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Time to address the perennial problem of unequal distribution of the medical workforce

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One of the questions I’m often asked as I travel across Australia is why can’t we get enough doctors to the bush, especially with all the medical students we are graduating.

The unequal distribution of the medical workforce is one of the perennial problems that has weighed down Australia’s health system. The reasons are many, as are the potential fixes offered.

Last year, we saw some positive signs that the Government has turned its gaze from funding more medical schools to addressing workforce shortages.

In this space, the issue du jour is the distribution of medical school places. As I write, a Government stocktake of the number and location of medical places, as well as the schools, campuses and clinical training sites is well underway.

The main focus is whether the distribution of medical Commonwealth-supported places should be changed. I understand that the recommendations that emerge from the review are likely to be considered by Federal Cabinet in April.

So would redistributing medical school places to universities with rural clinical schools, or to schools in rural areas ultimately get more doctors to the bush?

This question was given a great deal of thought by the AMA Medical Workforce Committee (MWC) at its recent meeting. As with many complex policy matters, there is no simple answer. But given the importance of the structure of medical training to Australia’s future medical workforce, it is critical that we get this issue right.

The MWC believes that unless there are more places for postgraduate training and in the undersupplied specialties, the problem of workforce shortages in rural areas will not go away over the longer term, no matter where the students are.

Should the Government decide to redistribute medical school places, then we believe it should be guided by three important principles.

Firstly, overall student numbers must remain unchanged (until medical workforce modelling recommends otherwise). Unless you are a university trying to improve your bottom line or a nervous politician in a marginal seat, it is accepted that workforce projections are on the money and we do not need to train more doctors or open new medical schools.

Secondly, any decision to redistribute places has to be based on rock-solid information. What are the infrastructure requirements at the destination university or region; what criteria will be used; will quality supervision and appropriate resources for teaching be assured?

Thirdly, any change to the distribution of places must be linked to improved availability of downstream postgraduate training posts.

On this last point, the AMA has a number of innovative policy proposals worthy of consideration. These include our community residency program and regional training networks model for enabling medical graduates to complete most of their training in rural areas.

We now recruit almost a quarter of medical students with rural backgrounds and almost a quarter of Australian students go through rural clinical schools.

Though the AMA believes these allocations could be expanded, we nonetheless have a promising number of rural graduates. What we need now is a strategic approach to providing the training pathways that will give them the opportunity for rewarding careers in the bush.

In the end, it is about better medical services for local communities.

These ideas are outlined in our recent submission to the review. It is available online at (URL to be advised). I encourage you to take a look.