The Australian Institute of Health and Welfare has again reported in Australia’s Health 2016 that “Australians living in rural and remote areas tend to have a lower life expectancy, higher rates of disease and injury, and poorer access to and use of health services than people living in major cities”.
This echoes the findings of the very first Australia’s Health report in 1988, which found regional variations in health services and outcomes some 28 years ago.
While there have been clear improvements in rural and regional health over the past three decades, we continue to experience GP and specialist shortages, higher rates of chronic disease and higher rates of preventable hospitalisations.
Today, as then, the issue is that metropolitan medical school graduates don’t want to work in rural practice. A recent survey by the Medical Deans of Australia found that the first preference of 85 per cent of medical graduates is urban practice.
Doctor shortages have been a problem in both rural and metropolitan areas for over 20 years. However, our response to these shortages have been markedly different.
In response to the shortage of doctors in our cities, the government funded the creation of a number of new city medical schools.
But this was not the case in rural and regional Australia. The government opted instead to send rural kids to study medicine in the cities, and to expand regional medical training, in the hope that medical graduates might consider rural careers.
So, what was the result of these two very different approaches to solving doctor shortages in metropolitan and rural Australia?
According to a recent submission by the Department of Health on the skilled occupation list, there is now an oversupply of doctors in our cities.
In rural Australia, however, chronic doctor shortages persist. The problem is not a lack of investment, or an undersupply of medical students.
The problem is, and always has been, the reluctance of successive governments to invest in rural medical schools with the same enthusiasm as they have invested in metropolitan medical schools.
The evidence shows that educating and training rural students at rural medical schools, alongside other rural health students, leads to more medical graduates working in rural areas. It makes sense. At La Trobe University in Bendigo more than 70 per cent of its rural health students move into rural employment after graduation.
La Trobe University and Charles Sturt University submitted a proposal in 2013 to the federal government to establish the Murray Darling Medical School (MDMS), with campuses in Bendigo, Orange and Wagga Wagga. The Nationals promised to establish the MDMS during the 2013 election campaign.
Since that time, the federal government has approved a further two new city medical campuses in locations with existing medical schools nearby, but no new rural medical schools.
It is time that we take real steps to address the health disparities between rural and city dwellers as identified in the AIHW report.
We know that rural medical schools, like the MDMS in Bendigo, will deliver doctors to rural practice.
We just need the same type of commitment to fixing rural doctor shortages, as we have seen to fixing city doctor shortages.