Discussion: Rural Workforce Shortages and Rural Entry Pathways

[DrDrLMG!]

To be honest, we literally have this conversation here at MSO every single year in one form or another, the same goes for the NZ side of the forum (it's part of why I struggled to find a thread to put this in!).

Undergrad medicine is roughly 1500 places, and the same for graduate entry. As far as I know, the only students "guaranteed" a place in medicine are those applying to non-interview schools on the basis of ATAR alone (so... Griffith?). ETA: And even they have to achieve a certain GPA to get through to the MD, so not technically guaranteed.

 

[derm4eva]

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[dotwingz]

What would a grass roots change look like?

Doctors, Lawyers, etc have been for the longest time very well regarded careers, and I really don’t see that changing ever really.

Again talking from my experience, I don't know of a single student from my school (give or take 3 years above and below, so a sample size of 7 years) who applied via a rural pathway and didn't get in. They are confident, have great interpersonal skills, dress immaculately and probably have an advantage rocking up to an interview with resources to prepare, a pair of RMs and a big personality over a TRULY RURAL student who maybe has not had the exposure or ability to prepare for an interview as well as them.

So you think rural entry is flawed? Does that justify completely removing it? I don’t think it does, perhaps adjust the end goal to make the criteria more strict and you will see a lot of people will actually agree with you.

 

[DrDrLMG!]

I see your point and it is honourable, but I don't buy that it justifies the current process. To provide an analogous example I'm at law in Sydney University and I'd say that 90% of students are wealthy to an almost excessive level and moreover the social divide between the 'haves' and the 'have nots' is appalling. I can't remember a Prime Minister who ever had a rags to riches story, or a leading scientist etc. I don't think that a warped admissions process is the solution - grass-root change is far more effective. I also accept the arguments that 'change needs to start somewhere' or 'it is better than having none at all' but the philosophical and ethical bar for such a justification is so low.

Law is quite different, though. In order to become a fully registered doctor, you have to do an intern year in a public hospital (for the most part). The state governments are responsible for your income and there is (currently) a COAG agreement that guarantees this. And that's not even touching on the state and federal government funded health management of the nation. I'm not explaining this very well, but Medicine as a career is quite unique and relies heavily on government funding and this is reflected in the way student numbers and demographics are selected. The government literally sets the number of students each university is allowed to take on.

Also, I do definitely concede that my experience of rural students is vastly different from yours as I come from a state with compulsory education only up to year 10, no selective schools, and no true boarding schools.

 

[Kakapo]

Derm4eva; I run a bulk billing GP in a rural area just 40km from the motorway and 80km from city. We are surrounded by onion, canola and cattle farms. I've been trying to recruit doctors for the last 18 months. Would you like to come work with us?

 

[DrDrLMG!]

So you think rural entry is flawed? Does that justify completely removing it? I don’t think it does, perhaps adjust the end goal to make the criteria more strict and you will see a lot of people will actually agree with you.

I think I saw that the LaTrobe dent rural pathway requires rural school location for year 11 and 12? I'm still not sure that's the right answer, as I can imagine there are literally students who live in parts of Australia where there are NO schools and boarding school is their only option, but maybe it's something more in line with that? But again, my experience of a rural student is quite different to those being talked about here so I don't see it as that big of an issue so I'm not particularly invested in wholesale change.

 

[dotwingz]

I saw that aswell. I didn’t think about that. On reflection, maybe a one size fits all will never really work well. Maybe universities just think it’s better to be more inclusive than exclusive.

I've been trying to recruit doctors for the last 18 months.

That’s crazy. I guess covid, and the reduced overseas doctors have put a strain on the system. Or is this a normal precovid shortage?

 

[DrDrLMG!]

I saw that aswell. I didn’t think about that. On reflection, maybe a one size fits all will never really work well. Maybe universities just think it’s better to be more inclusive than exclusive.

Although, tbh, I am very cynical about universities in general and rarely ascribe them altruistic motives

 

[dotwingz]

Yup ahahaha. More likely answer is that it’s cheaper to not care and fulfill their government obligations

 

[derm4eva]

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[DrDrLMG!]

That’s crazy. I guess covid, and the reduced overseas doctors have put a strain on the system. Or is this a normal precovid shortage?

The (admittedly very remote) place I was originally allocated to for JFPP had their only GP retire after my first placement (end of 2018). I've not been able to go back there and have had to be re-allocated to a different location because they've not been able to replace that GP in the almost 3 years since...

 

[dotwingz]

That’s crazy! In areas where the population probably only justifies one practitioner that’s a serious blow

 

[derm4eva]

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[DrDrLMG!]

I suppose at the top end of Law it is the same? Magistrates, Supreme Court judges, High Court judges are also technically government servants -

But this is such a small portion of the total law workforce, the vast majority of which would be private practitioners. This is reversed for medicine, particularly when you consider that, in addition to public hospitals and public community based clinics, GPs, while technically private practitioners, still rely on MBS, the PBS, vaccination schedules, and other government health programs for the majority of their funding/feasibility.

 

[derm4eva]

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[Kakapo]

Would you like to come work with us? We ask this question to every locum that comes here, every doctor we meet at conferences...over the last 15 years, and the answer is always the same; I don't want to be a rural GP.
I want to be a Cardiologist/Surgeon/Pathologist/Opthalmologist...........Researcher/Nobel prize winner/Rocket Scientist.........fill in the blanks.

The best rural doctor is not the one with the highest ATAR/UMAT scores. The best rural doctor is the one willing to come work in a rural surgery 40km from the motorway, 80km from the city and willing to bulk bill onion and canola farmers.

 

[DrDrLMG!]

Not that small: Number of judges and magistrates in Australia, March 2019 - Judicial Commission of New South Wales

in 2017/18 there were almost 40k GPs in Australia

 

[derm4eva]

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[derm4eva]

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[DrDrLMG!]

Not sure what your point is BobLarry, as I said above, you should be asking the people who gained admission on the basis they would address this shortage - the candidates with scores in the 50s and 60s.

I'd argue that the students who gained admission on the basis they would address this shortage are those accepting BMPs rather than rural students. Rural students are under no obligation to practice rurally, it's just recognised that they are (somewhat) more likely to than their non-rural counterparts. BMPs are open to all domestic applicants and these DO have a degree of obligation inherent in them - it's just that they come with a 'get out of jail for the cost of your medical degree' card that is not uncommonly invoked.

ETA: I also just want to clarify that I don't think the BMP program is all that fit for purpose. Expecting ~18 year olds to understand, respect, and commit to their future role in fixing a systemic and deeply ingrained problem that has been evolving over decades in an industry they haven't even studied a day in yet is kinda nuts in some ways...

ETA2: the numbers. I agree, not the biggest point, but definitely still an important one. If Law relied on government funding to anywhere near the degree that health does, the government would be all over regulating that, too.