PDH CEO Advocates Better Rural Medical Training Pathways

Thursday, 29 March 2018
Portland District Health CEO Chris Giles is advocating more healthcare training in rural areas to alleviate shortages of doctors in rural Australia.

Ms Giles was recently invited to participate in a national summit in Canberra to discuss rural health medical workforce needs.

The inaugural summit hosted by Australia's first National Rural Health Commissioner, Emeritus Professor Paul Worley was attended by rural health services representatives who face the daily challenge of rural medical workforce shortage, as they strive to provide safe, high quality care, close to home. Minister for Rural Health Senator Bridget McKenzie attended part of the summit.

Ms Giles said the summit looked at what’s working and not working in rural health and discussed what needs to be done to attract more doctors and health workers to rural areas.

She backs the suggestion at the summit that potential candidates be identified in high school and supported to become doctors without having to leave their local communities.

With digital and virtual technology most of what is taught in university could be done anywhere, Ms Giles said. It might be time to turn medical training around; less time in the city, more time in your local community with a few intensive teaching blocks in the city.

It is challenging but potentially an excellent idea.

Ms Giles said doctor shortages are the norm, not the exception in rural Australia with locums the backbone of the rural sector. The skilled rural medical workforce is getting older and there is ongoing reliance on International medical graduates, as we fail to attract and retain our Australian medical graduates.

The current methods/system of training both pre-Medical Board Registration (undergraduate) and post Medical Board Registration in a rural area are not working, they fail in a number of crucial areas which include:

  • Student selection processes don’t support the truly local rural student gaining entry to a University place
  • City centric courses with multiple rural placements which are usually not in a student's home base community.
  • Competition for Intern places – no certainty of getting into a place close to home and then having to undertake a 10-12 week rotations program to potentially different locations each rotation
  • Middle year resident training involving 10-12 week rotations. For a rural resident, this often means moving town frequently.
  • No joined-up pathway, each year the junior doctor must apply and get onto an annual program with no certainty of staying in the same location for each year.
  • The complexity of getting onto and completing a specialist training pathway is difficult to navigate and virtually impossible to achieve based in one location for a rural trainee.
  • Competing with metropolitan incentives both financial and lifestyle

Ms Giles said, becoming a doctor is now largely a post graduate course, new doctors are now older when completing university, female doctors are equally represented in training numbers. Many young doctors are finding partners and starting families, they need a stable work location which the current system cannot provide if the doctor is on a GP / specialist training program pathway.

We need universities, health services, training providers and medical colleges to work with rural communities to find and support the rural student to become that rural community's GP/ medical specialist into the future.

Ms Giles said the summit workshopped a number of issues looking for innovative, practical ways to facilitate the local student to achieve the score needed to get into medicine and then have a joined-up rural training pathway from medical student to GP/medical specialist/rural generalist based predominantly in the student's home town.

The confusing, complex and very fragmented current system hampered with traditional thinking and inflexible rules is not helpful, she said. Many of the current systems are touted as ensuring good doctors are trained in Australia, yet they consistently fail to deliver on the needs of our rural communities. The time has come to change up the system, challenge thinking and make sure we have a system that embraces technology and innovation to train a better doctor for all Australian communities not just our metropolitan centres.

In Portland, Ms Giles said she would be looking closely at how PDH approaches its junior doctor / specialist doctor training “to work out how we can change it up for our community.

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