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New medical schools no panacea for rural health

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If the proponents of new medical schools voted Liberal or Nationals thinking a Coalition Government would help their chances, they miscalculated.

Our new Prime Minister ran on a ticket of fiscal responsibility. Our new Health Minister’s policy is to increase resources at the front line and remove unnecessary bureaucracy.

Our new Education Minister has said he’s obsessed with quality.

None of the proposed new medical schools – at Charles Sturt and La Trobe universities on the east coast, and Curtin University in the west – stack up against these objectives.

Fiscal responsibility demands respect for the taxpayer’s dollar. Roughly one-third of taxpayers live in regional or remote Australia. They are getting a relatively raw health deal at the moment, with about 200 doctors per 100,000 head of population compared with 370 per 100,000 in the major cities. Same tax rate, half the doctors.

This isn’t a new problem, and it is in fact why our Prime Minister oversaw a massive expansion in new medical schools the last time he was in Government. As Health Minister, Tony Abbott in 2005 spoke at the graduation ceremony for the first doctors to come out of Australia’s first regional medical school, at James Cook University in Townsville. Since then, more new schools outside of major cities have opened.  As of 2013, Australia has 18 medical schools and one-third of medical students participate in a rural clinical school program.

Among medical students, demand for rural clinical rotations is high, even at campuses like the University of Sydney.

When my cohort was offered the chance to spend up to a year in Broken Hill, Lismore, Dubbo or Orange, the school had to run a ballot. The year after mine, bystanders live-tweeted the drama.  Unfortunately, most of this rural excitement during the medical school years is killed off post graduation.

When the first 46 doctors from the University of New England’s medical school started work this January, none of them was still in Armidale. This wasn’t the students’ fault: Armidale Hospital isn’t accredited and resourced to train interns. (My hospital, Royal Prince Alfred, took 58 this year.)

Job opportunities in rural Australia are thin for junior doctors. The emergent issue with our medical workforce is not a lack of students, but a lack of training positions.

Australia has gone from graduating 1500 medical students a year to more than 3000, but not enough effort has gone into expanding workforce capacity.

More than 2000 applications were lodged this year for just 1200 places in the general practice training program. More than one in three junior doctors who wanted to serve Australia as a GP missed out.

So, what of the specious claim that another rural medical school is the panacea we’ve all been waiting for? Firstly, the Curtin proposal is in east Perth. It would be another urban medical school.

Secondly, there is no strong evidence to support an assertion that new rural medical schools would address the inequitable distribution of doctors. We don’t yet know how to fix this internationally-shared problem. A 2009 Cochrane review on the topic concluded that there are “…no well-designed studies to say whether any of these strategies are effective or not.”

All these new students need somewhere to train, and the proposed Murray Darling Medical School wants to use Bendigo Hospital. This hospital is already full of students from the University of Melbourne and Monash University. With doctors forced to supervise more students, patient services would decrease, teaching quality would be compromised, or both. Would a dilution of clinical teaching and supervision appeal to quality-obsessed Education Minister Christopher Pyne? To patients?

Medical graduates can’t fix a rural workforce shortage if there aren’t rural jobs to go to. Without an expanded rural training capacity, the new doctors would be forced to return to the cities for their internship and specialty training. There, they would likely settle down.

Rural communities deserve better than to be undersold in the veiled hope of improving a few universities’ reputations.

Rejecting calls for new medical schools and investing in expanding rural training capacity would be fiscally responsible, deliver on the promise of redistributing funds to frontline services, avoid duplicating university bureaucracy, and maintain the quality of medical education.

In time, both quality and quantity would improve as more supervisors become available to train medical students at our 17 existing rural clinical schools.

Now is Prime Minister Abbott’s chance to finish the job he started as Health Minister a decade ago.

Benjamin Veness is the president of the Australian Medical Students’ Association. He is studying medicine and a Master of Public Health at The University of Sydney. Follow on Twitter @venessb and @yourAMSA

A version of this article first appeared in The Sydney Morning Herald on 30 September.