Charles Sturt University (CSU) has called for a fundamental overhaul of strategies to address the chronic shortage of doctors in rural and remote Australia, questioning whether increasing incentive payments or forcing doctors to work in rural areas is the long-term answer.

The University set out its arguments in a submission to the Senate Inquiry into factors affecting the supply of health services and medical professionals in rural areas.
“We have been applying ‘band-aids’ to rural medical workforce policy failures for so long that we have lost sight of the illness we are trying to cure,” said Professor John Dwyer, former head of medicine at the University of NSW’s medical school and a consultant to CSU on rural medical and health workforce programs.
“The problem is that the majority of medical students are from metropolitan areas, and all the evidence shows us that they simply won’t work in rural and remote Australia in the numbers needed to address rural doctor shortages.
“Only five years ago people were talking about a ‘tsunami’ of new medical students and graduates coming out of metropolitan-based medical schools and flooding into rural communities. It was implied that these graduates would go on to become the next generation of rural doctors.
“Yet this hasn’t happened. There is no evidence of a sizeable increase in the number of Australian-trained doctors entering rural practice, or that this is likely to happen in the future.
“National and international evidence tells us that if we train rural students in the bush, we are significantly more likely to retain rural medical practitioners in the bush.
“Metropolitan -based medical schools are expected to have at least 25 per cent of their medical student cohort from rural areas, yet only around half of Australia’s medical schools meet this target.
“The fact is that even the very best metropolitan-based rural medical program wouldn’t come within cooee of a regionally-based medical program in terms of recruitment and retention of rural students.
“If metropolitan-based universities cannot recruit rural students into their medical programs, then those medical student places should be reassigned to regional universities who have proven that they can attract rural students into medicine and health science programs.”
Professor Dwyer suggests that, rather than building medical schools at regional universities where they are needed, an absurd system exists where metropolitan medical schools are forced to enroll rural students regardless of whether they have the demonstrated skills or capacity to deliver genuine rural workforce outcomes.
“It is time to throw out the assumption that we can grow the rural medical workforce by forcing rural students to study medicine in major cities; by forcing metropolitan medical students to undertake training in the bush when they have no intention or desire to work there; or, by forcing overseas-trained doctors to work in the bush to gain residency.”
Professor Dwyer also questioned the effectiveness of financial incentives to attract and retain doctors in the bush.
“It is one thing to argue very properly that rural doctors should be compensated for the tremendous job they do by targeting funding to address the increased cost of rural practice,” he said.
“It is an entirely different thing to argue that money should be used to attract doctors to rural practice. What sort of doctors will this attract?
“We cannot build a sustainable rural health system by forcing or enticing doctors to work in rural areas if they don’t want to.
“The only way we can start to seriously address the problem is by making sure we  train the right students in the right location, and using the right curriculum.
“That means recruiting more rural students, training them in medical schools integrated into health faculties at regional universities, and ensuring that they are exposed to a curriculum that gives the skills and resilience to work in rural and remote locations in the long-term.
“Too much money is being given to metropolitan universities to develop rural programs that have variable results, while we ignore the significant successes of regional universities in attracting and retaining rural health workers.

“We can only find a genuine solution to the rural medical workforce crisis if we start treating the illness,” Professor Dwyer said.


Submissions to the Senate Standing Committees on Community Affairs inquiry into factors affecting the supply of health services and medical professionals in rural areas are available here.  The Committee will report by 30 April 2012.