Discussion: Rural Workforce Shortages and Rural Entry Pathways

[dotwingz]

So many non-rural students have an 'I don't give a shit about rural areas' attitude because they feel that they had to work and fight so much harder relative to the population that they are eligible for to earn that spot

This is a pretty ridiculous comment, and does not reflect at all what most people think. Medicine is not a field where you should be looking down on people just because they have done less than you.

Are you going to be less responsive to the needs of ATSI people because they have their own entry schemes? No of course not, you would be judging an entire race on something that would be out of their control. There are medical workforce mal distributions in both ATSI people and Rural areas.

Medicine is a field where you help everyone. It’s legal responsibility in some scenarios and it’s a privilege to be in a position where your name carries so much weight. Sure, I believe doctors are well within their right to do what’s best for them, wether that’s taking a higher paid roll or moving to areas of need. But at the very least they need to be conscious of the health issues of society around them, and be in a position to help when they can.

If you’re spiteful to a certain group of people because systems were in place to help them, then i really don’t think medicine would be for you. This will not be the last time in your life that someone will have a leg up against you and you will just have to deal with it.

Seriously? I don't even want to get the statistics out of the percentage of tax received from urban areas v rural areas. Equally, the number of transfer payments made from state/federal governments as a percentage of contribution with regards to rural areas speaks volumes...

Unfortunately with a society there will be people who support more than average, and those who submit far less. Nonetheless, they are all deserving of the fruits of societies labour. In healthcare, this means doctors need to be out in rural areas, even if they don’t contribute to the tax fund as much, and one of the best easiest way of doing that is selecting rural students

Feel free to continue having this discussion (I personally find it interesting to hear different perspectives) without personal digs - I am not the only non-rural student to feel this way and I am definitely not coming from an entitled perspective.

Yes this conversation has been awfully pleasant compared to previous conversations surrounding similar topics which quickly turn into flame wars (which is why LMG thought it was best to put it into its own thread to avoid connotations with those other toxic ones). That being said I think we’re going in circles here and probably have to agree to disagree.

I still firmly believe that because everyone is entitled to healthcare, and not everyone is able to get healthcare, all that can be done to fix maldistribution, needs to be done, and selecting students based off rural background is as valid as an indicator for their value in the medical workforce than ATAR/UCAT will ever be. Even if it is unfair, because you know sometimes life is just unfair.

 

[Crow]

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.

Respectfully, it is clear by this that you come from a highly privileged background and simply do not understand the underlying factors that disadvantage those from rural and low socioeconomic backgrounds. This comment would be highly insulting to those from that category.

 

[derm4eva]

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[derm4eva]

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[A1]

No, it is not... I am talking specifically about the use of the UCAT and the way in which it is used to offer interviews (which is the first barrier in the selection process).

I take it that you have two main gripes in this topic :

1. Rural-entry schemes reduce places available to non-rural, making non-rural entry difficult with extremely high UCAT.
The following numbers will show that's not true. To address the shortage of doctors in rural areas some 15 years ago the gov gave med schools 40% extra places (the BMP scheme, but don't alarm I'm not discussing the BMP itself). So the places increased from say 1,000 to 1,400. Out of this 1,400 the gov requires schools to allocate 25-28% = ~360 places to rural entry, which results in currently:
- Non-rural roughly 1,040 places (comprising 740 unbonded + 300 BMP)
- Rural-entry 360 places (comprising 260 unbonded + 100 BMP)

Note I'm not debating the effectiveness of the BMP/rural schemes here. All I'm showing is before these schemes there were 1,000 places available, now there are still ~1,000 places available to non-rural applicants. They have not been short changed by the rural considerations.

2. So tough for NSW students with 99.2/92%ile not getting an interview anywhere (bar JCU/Bond).
This I totally agree with (and I believe it's the same situation for Qld students too?)
This ultimately comes down to NSW & QLD med schools being fair to all applicants while the schools in other states not being fair in reciprocal to NSW/QLD applicants. I don't know what we can do about it, but please don't shift the blame to rural entry.

 

[ucatboy]

@ucatboy I am not sure what university you are at but this is most definitely a topic of contention at universities in Sydney, namely USyd and UNSW.

I am not bitter either and I feel you're, rather uncharitably, trying to characterise me as such. I actually received an offer for dentistry last year (which I declined) and am already studying something I reasonably enjoy. I have several family members and close friends who are studying/are already doctors so I think I am fairly well informed and have an insight into how the field works.

As for my personal reasons, I am already studying for a degree that lends itself to extremely high earning potential, is often labeled as elite, and in which many people in my cohort 'look down on others.' My desire to change degree programs if anything should be indicative of the fact that I don't align myself with those values. My reasons are for studying medicine pretty personal (as they are for many people) and while I can't claim to be an expert in many things, I am 110% sure I am pursuing it for the right reasons.

I'm studying at Monash in Melbourne so admittedly know very little about the nuances of uni life in Sydney, so I'll take your word for it. It's good to hear that you're in close contact with many in the field of medicine and I apologise for the throwaway remark at the end of my last post, but it was more so my surprise at your statement So many non-rural students have an 'I don't give a shit about rural areas' attitude because they feel that they had to work and fight so much harder relative to the population that they are eligible for to earn that spot, which was very out of left field but I can see you've elaborated on further.

That's a mischaracterisation - out of my immediate circle several people are doing medicine and while they are not resentful, they definitely don't see any need for them to support or go out of their way to work in rural areas. In fact, many of them are only considering rural placements as they feel it would help them demonstrate their engagement with those areas (among other things) when it comes time to apply to competitive specialities. As for gratefulness, I don't agree with the use of that term as it implies a sense of luck when the non-rural students I know - while they are certainly pleased to be able to study medicine - do not see luck as having played a part in their admission. It was an opportunity that they had to go out and hustle for. Also, people are unlikely to say their views in public when you can get cancelled at the drop of a hat?

This sounds much more reasonable. Your previous statement seemed to directly equate rural entry schemes with rural health inequalities, as in, the rural entry schemes, rather than improving the situation, actually made it worse by making everyone else in the cohort resent working in a rural area because they'd been "wronged" by the selection process. I hope we can both agree that, while rural entry schemes aren't the magic bullet for our problems, they at least improve the situation in a net positive way i.e. rural schemes are better than no rural schemes at all. Basically, what I'm trying to say is that flawed/questionable entry schemes and rural health inequalities are two very separate, very valid issues, and one is not responsible for the other.

Perhaps grateful was not the right word, but I don't see any reason for a non-rural applicant, having successfully gotten into medicine, to then proceed to shit on everyone else around them who qualified for "lesser" schemes. That's less of a reflection on the entry schemes themselves and more on your character, focus on yourself. I hope your friends don't treat their rural peers in contempt because they got in with a 97 ATAR and a 60%ile UCAT or something, that's universally awful no matter what state you're residing in.

 

[Caffeine]

I imagine a way to reduce the scores for entrance would be to reduce the salaries on offer for doctors at both specialisation and internship. It would be interesting to see the effect on admissions if internship salaries were bought to 50k with no overtime etc payed with specialities halved as well [no overtime pay either]. You could also add like a 7 year+ duration of medical degree bond & a duration of speciality program bond to work in a rural location to the majority of incoming/current medical students/doctors to address lack of access [I think that would be 20 years in total for some] .That would hopefully result in similar entrance scores [Might also lead to a lot people quitting]

 

[dotwingz]

Forcing people to do things never work, especially people who have plenty of other options like those smart enough to get into and complete med school

Fixing the Recruiting and Retention Problems in Britain’s NHS

Although Britain’s National Health System (NHS) has provided effective universal coverage for almost 70 years, it is facing a major health workforce crisis that jeopardizes its future. The NHS is increasingly struggling to recruit and retain its health workforce. Despite the years of training...

hbr.org

Look at the NHS for example, it’s not a coincidence that junior doctors get paid ~22000£/pa and 48% of doctors quit after PGY2. That’s not very efficient from a education point of view, to sink hundreds of thousands of public dollars into universities just to get 2 years of work out of a doctor, in which they don’t really contribute as much to the healthcare system as say a fully trained doctor would.

Bonds have a similar effect. People have a myopic view when they get into med school, they don’t know what it’s actually like because it’s hard to know. If people finish 5+ years of uni just to be locked into a job far away from the life they’ve set up already on a bad salary and working conditions they’ll just quit and go elsewhere. Doctors (who took a more linear life route) are only in their mid 20s when they graduate, and a med degree looks good on a resume.

High entry scores are really only a problem in the circle of med hopefuls… the rest of the country doesn’t really care lol (in fact most mistakenly believe that they should be as high as possible)

 

[ricenbeans]

Of course, I nor anyone else is entitled to anything, but nor is a rural student who is pretty advantaged

 

[Gungeon]

To also weigh in as pretty advantaged NSW rural student at a Sydney med school, I agree its a crap system but you know the system and rather than get upset at it or us, you could plan to make the system work for you. Nothing is stopping you from doing a Bachelor and Masters at UoN for 5 years and then you'd be an advantaged NSW rural student too. Or maintain a GPA and have a crack at the GAMSAT. Looks like you'd kill S2 derm4eva. Or work at pub in Darwin for 5 years while doing the UCAT each year (this one would be fun).
I don't feel guilty for taking your or anyones spot, I just showed up and applied in all the pathways in which I was eligible. Just as we all did. What I'm trying to say is dont hate the player, hate the game and carpe diem baby.
I've loved reading this thread.

 

[A1]

I don't feel guilty for taking your or anyones spot

Practically every med school that has a rural-entry pathway allocates a set quota of places for it. Having made yourself eligible for the rural criteria you got in fair & square. You didn't take away a spot from any non-rural because non-rurals are not eligible for that quota anyway.

Funnily enough I haven't heard rural students complaining about this practice (people living 5 years rural to become eligible). All criticism I've heard was from non-rurals.

 

[Crow]

It’s got to be a very small minority of applicants (if any) that moved to a rural area and stayed for 5 years minimum purely to get into medicine…. If you stayed rurally for that long it demonstrates a commitment to living rurally in my opinion, which is what the quotas are effectively aiming to select for anyway.

 

[forevafrensbear]

For the record:
1. No one cares whether you are a rural student or not when you qualify
2. No one cares or even knows whether you are a bonded student or not when you are on rotation unless you make it known
3. Priorities change and are dynamic. You cannot know for sure what speciality you want to do ; whether that is rural compatible or whether that may be compatible with your life/lifestyle/partner (if applicable).
4. The multifactorial reasons why rural areas are short of medical practitioners are well described and system based issues that are difficult to fix.
5. Being judgemental and having attitude will quickly flag you with your peers, consultants and post-graduate medical education and whilst nobody may tell you to your face, we are unlikely to want to work with you again.
6. Be thankful we are unlike some countries that will send graduates anywhere (including rural) as part of their job allocation post-graduation.

I don't remember rural coming up other than as a preference for terms with job selection. And I scored applications only recently.

 

[rose4]

There's a big loophole in Queensland for the rural pathway program. Of course it makes sense for those living in rural areas and attending local high schools or being forced to travel long distances to reach school everyday to receive a boost. It is a bit iffy that rural students can attend elite boarding schools and still be considered as disadvantaged as the above. However the biggest problems is that students who have only lived in rural areas for primary school or earlier, are considered rurally disadvantaged. This is even if they then move to metropolitan areas and attend elite schools. Living rurally from ages 2-7, while probably having some effect on schooling does not compare to the entirety of schooling being at a disadvantaged school. High school has the biggest effect on one's future, and I believe the system should be changed accordingly.

 

[dotwingz]

rose4 I moved your post into a more appropriate thread. Give this one a read, its only a loophole if the point of the rural schemes are to account for rural disadvantage... but actually they're used to select applicants who are more likely to practice rurally

 

[Crow]

rose4 - while this may be perceived as “unfair” or a “loophole” the system is not designed to address disadvantage. The system is designed to recruit those who are more likely to practice rurally once they’ve graduated. The evidence shows these are people who have lived rurally previously.

ETA: As per DW seconds earlier….

 

[dotwingz]

Better luck next time Crow B) I suggest using 2 hands on the keyboard if you want to develop typing skills like mine

 

[Crow]

Better luck next time Crow B) I suggest using 2 hands on the keyboard if you want to develop typing skills like mine

Spoiler: OFF-TOPIC

We know my technology skills render me incapable of such a talent

 

[rose4]

rose4 I moved your post into a more appropriate thread. Give this one a read, its only a loophole if the point of the rural schemes are to account for rural disadvantage... but actually they're used to select applicants who are more likely to practice rurally

I wasn't aware of that. Thank you for clearing up the confusion cause I never understood the system before. Bit of a shame though because despite being an urban med candidate I would love to work rurally! My mum's fellowship was primarily rural and indigenous work (sadly not enough time spent to qualify me for rurality) and it really inspired me to apply for Med myself. There's such a large gap in healthcare and it's hard to describe to people who have only ever lived in urban areas.
Not sure how to address Crow as I'm a new user, but thank you for replying as well

 

[dotwingz]

Ah absolutely. This why JCU with their personal statement and rural focused curriculum is the most successful in getting doctors in the bush in the country… sadly it’s a pretty work heavy (read: expensive) process to filter applications for *thousands* of applicants… which is why most unis fill their obligation with the government and just move on