Medical schools and rural practice

At first glance, the likelihood of another medical school being set up in New Zealand seems remote. 

Surely,  spreading expertise and increasing costs is unwise. 

Medical education is expensive and the establishment costs of a new school all the more so. 

Surely, there are much higher priorities for taxpayer dollars.

Nonetheless,  the Waikato District Health Board and the University of Waikato have made a joint bid to the Government to set up a school. 

They have their arguments and, no doubt, because politics is always involved, the outcome is not entirely predictable. 

For those reasons, the proposal needs to be rejected promptly.

The school’s backers say it would differ because it would be graduate-entry (many of the entrants to the Otago Medical School are in fact graduates now), training would take four years and it would focus on attracting students from areas that need doctors. 

It would aim to have 60% of students specialise in general practice.

The rural GP argument requires a response. 

It is, and has been for decades, a struggle enticing doctors to rural practice.

The two medical schools, Otago (with schools in Dunedin, Wellington and Christchurch) and Auckland (with a clinical school in Hamilton), are already well aware of the issues.

Measures like compulsory community placements and restructuring general practitioner training have been implemented.

The New Zealand Rural General Practice Network is  engaged and encourages a rural student mentor scheme as well as providing locum recruitment. 

It often works with "international medical graduates" who fill many of the rural positions, typically for six months to two years.

Some, as seen in parts of Otago,  choose to stay permanently.

As Otago health sciences pro-vice-chancellor Peter Crampton said this week, the worthy objective of increasing rural GP numbers was more complicated than just setting up a school.

Crucially, essential training places for students and graduates have become hard to  find. 

More students would just worsen this bottleneck, a situation which alarms the New Zealand Medical Students Association.

It yesterday said hospitals struggled to find jobs for medical graduates this year, and doctors usually needed such training to be registered.

This issue has also stood in the way of retraining requirements for many overseas-trained doctors.

While the highest standards are required for overseas doctors from countries where medical training is not recognised, a useful reservoir of skill and talent is being too often sidelined. 

Sometimes, it seems  doctor and specialist associations are determined to maintain their exclusivity and the shortages.

Thereby, their power, status and wealth is maintained.

National has staggered an increase of medical student places of 200 over several years and if this country produces more doctors than needed, more than usual will emigrate and a huge taxpayer investment will be lost.

More places will not solve issues of shortages in some specialties nor make country towns and  practice appealing.

There remains the matters of partner job opportunity as well as the isolation from colleagues and support services. 

For a few, though, the appeals of a vocation as an essential part of a small community and of the outdoors, can attract.

It should also be pointed out that Dunedin, surrounded by Southland, Otago and South Canterbury,  already is a centre where there can be more emphasis on rural practice.

It has a history in the area, with long-time Queenstown GP the late Pat Farry leading the way.

He helped found the University of Otago Te Waipounamu Rural Health Unit for rural doctor education, founded the Matagouri Club for undergraduate students with an interest in rural medicine and developed the first one-year Rural Medical Immersion Programme for medical students.

Waikato University and the DHB based in Hamilton have focused on problems with rural GP recruitment and retention. 

It is, however, difficult to see their proposal for another medical school  doing much to solve this matter.