Assessment of the Distribution of Medical School Places in Australia: Joint Submission - Medical Deans Australia and New Zealand, Group of Eight Deans of Medical Faculties Group
This is a joint submission from Medical Deans Australia and New Zealand and the Group of Eight Deans of Medical Faculties Group in response to the request for views on the assessment of the distribution of medical school places in Australia being undertaken by the Departments of Health and Education.
The lack of access to health services and the related poorer health outcomes for people who live in rural Australia is unacceptable. The medical workforce is a national resource in which Government along with individuals have made substantial investments. As has been previously expressed, by Medical Deans, at this point in time, the establishment of yet more new medical schools is not the solution to the maldistribution of the medical workforce. The most immediate challenge in meeting the workforce needs of rural Australia is to ensure that the increase in medical graduates translates into doctors in the specialties and locations most needed.
Medical school are committed to continuing to work with Government to address rural health challenges as we have done in the past. It was advocacy and advice from Medical Deans along with other stakeholders that informed the shape of the Integrated Rural Training Pipeline package of initiatives. Medical schools have also invested substantial resources, time and energy in establishing rural clinical schools, which have been successful in both providing medical students with exposure to rural practice and improving the clinical infrastructure in rural communities.
There is now a substantial body of evidence about the impact of rural origin and/or a quality rural training placement on the likelihood of working rurally. The World Health Organisation global policy - “Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention” makes recommendations relating to Education, Regulation, Financial Incentives, and Personal and Professional Support (see Appendix 1). An important point made in that report is that effective public policy on rural workforce involves a tailored package of interventions that must cut across education, health and other policy areas; and that “long-term vision, effective and sustained political commitment and political will are important for successful implementation of the chosen package…”. Further evidence is outlined in the response to Question 9.
However this evidence must be viewed in the context of the medical education training pipeline. The period of training for a medical practitioner is long, including entry-level training, prevocational training and specialty training. What happens all along this training pipeline will influence the geographical location in which a doctor ultimately lives and serves. Medical school places are in play for part of this journey and can therefore make a useful but necessarily limited contribution to addressing workforce need in isolation.
Many junior doctors interested in working in rural Australia are currently obliged to move back to the city for specialist training. The most important current solution is not another new medical school nor a redistribution of medical school places. Medical Deans have long advocated that what is needed to achieve a better distribution of doctors in rural Australia is a “flipped” model of regionally based specialist training with rotations back into metropolitan hospitals if needed. There are some good examples of this already happening such as the West Victorian General Surgery Training Program and the Northern Clinical Training Network involving James Cook University and four of the regional Queensland Health and Hospital Services.
The assessment of the distribution of medical school places, provides the opportunity to focus on this issue and Medical Deans welcome the commitment from the Assistant Minister for Rural Health Dr David Gillespie, outlined in his press release that the Government “must ensure access to high quality postgraduate training for the existing numbers of medical students and recent graduates in regional, rural and remote Australia.”
Further work needs to be done to better understand the factors that influence the decisions of doctors to work in rural areas. The Medical Schools Outcomes Database (MSOD) Linkage Project (funded by the Department of Health) aims to link the MSOD with the National Health Workforce Dataset to provide longitudinal data and analyse the predictive factors that are influential in doctor’s career choices.
This submission sets out in more detail responses to the questions put by the Department of Health in their discussion paper. Medical schools see this submission as only the beginning of our involvement in this assessment and look forward to further discussion with both Government and the Departments of Health and Education on this important issue.
For access to the full submission, please download the PDF file, below.