If the Waikato bid to set up this country’s third medical school fails it has at least highlighted an important issue — shortages in general practice and, in particular, rural and provincial general practice.
The University of Waikato and the Waikato District Health Board claim their school would go a long way to solving this issue through a fresh community-based academic approach, graduate entry and a focus on general practice.
This sounds well and good but is in essence impractical and wishful thinking. Establishing a Hamilton-based medical school, or any new school for that matter, would be inadvisable on several grounds.
New Zealand’s medical graduate numbers are rising steeply.
Student entry numbers since 2008 have been increased by 200 a year, staged over several years.
At the same time, Australia, where many graduates in the past have left for jobs, has hugely increased its student numbers, so much so it is claimed it now produces more doctors per capita than all other OCED nations. By the time any extra New Zealand school had trained it first doctors, the doctor surplus could well be significant, even allowing for population increases.
As it is, acute difficulties finding house surgeon placements have already arisen, and that despite pressure on health boards to fund places.
These are an essential element of doctors’ education and experience and the bottleneck would become particularly fraught in the upper North Island.
Auckland already operates a clinical school in Hamilton, although without the independence and scope of the Wellington and Christchurch branches of the University of Otago’s medical division.
Another issue for a new medical school is attracting sufficient high-calibre staff. And if some come from Otago and Auckland, that will just dilute the limited expertise in this country. Then there is the cost, both of the set-up and the about $48,000 a year per student the Government pays towards medical education.
Otago and Auckland already operate special entry schemes for students from rural and provincial backgrounds (Otago admits at least 50 students preferentially because of their "rural" background), and Otago has a rural immersion programme.
Rural placements have been increasing.
Waikato points to a northern Ontario example and a rural Murray Darling Medical School is proposed in Australia.
No doubt, a reasonable number of students would be willing to return to the country if that is where they come from and where they train. But Dunedin, by international and even Australian standards, can hardly be considered a big city, and the population of the Hamilton urban area is now considerably higher.
There is more potential to build the general practice and rural practice expertise and ethos at Otago.
Both Auckland and Otago can also push ahead with their proposed national School of Rural Health, with all that could entail.
But, even with all that, and even if there was a rural-focused medical school, attracting doctors to provincial cities and country areas will be difficult. Immigrant doctors will fill gaps for years to come.
Often, for example, there is the matter of a job to match the qualifications and interests of the doctor’s partner. Pay is likely to be much higher in most other medical specialties, and working in isolation brings many additional challenges, even if it brings its own kind of rewards.
Medical students, young doctors and doctors have opposed Waikato’s bid, putting forward convincing arguments, although their associations and members have vested interests in limiting doctor numbers.The matter of attracting doctors to rural areas needs more attention. But a rural-focused medical school based in Hamilton is not the answer.
