SOLVING THE SHORTAGE: Minister for Rural Health, Senator Bridget McKenzie, is pictured with Member for Mallee Andrew Broad, centre, and Member for Mildura Peter Crisp during last week’s announcement at the Monash Medical School in Mildura.
By JOHN DOOLEY
THE issue of doctor shortages in rural and regional Australia is something that has been grappled with for many years, and now a bold initiative from the Federal Government is set to transform the way doctors are trained and retained in regional Australia.
The Federal Government last week announced an investment of more than $95million for the Murray-Darling Medical Schools Network (MDMSN).
Speaking at a round-table discussion during her visit to Monash University’s Mildura medical school last Friday, Minister for Rural Health, Senator Bridget McKenzie, said that Monash, in cooperation with La Trobe and Melbourne Universities, will provide country students with the training and clinical experience delivered locally in the regions.
“This will provide them with the knowledge and skills they need to become local doctors in our communities,” she said. “The new network will establish a continuum for students to undertake the majority of their medical training in the regions, effectively flipping the current training model on its head, and will be a game-changer for regional communities.”
It’s interesting to note that as far back as March 2014, the Department of Health released a paper entitled ‘Rural Community Intern Training’, which articulated a plan to vertically integrate medical undergraduate – graduate, intern and basic physician trainees – with the opportunity to complete their training in one region.
Also attending the meeting with the Minister was Member for Mallee Andrew Broad, who said students will begin to study within the network by 2021.
“When fully operational, approximately 140 medical students will commence their studies each year in the Murray-Darling region,” he said. “This new network will provide significant benefits to the local Mildura community, and more broadly across our regions, as more country doctors complete their training and begin working in regional general practices and hospitals throughout the Wimmera-Mallee,” he said.
It’s hoped the new MDMSN, which is seen as an innovative, bold initiative, will provide the next generation of rural doctors with an opportunity to study and practise in their local community.
“Attracting and retaining doctors in our patch has been a significant issue, and it’s great to see a measure like the MDMSN training more doctors locally, and as recent research shows, they are more likely to remain in a rural town if they complete their training in a rural town,” Mr Broad said.
“The network will also mean a larger university presence, new infrastructure and professional support over the longer term.
“Local hospitals and medical practices in the electorate of Mallee will benefit from rural doctors who have come from the regions, trained in the regions, and plan to stay in the regions.”
Mr Broad said students living in Mildura and neighbouring regional communities will be able to continue living in the area while undertaking the majority of their study and training as part of their medical degree at the Monash University campus.
“This means they can focus more on their education and training without the pressures and expenses associated with relocating to capital cities where many of our medical schools are generally located,” he said.
The MDMSN is part of a 2018-19 Federal Budget investment of $550million in the Stronger Rural Health Strategy (SRHS) to improve access to health services for people living in regional, rural and remote areas of Australia.
Minister McKenzie said that the SRHS would support 3000 additional specialist GPs and 3000 extra nurses and allied health professionals in rural general practices over the next decade, focusing on teaching, recruitment and retention of medical practitioners in country communities like Mildura.
Many graduates want to stay here
Director of Monash School of Rural Health, Associate Professor Fiona Wright, said there were a lot of graduates who want to stay on in Mildura and do their internships at Mildura Base Hospital (MBH).
“Students are attracted to Mildura, and they enjoy undertaking their medical training here, but as we all know it’s the years after that are at issue, when they are forced to attend a metropolitan hospital to complete their internships,” she said.
“Under this new funding, the opportunity will be there for local training pathways to be established, opening the way for graduate students to be able to complete their specialist training in a regional centre like Mildura.”
Senator McKenzie cited the example of the South Australian experience, which she said was a very serious situation.
“You look at South Australia just across the border, and they have locums in every hospital because they only have about five training positions in the south-east corner of the State, and so they’re effectively not training anyone in regional SA, hence they practically don’t have any doctors in their regional hospitals,” she said.
Monash Rural Health Head of School, Professor Robyn Langham, said the frustrating thing from the development perspective was that a centre like Mildura, which is able to train not just GPs but also specialists, experienced real lag between the realisation and the accreditation processes that happen at College level.
“The State Government controls the intern positions over a computer algorithm matching system, and what we believe would be a better thing is if Mildura could actually take their jobs out of that, and employ their own doctors, and have the doctors who have come to the region and are committed to it, rewarded and recognised and then they will stay,” she said.
Minister McKenzie, in highlighting another issue, said that the new package aims to change the system whereby a hospital ‘owns’ the training doctor 24/7, and controls their entire capacity to earn an income outside of the emergency department – an issue allied to the current regime.
“We have some incentives there for doctors to be able to earn more and have a more flexible approach to their work throughout the training pipeline, not just at the end,” she said.
Also joining the discussion was MBH intern Dr Madeleine Leung, who spoke of her experience in being chosen to complete her medical training, leading to her internship in Mildura.
“I came here in my fourth year, I’m not a rural student (Monash is split into their extended rural cohort students and the non-extended rural cohorts students)… there weren’t enough rural students and so they basically said, ‘We are going to draw some people out of a hat’, and then they said, ‘Congratulations you’re off to Mildura,’ and I said great, I’m not sure where that is,” she said.
“When I got here it was great, my student days were very good with excellent teacher support and importantly we learnt a lot from our hands-on experience.”
Dr Leung highlighted the benefit of the hands-on training in a country hospital.
“I do, however, think that some of the issues, particularly around training programs, are restricting the numbers of people who want to stay here,” she said.
“For a lot of students who really enjoyed there time in Mildura, when it comes to applying for jobs, they think well why would I go to Mildura if I can’t fully train?”
Former intern Dr Travis Taggert came to Mildura after completing his medical degree at Monash in Melbourne in 2014, and now works as a GP at the Ontario family practice, and also in the emergency department at MBH.
“I’m from Bridgewater, and grew up on a farm, and I preferred not to live in the city and decided I would come to Mildura for my internship,” he said. “Unfortunately the way it currently is unless you decide to train purely as a GP, given there are no other training programs being brought here, you will eventually have to go to the city to further your career.
“If you do decide to do that, you need to enter a training program run at an accredited metropolitan hospital, and spend three or four years further training, by which time you have started to build a life there, and it’s then unlikely you’d move back to the country.”
Dr Leung agreed: “Yes if I can stay I will, if I can’t, then I’m not going to jeopardise my career just to stay in a place that I like.”