ASK anyone in the medical profession and they will agree: there is a shortage of doctors in rural and regional Australia.
And this shortage has created a clear – and disproportionate – divide between healthcare available in cities, and healthcare in the country.
But when it comes to solutions, there appears to be far less agreement.
Are medical students not being encouraged to move to the country when they finish training? Are those training in the country not staying in the country?
Or are country-based students forced to move back to the city to finish their training?
It’s a complicated issue, but the facts are clear.
At the start of their studies, 20 per cent of medical students intend to work in a regional centre or small town.
By the end of their studies, that number drops to 17.8 per cent.
More than 22 per cent of medical students start their studies in the country, and 20 per cent finish there.
With country Australia making up 30 per cent of the population, an imbalance is inevitable.
La Trobe University believes it has the answer. Combining with Charles Sturt University, it wants to establish a new Murray Darling Medical School based in Bendigo, Orange and Wagga Wagga along with 16 clinical centres in the regions.
They are seeking government funding for infrastructure upgrades to allow 60 students to enrol in medicine at La Trobe in Bendigo per year, and a further 60 in both Orange and Wagga.
The university has made another submission, released on Wednesday, to the Health Department advocating the proposal – and they hope for a response within six months.
La Trobe University vice-chancellor John Dewar said the medical school was a new approach.
“This is designed to provide regional students with new alternatives, of staying in regional areas like Bendigo, studying to become a doctor, and then staying on in those regional areas to practice as a doctor,” he said.
There’s only one problem: students can already study medicine in Bendigo.
The Bendigo Rural Clinical School, run by Monash University and Melbourne University, has existed for more than 10 years.
Monash provides about 25 places each for students in their third, fourth and fifth years, to study in Bendigo.
Melbourne offers a four-year post-graduation course, as well as years two and four in Bendigo, and year three in another regional area.
La Trobe and CSU are proposing to allow students to spend their entire degree in Bendigo and other regional areas. They are promising 80 per cent of their students will be from the regions.
Professor Dewar believed the current model was failing to encourage students to stay regional.
“The difference in the MDMS proposal is that the students would be enrolled throughout their degree in Bendigo or other regional settings,” he said.
“That’s what will make the difference in ensuring that these students end up practicing as regional doctors.”
But what happens at the end of their degree?
A large majority of graduates return to Melbourne to finish their specialist training. This training can take between five and 10 years – by the end, graduates are entrenched in the cities.
Very little specialist training occurs outside of major cities – and it’s up to the government, rather than universities, to provide places for this training.
Access to specialist doctors is also a major problem for regional people.
Professor Dewar said the new medical school proposal would encourage governments to base more specialist training in regional areas.
“In order to make it easier for students to pursue specialisation qualifications in regional areas, we have to start somewhere, and a good starting point is having a regionally-based medical school that produces a majority of graduates who want to work in regional areas,” he said.
“That will then start to bring more of the training pipeline out of the cities and into the regions, which is what we want to happen.”
La Trobe and Charles Sturt universities failed to get a funding commitment from either major party in last year’s election campaign, despite lobbying by Nationals MPs.
The proposal has also faced strong opposition from the Australian Medical Students Association, which argues investing in specialist training was the best way to bridge the city-country healthcare divide.
Since 2000, only two of 11 new medical schools in Australia are located outside of major or capital cities – in Townsville and Armidale.
La Trobe and CSU have remained steadfast however, and in their submission they argue rural-based universities offered the best solutions. Their submission is based largely on the success of James Cook University in Townsville, which has 52 per cent of medical students from rural backgrounds.
There is a strong focus on GP training in Townsville, where specialist facilities are limited.
But with the new Bendigo Hospital, and Bendigo’s location in the heart of regional Victoria, should there be the same focus on GP training, rather than other forms of specialist training?
Professor Dewar said a new medical school would result in more training.
“Our argument is that having a vibrant regionally-based medical school in Victoria and NSW is an essential first step in getting students specialisation opportunities in the regions,” he said.