The proposed Murray Darling Medical School has failed to win a crucial vote of confidence from the rural doctors’ movement
The proposed Murray Darling Medical School has failed to win a crucial vote of confidence from the rural doctors’ movement, despite arguments that its all-rural training model would deliver more doctors for the bush.
The joint-venture school, to be run by Charles Sturt University and La Trobe University, would occupy three rural campuses across two states: Wagga Wagga and Orange in NSW and Bendigo in Victoria.
It would offer places to 180 students, redistributed from existing medical schools, favouring those from rural backgrounds, with all three phases of training – undergraduate, internships and vocational training – happening on the rural campuses.
The idea has supporters at high levels of the National Party, though it’s understood Assistant Health Minister Dr David Gillespie is not among them. The federal government has commissioned consultants Ernst and Young to assess the plan, with a result expected later this month.
But the Rural Doctors Association of Australia says the bid falls short because it does not focus on solving the desperate shortage of postgraduate training places facing junior doctors.
“The challenge for Murray Darling is, we have a bottleneck,” RDAA President Dr Ewen McPhee told The Medical Republic.
“We don’t need more input. We need better-structured output and better-structured training for medical students and graduates into disciplines that are necessary and need support, rather than disciplines that are attractive and just a pathway to a provider number,” he said.
“If the focus was on improving the pipeline after graduation, I think we’d be very supportive (of the proposed school).”
The RDAA has released a statement saying the investment would be better spent on creating new training opportunities in provincial centres across general practice, hospitals and advanced skills training.
“Many graduates of our existing rural medical schools desperately want to stay in rural locations to undertake the next stage of their training, but they can’t find the training places or rotation opportunities they need. The demand for existing places is too high,” Dr McPhee said in the statement.
“Once this happens, many potential rural doctors, who would otherwise happily have stayed in the bush, are lost to the city forever.”
A major critic has been Sydney University, a possible loser of student places in any reallocation. The university, which has rural clinical school campuses at Dubbo and Orange, has taken ads in local NSW newspapers arguing against the plan.
Data from Sydney University shows what the RDAA calls the “negative impact of a city education” on the chances of rural-origin medical students becoming rural doctors, compared with “longitudinal” programs elsewhere that keep students and trainees in rural settings for longer.
At the outset, 59% of Sydney’s rural-origin medical students said they intended to practice rurally, but by graduation those intentions fell to 31%. In the next step, only 9.9% took up a rural internship.
Among all students who elected to go to the university’s rural clinical school for an extended rural year, just one in five went on to a rural internship. The figure for all medical graduates was just 8.6%.
The Sydney figures illustrated poor returns on investment in commonwealth-supported places and schools of rural health at elite, city-based universities, the RDAA said in a submission to Dr Gillespie’s ongoing inquiry into the distribution of medical school places.
“It is a reason to think twice about requiring even more rural-origin students to be accepted to such schools,” it said.
At Charles Sturt and La Trobe, part of the argument is that regional postgraduate training positions would open up for their medical graduates, as they did for James Cook University’s successful rural-oriented medical school in northern Queensland.
“They are the closest model in Australia,” Charles Sturt’s Vice Chancellor Professor Andrew Vann said, adding if the Murray Darling school was approved tomorrow the postgraduate path would be eight years away.
“I don’t think these are credible objections.”
The two partners both have extensive schools of allied health at existing rural campuses and high rates of rural retention.
“Our experience with allied health is that 75% to 80% of our students from regional backgrounds go into regional practice. Two-thirds of our dentists go into regional practice. It is hugely different from what happens when you train people in metro centres,” Professor Vann said.
La Trobe’s Vice Chancellor for Science, Health and Engineering, Professor Robert Pike, said 85% of nursing and social work graduates from the university’s Mildura campus had ended up practising in the local area.
“We have an incredible demonstrated ability to produce practitioners in the health space who actually stay in rural and regional areas,” he said. “If you speak to CEOs of regional health bodies like Albury-Wodonga and Mildura, there are major problems with ageing populations … and no one to look after them.”
