Opinion Editorial: Pipeline to a robust rural medical system

26 Apr 2017

The Australian, 26 April 2017

By Christina Mitchell

The perfect medical education system is neither easy nor simple to deliver. But we must guard against emotive, kneejerk decisions that masquerade as good policy that may only make the situation worse.

There has been some strong lobbying to see the establishment of a new multi-campus medical school in regional Australia. But that is simply a damaging and expensive idea that largely misses the point.

Australia is not short of medical graduates, being well above the OECD average. We are also far from short of regional medical schools or regional and rural medical graduates.

The only thing missing is an articulated pathway in the rural setting to bring those graduates to the point of practice. It is confusing, then, that two campuses of the proposed new medical school are within daily walking distance of existing regional medical schools. They are an unnecessary duplication, not a new addition.

There is no point delivering more fully trained medical practitioners — in particular generalists and selected specialists. A misguided solution at the wrong end of the medical training pathway has no credibility. The pipeline of doctor training is long. It can take more than a decade from entry level through pre-vocational to specialist training.

It is at the later stages of that pipeline where Australia has issues with regional delivery: abundant and competent generalists and specialists. Specialists may visit local hospitals only periodically or not at all; there may be a lack of specialist medical equipment; or doctors may require accreditation from the relevant college to perform specialist procedures. There are also too few specialists working in regional and rural areas to carry out training and oversight of junior doctors seeking to become specialists.

But we need everyone to agree — politicians, universities, medical advocacy groups and specialist colleges — that what is in place is unacceptable in a First World economy.

Many existing medical schools, including those of the Group of Eight, have established rural clinical schools and through these, students are already taking up limited rural internships.

The key is ensuring those interns have access to further specialist and general training in the regions, and so we welcomed last week’s $56 million government announcement that will facilitate movement of students through the pipeline from university into postgraduate medical training within rural Australia.

It will take a few years to determine if this new initiative is successful in addressing the lack of specialists in rural regions, but it will be quicker than a new medical school to have a demonstrable impact.

To achieve a better distribution of doctors in rural Australia we need a flipped model of regionally based training that has rotations back into metropolitan hospitals as needed. In other words, the main specialist training is in the regions, not the cities.

Christina Mitchell is chairwoman of the Group of Eight deans of medicine, and dean of medicine, nursing and health sciences at Monash University.