guy is, he embodies white middle-class privilege and, by that very fact, he is not the doctor they need. We know doctors get better results when they have a good therapeutic alliance.
We know that on almost every single marker of health and wellbeing in New Zealand, well-off Pa¯ keha¯ do better. They live longer. They’re less likely to be under the Mental Health Act. They’re more likely to be offered intensive treatments under oncology.
The current health system designed and dominated by the white middle classes is not working for the rest of the population, and we need a diverse workforce that can generate solutions that work for more people.
It will take years of overrepresentation of Ma¯ ori and Pasifika in our medical schools to start having a senior medical workforce that represents our population. No-one needs a doctor just the same as them, but doctors
I’m a Pa¯keha¯ psychiatrist working in a team where onethird of my patients are Ma¯ori. No matter how hard I try, how many books I read, I’m not Ma¯ori.
as a whole seem more approachable when the demographics of the profession reflect the population.
I’m a Pa¯ keha¯ psychiatrist working in a team where one-third of my patients are Ma¯ ori. No matter how hard I try, how many books I read, I’m not Ma¯ ori.
I haven’t experienced colonisation and what it feels like to be placed under the Mental Health Act by a descendant of those who did the colonising.
I don’t get discriminated against by the racism that remains in New Zealand.
I might be a member of a minority, I might have grown up poor (low-decile primary school, state house, widow’s benefit) but it’s not the same.
Once you start trying to improve representation, every way you do this is contestable. I wouldn’t get a lower socio-economic place because I grew up in Nelson where there is no decile 1-3 high school – but it is better to try than do nothing because the measures are imperfect.
When it comes to ethnicity, I can’t believe this needs saying in modern New Zealand, but you are Ma¯ ori if you are tangata whenua and you don’t need to look or sound Ma¯ ori enough in the opinion of some middle-class white guy’s dad.
The medical school should respond to the needs of its community, not individual wants.
If we really wanted to add a personal story to these statistics it should be the stories of those in our community the current health system is failing to reach, not Harry.