What universities are doing to address the rural doctors crisis: opinion

The Weekend Australian article ‘Doctors crisis’ (Jan 30-31) draws attention to the significant challenge of addressing the shortage of doctors in rural and regional Australia. 

The Grattan Institute’s Professor Stephen Duckett’s assertion in the article that there is little encouragement by city-based universities to encourage their medical students to seek training and employment in rural areas – is simply incorrect.

As a key stakeholder involved in rural medical workforce training we are certainly conscious of these trends and are not sitting on our hands with respect to this challenge.

The Australian Government under the collaborative Murray-Darling Medical Schools Network (MDMSN) initiative aims to address the shortage of rural doctors. The partners in this network are University of NSW, University of Sydney, Charles Sturt University, University of Melbourne, La Trobe University and Monash University, involving five rurally-based graduate entry programs across the Murray-Darling region that train medical students rurally ‘end-to-end’, with the aim that they will remain in clinical practice in the region.

Three of the five programs in this initiative take their first student intakes this year. By 2027 there are expected to be nearly 700 students in this program.

Rural clinical practice is strongly promoted by most universities and opportunities for rural and regional placement are provided. For example, at Monash University there are strong rural programs embedded in the medical course at every year level managed by the School of Rural Health: Year 1 of the Monash Graduate Entry medicine course has its preclinical program situated in regional Gippsland and, for over a decade, an extended rural cohort of the Direct Entry (secondary school leavers) program has been based in North-West Victoria, with these students completing at least 2.5 years of their three clinical years in the regions.

Across all clinical years, around one quarter of Monash medical students cohort are placed in rural and regional settings.

Numerous research studies have shown that students who spend an extended time in rewarding rural clinical training placements are more likely to consider a career in rural practice, whether they have a rural or metropolitan background. 

A survey conducted by the Medical Deans of Australia and New Zealand in 2020 found that final year students at medical schools across Australia continue to express their interest in rural practice, with around 36 per cent indicating a preference for a future career working outside of a capital city. 

A 2018 study published in the journal Medical Education, looked at rural immersion programs for 19 university medical schools nationally from 2008-2016. It found that 13 schools offered more than six months of immersion in small rural towns, attached to general practices in the community and revealed that students with rural backgrounds are more likely to pursue rural practice with these immersion opportunities. Further, students undertaking longer duration immersion, including those from metropolitan areas, may be more likely to work rurally. 

Importantly, the rural medical training pipeline does not start with the enrolment of medical students into our courses. Universities are engaging with rural and regional primary and secondary schools to engage with school-aged children to promote and encourage pathways into medicine and other health-related courses. 

Another very important initiative within the RHMTP is the establishment of Regional Training Hubs within Australian University Schools of Rural Health to strengthen links between universities, health services, medical speciality colleges/training organisations, primary health networks and rural clinicians.

These connections will, in turn, lead to more rural and regional training opportunities and support for medical students, medical interns and young doctors interested in practicing rurally. 

In place nationally for just three years, it’s clear from the Victorian training hubs managed by the Victorian universities, with which I am familiar, that these hubs are working with increased rural specialist training positions, unique rural specialty ‘taster’ programs for young doctors in their second- and third-years post-graduation (programs unavailable in the metropolitan region) and extended rural-based specialty training, for example in paediatrics already in play.

The rural doctor shortage is real and the rural medical training pipeline outcomes have been below original expectations. Rather than uninterested, all the stakeholders working within the pipeline are deeply committed to – and invested in – increasing the rural medical workforce.

Professor Shane Bullock is acting head of Monash University School of Rural Health.

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