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Discussion: Rural Workforce Shortages and Rural Entry Pathways

dotwingz

Google Enthusiast
Moderator
I think BobLarrys point is that if you look beyond you and your experience of not being able to get into medicine, there’s thousands of people out there who are not able to access medical service through no lack of trying.

The needs of the many outweighs the needs of the few, Im not convinced that canola farmers would really care that people who grew up in the city found it unfair that they couldn’t get into medicine, instead they would care more about the fact they can’t access services themselves, and in return would support any program that got more country kids like themselves into medical schools, even if a few privileged boarders slipped between the cracks
 

dotwingz

Google Enthusiast
Moderator
Why select using any metric? Why should students get a significant concession in ATARs if they get a good UCAT in the arbitary hope they have better pattern recognition and bedside manners? Why should students get a significant concession if they score well in the interview in the arbitary hope they communicate well to patients?

People who score well in interviews could still very well be completely horrible communicators and not care at all for the profession despite lying to the interview committee.

If we don’t select medical students on what would most help the medical workforce for everyone, then what are we selecting them for?
 

DrDrLMG!

Resident Medical Officer
Administrator
Ok so circling back to the main point... is a system justified whereby students are able to receive a significant concession to gain admission to one of the most (if not the most) competitive degree in the arbitrary hope that they are somewhat more likely to practise in rural areas? There is no practical mechanism in the system to ensure that they actually fulfil this moral obligation unlike BMPs. There is no effective process to ensure that 'rural' students who are actually privileged do not abuse the system. There is no mechanism to ensure that even if such a system were to exist, it would not further warp a system whereby state based quotas apply pretty much everywhere except NSW.

So are we now saying (more) BMPs are the solution to shortages? The rough principles I can see here is that avenue is a far more merit based system which actually addresses the shortage of medical professionals in rural areas than the rural entry pathway does. 😊



A large part of the whole point I have been making is that it is not a 'few'... Though applying the same reasoning, why does it matter that a 'few' rural students want to study medicine? Let's just have BMPs which solve the issue!

More BMPs is definitely not the solution, as I indicated in my original post and in my ETA. The problem probably doesn't have a neat solution, and definitely doesn't have a solution that can be addressed solely by medical students. But I feel pretty strongly that saying only selective and boarding school students can become doctors is thoroughly not going to contribute (which is what the removal of a rural pathway and the UCAT would effectively ensure - is that what you're arguing?? TBH, I'm not entirely sure... ).

And to your last reply, in my 'circles' the lack of diversity in law and other areas of community life such as policing, politics, and local government is definitely a topic of conversation pretty routinely in various ways (including here at MSO).
 

dotwingz

Google Enthusiast
Moderator
Addressed this earlier - this because there are tangible differences in a general rural student's ability to get a high ATAR compared to a student from the city. The UCAT is meant to be an 'aptitude' test, so the issue is taking someone with a far, far lower aptitude.
Im going to take a page from my introductory philosophy course in first year but WHHHHYYYY

Why do we use ATAR? Why do we use UCAT?? Why do we use Interviews??

It’s because these metrics show that students with good marks in these do well in med school.

So why not extend that to demographics in the medical field? If we use ATAR because it’s shown applicants with higher ATARs do better in med school, how come it’s not valid to select based on ruralility because they are more like (albeit not certain) to practice rurally

Think outside the status quo. Why is ATAR the star metric in your worldview, whilst everything else is second best? If studies show that applicants with good-ish ATARs and good-ish UCATs but a rural background play a good part in medical workforce demographics, why not select them? They would be more valuable as anyone else
 

Kakapo

Lurker
I like steak with jus, mushrooms on top, side of brocolli and crisp green beans. Fresh bread roll with churned butter, finished by berry coulis on cheesecake and a full bodied shiraz.

If we do not have interest, inclination, obligation to care for our beef farmer, mushroom/broccolli/bean growers, dairy family and vineyard owners......and they have having chronic illnesses with higher mortality, from where comes our food?

Is it not in our best national interest to secure our food supply/and suppliers?
 

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JeydinNewWon

Regular Member
Ok so circling back to the main point... is a system justified whereby students are able to receive a significant concession to gain admission to one of the most (if not the most) competitive degree in the arbitrary hope that they are somewhat more likely to practise in rural areas? There is no practical mechanism in the system to ensure that they actually fulfil this moral obligation unlike BMPs. There is no effective process to ensure that 'rural' students who are actually privileged do not abuse the system. There is no mechanism to ensure that even if such a system were to exist, it would not further warp a system whereby state based quotas apply pretty much everywhere except NSW.
Hi! I'm new to this conversation so I'll give a bit of my take on it. Preface: I am not a rural student but I am someone from a low SES school and area, so I can (somewhat?) sympathise with rural students.

For the record, I think the Rural entry pathway is justified. Whilst there is no guarantee that rural students will go back and study with their areas, (despite rural students being more likely to still go back and study there). I think the Rural Entry pathway serves also a much greater purpose and that's addressing equitable access to high-end courses such as Medicine.

This is a whole other issue that I'm talking about but I don't want a medical school admissions system that tells students who are literally born in certain locations that they will have near 0 chances for entry into medicine. Now you might say that this can be addressed with an EAS system that boosts rural students' points but I really don't think this will have any effect considering the UCAT exists. We don't have access to information regarding how well rural vs non-rural students perform on the UCAT, but just getting a general gist from the scores I've seen from many rural applicants across MSO is that they're nowhere near the prevalence of the high 90s+ from non-rural applicants. I think the UCAT personally is debatable since I don't think it actually measures your aptitude for medicine that well, and that it's just used as a culling system to create an interviewee pool. There's also the issue of prep companies and training programs which can be purchased to practice more for the UCAT, whereas someone from a rural area who I assume would be disadvantaged, won't have access to this and is limited to the free resources online.

And when you mention the 'difference' in score between say a 92nd percentile and a 40s percentile, and immediately conclude the 92nd percentile did more practice and was more 'deserving', who's to say the person in the rural person in the 40s percentile didn't give it their all? Who knows how much they really tried? What if they simply didn't have access to the plethora of practice material as people from non-rural backgrounds? You can't compare how much someone tried, and by extension, 'deserved' simply by their marks in something. Someone who scored higher got into medicine because they got the higher score in the system. It doesn't mean they tried any harder and you can't compare that.

Granted, you did mention that privileged 'rural' students abusing the system, and I think it's the fault of the unis for not counter-measuring this. So what I suggest is to make additional criteria. Rural entry pathway is limited to people who have lived in a rural defined area for x amount of years and attended a rural school for at least Year 11-12 or greater. This will cap those who are 'rural' from abusing the program meant for actual rural students. Local state quota is a whole issue in itself that should be resolved by unis themselves but I can see why it exists in a state such as Victoria having literally one Undergrad medical school (Monash).

I think the current system makes it ridiculously hard to enter Medicine despite mildly curbing the shortage of rural doctors, but I think removing the Rural Entry Pathway is going to make this even worse. I'd much take the 'lesser' of two evils per se, with a slight-medium chance of improved rural shortage rather than none. Here's not to say I don't sympathise with non-rural students getting 99.2 ATARs and 92 UCATs and still having zero chance anywhere. I'm not sure what can be done to combat this other than (increase spots in medical school which is currently not possible).

Side Note: I'm still 18 and rather new to all this medicine stuff, definitely not as experienced as heaps of people here on this forum so if I am ill informed on anything, feel free to correct me! I just happen to be passionate on these types of issues :)
 
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A1

Rookie Doc
Moderator
Circling back to my point that the people using this entry pathway aren't necessarily as disadvantaged as they might seem to justify UCAT scores in the 40s/50s receiving interviews and scores in the 90s getting rejected.
I think this^ is a major flaw in your premise in this discussion. The rural-entry schemes are NOT meant to compensate for rural students' disadvantages, that's for EAS to address (eg. disadvantaged schools which many rural schools are, financial difficulties etc).

Again rural-entry schemes are to attract students who statistics show are more likely to practise in rural areas, whether the students are disadvantaged or not. The lower UCAT required of them is not a concession, it's simply the result of significantly fewer rural applicants relative to their allocated quotas. Example UNSW 2019 had 2,200 non-rural applicants from which 400 were selected for interview, ratio 1 in 5.5. Otoh 200 rural applicants from which 150 were interviewed, ratio 3 in 4 thus obviously much lower UCAT.
 

AM74

Regular Member
I think this^ is a major flaw in your premise in this discussion. The rural-entry schemes are NOT meant to compensate for rural students' disadvantages, that's for EAS to address (eg. disadvantaged schools which many rural schools are, financial difficulties etc).

Again rural-entry schemes are to attract students who statistics show are more likely to practise in rural areas, whether the students are disadvantaged or not. The lower UCAT required of them is not a concession, it's simply the result of significantly fewer rural applicants relative to their allocated quotas. Example UNSW 2019 had 2,200 non-rural applicants from which 400 were selected for interview, ratio 1 in 5.5. Otoh 200 rural applicants from which 150 were interviewed, ratio 3 in 4 thus obviously much lower UCAT.
Many of the universities say the opposite, that the rural entry is to acknowledge the difficulties faced by students in rural areas in accessing quality education.
What this discussion has overlooked is the difference in educational opportunities in a rural area. In many smaller places school finishes ar Year 10. Those students should not be penalised for attending boarding school in Year 11 and 12. What other option do they have?
in regional and remote areas there is a constant turnover of school teaching staff with 1-3 years teaching experience being the norm for the majority. There are subjects for which it is not possible to attract qualified teachers to rural areas due to statewide shortages. You cannot tell me that a student studying Chemistry or Physics under a Junior science and biology teacher, or studying Geography under an Art teacher, will have an equal opportunity to gain a 99 plus ATAR compared to city counterparts. If there is no teacher of their chosen subject in the town there will probably not be a tutor to help either. Online tutoring can be an option in some areas but the internet is still very patchy if you try to use zoom. These are genuine educational barriers to achieving a top ATAR score,
 

A1

Rookie Doc
Moderator
Online tutoring can be an option in some areas but the internet is still very patchy if you try to use zoom. These are genuine educational barriers to achieving a top ATAR score
As I mentioned, these issues^ are supposedly the domain of the EAS schemes which give ATAR adjustment/bonus points to disadvantaged schools (low socio index), under-represented schools (lack of high ATARs), home addresses, etc.

Many of the universities say the opposite, that the rural entry is to acknowledge the difficulties faced by students in rural areas in accessing quality education.
We can't prevent what the universities say for themselves. Officially the gov policy requiring med schools to allocate rural-entry quotas says it's from studies showing rural-background students are more likely to serve in rural areas. (I will provide the link if I can find that gov webpage again).

Also consider the fact except JCU no other med schools I know of give rural applicants a compensation bonus (to equalise) to compete against non-rural applicants. Rural competes against rural in a separate pool for the place quota required by the gov. It's different to compensating to make them competitive against non-rural.
 

dotwingz

Google Enthusiast
Moderator
The validity of the ATAR is irrelevant in this debate.

But it is… your whole premise is that non rural students with high ATARs/UCATs should get in, but why! Why do we select med students based off those marks?? Why don’t we select based off a portfolio, or a written application, or volunteering experience, or research, or one of the many hundreds of ways people can achieve things. The answer is because ATAR/UCAT are a pretty convenient, but not perfect, but otherwise a valid way of scoring applicants who will do well in med school, and then in the workforce.

Selecting students from rural backgrounds is the same ethos. It’s a pretty easy way (although not perfect) to increase the likelihood that a medical student will go and practice in a rural area where from BobLarrys post we can see that even practices which are only 80km from the city, are unable to fill positions for 18 months. It should be coupled with proper rural placements, and more importantly good rural training opportunities, but it’s a important factor nonetheless.

To say this in the nicest way, I can absolutely be certain that a canola farmer who lives near BobLarrys practice could not give two hoots about a non rural student with good scores not getting in, especially when their own communities are under serviced.

You’re coming at this from a pretty self centred view, you aren’t owed anything by this world, in the grand scheme of things a high school student who has to take a few extra years getting into an extremely coveted degree is a very minimal effect. Entire communities missing out on healthcare is not.

Everyone pays tax to fund the healthcare system, so we should be doing what’s possible to provide services to everyone. This is counter productive to the fact that everyone also funds tertiary education, and should all be given a fighting chance, but a balance lies somewhere in the middle. If anything we are not supporting rural applicants enough. Unfortunately life cannot be fair for everyone.
 

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ucatboy

final year eek
Valued Member
So many non-rural students have an 'I don't give a shit about rural areas' attitude because they feel that they had to fight so much harder relative to the population that they are eligible for to earn that spot - I don't agree with it, but at the same time I don't blame them...
I take issue with this statement because I feel that you're projecting your own feelings of resentment about rural/non-rural entry pathways and trying to frame it as the cause of the greater issue at large - rural/non-rural health inequalities. No-one I've spoken to so far is against rural placements/opportunities (many are actually quite enthusiastic and open-minded) simply because of resentment or vengeance towards the entry pathways that got them in - that just sounds petty to me. In reality, their considerations are more practical in nature - perceived opportunities, being away from family and friends, finding a good school for their kids etc. In fact, I think anyone who HAS been accepted into medicine is more grateful than resentful - at the end of the day, against all these "unfair" schemes you're talking about, they got in, didn't they? They don't have much to complain about. I can't imagine getting in and STILL complaining about how my rural peers got it easy - we're all in the same boat now. Perhaps you'll find that most of the resentment you're referring to stems from outside the cohort (i.e. those that didn't get in and are frustrated about it), rather than within.

I take it that you are not currently studying medicine so I'm not sure how informed you are about the attitudes of currently enrolled medical stuents.
 
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JeydinNewWon

Regular Member
That is just factually incorrect, and again just a low philosophical bar. There are financial concessions on the $299 test fee, there are plenty of free resources (content removed)). The barrier to doing well in the UCAT is in no way comparable to the barriers that truly rural students face in obtaining a high ATAR which is influenced by far more systemic factors such as quality of teachers, class environments, parental education etc. Note (and I repeat): I am specifically referring to the use of the UCAT not the ATAR.

If only 'giving it your all' was the solution to every problem in life. I am finding it hard to be persuaded that someone with a UCAT of 40 'gave it their all' and is more deserving of an interview place than someone with a score of 92. There are rural students achieving scores in the 90s and kudos to them, by all accounts they deserve an interview, but then again they aren't the group I am referring to
Never said that 'giving it your all' was the solution to everything in life. I was just addressing the point you made regarding that somehow the non-rural who got 92nd percentile definitely worked harder than the rural person who got 40s- percentile. I didn't like how you made it seem like the 92nd percentile was more entitled to receive it than the 40s percentile. The truth is: they aren't. There isn't a perfect indicator of who is going to perform well in medical school and who isn't. If there truly was, then yes I would argue (in consideration of a person's circumstances) that the 92s scorer would be more 'deserving' of entering Medicine. But that doesn't exist. UCAT is more or less a culling tool and if it truly is actually so important, unis can just set an 'at least xth percentile' or something bar.

I don't know exactly what it's like to be truly rural or anything like that, but from how and where I was raised, the $305 (or $200- something for concession) isn't easy to come by. And, I don't know about you but getting access to these good resources behind paywalls I think already is quite inequitable in itself. Especially considering that despite being labelled as an 'aptitude' test that tests your innate ability, the test itself is actually highly preparable.

I'm sure it's much harder to get a high ATAR in a rural area but I don't think UCAT is quite equitable, either. I read a study that did conclude that students from low socioeconomic backgrounds do in fact perform worse on the UCAT. (Not sure how much of an overlap is between 'rural' and 'low-socioeconomic' but the average score for rural students is roughly the same). It goes on to further say that entry pathways for rural and disadvantaged areas should be kept in check.

I don't know what change you're trying to advocate for - but I think removing the rural entry pathway is going to make the shortage of rural doctors even worse. I understand your POV in that 'why must we sacrifice these 92nd percentiles and 99.2 ATARs in favour of the slim chance of improving rural doctor shortage?', however. I don't think this is a situation where everybody wins; unis have to choose, and they did. It just happens that this choice is much more beneficial and equitable than the former. It at least contributes to a wider shortage of rural doctors but it also improves and gives chance to people who might never get to touch medicine.

Side note: I don't really like the use of your smiling face emoji here - this might seem small but it feels like a condescending microaggression from my point of view. Though I could be mistaken, so I would like some clarity here.
 

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