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Health cuts and education deregulation: critical issues for Indigenous doctors

Members of the Australian Indigenous Doctors’ Association are gathering in Melbourne today for the start of their annual conference, at a time of great uncertainty for Indigenous health and Indigenous doctors.

In previewing the conference, AIDA president Dr Tammy Kimpton raises concerns about the impact of the Federal Government’s plans for deregulation of higher education.

Dr Kimpton, a Palawa woman from the west coast of Tasmania, also highlights the importance of growing the number of Indigenous doctors – and how universities can do more to help this.

She also shares some of her own personal and professional story:

“What I absolutely love about my work is that I get to be very involved in people’s lives. I’m a doctor to patients who come and tell me stories that often they haven’t told anyone else. I love the fact that I have their trust and they share their lives with me.”

Marie McInerney, who conducted the Q and A below with Dr Kimpton, is covering the conference – Science and Traditional Knowledge: Foundations for a Strong Future – for the Croakey Conference Reporting Service. 

***

Interview with Dr Tammy Kimpton, President of the Australian Indigenous Doctors’ Association

Q. How many Australian Indigenous doctors and medical students are there now, and what proportion are they of the medical workforce and of medical student numbers?

According to the latest Medical Deans Australia and New Zealand data, we currently have 310 Aboriginal and Torres Strait Islander medical students. Last year we had 24 graduates, our highest number ever, which made up about .08 per cent of the graduating class. Our most recent doctor number is 204, also about .08 per cent of all doctors registered in Australia.

With Aboriginal and Torres Strait Islander people making up 3 per cent of the Australian population, we would need to have 2,895 Aboriginal and Torres Strait Islander doctors to reach population parity, so we are obviously still well short of that, but it’s fabulous that we have been able to double the number of Aboriginal and Torres Strait Islander doctors over the past nine years. That’s pretty exciting.

Q. How does Australia compare with other countries (eg Canada, NZ, US) re the proportion of doctors and medical students who are Indigenous?

We don’t have all those numbers but none of those countries are at population parity either.

One interesting difference is that all of those countries graduated their first Indigenous doctor a very long time before Australia did, most of them about 100 years before. Professor Helen Milroy, Australia’s first Indigenous doctor, graduated in 1983, while most of the other countries did so either in the early 1900s or the very late 1800s. So that tells us we still have a lot of work to do.

It’s interesting when I go to meetings in New Zealand and they talk about Maori doctors who come from families with generations of doctors among them. In Australia, we now have three Indigenous doctors who have an Indigenous doctor parent. Many non-Indigenous doctors comes from families where a parent is a doctor, but the majority of Indigenous doctors or medical students don’t have a parent who has graduated from university at all, much less in medicine. This raises important issues about role modelling and the capacity of people to have lifestyles that lead to a medical degree.

Q.What do we know about Indigenous doctors?  Gender? Their backgrounds? Their practice (eg general practice or what other specialty areas are they working in), whether rural/metro etc?

Our doctors are spread pretty thinly across the country, from Hobart to Kununurra and in between. We have slightly more females than males, and they are more likely than non-Indigenous doctors (50 per cent versus 25 per cent) to be from a rural or remote background.  They also come much later to medical study than non-Indigenous students – in their early 30s rather than late teens.

Our doctors work across the spectrum in terms of hospitals, private practices, and Aboriginal health services. By and large, a great proportion are fellows of the Royal Australian College of General Practitioners (RACGP) or the Australian College of Rural and Remote Medicine (ACRRM), but we also have 3 psychiatrists, 2 surgeons, 1 obstetrician, 1 cardiologist, 1 radiologist, emergency medicine physicians, and registrars across obstetrics, gynaecology, surgery, ophthalmology, psychiatry specialisations.

Q. Does AIDA have a goal, re the numbers of Indigenous doctors and medical students that would be considered ideal or appropriate?

We really have avoided setting an annual target, although we obviously want to at least maintain the level of recruitment we have now in first year. Getting the 2,895 doctors to meet population parity is a very long-term goal – today’s first year medical students will take at least 16 years to get through to fellowship training.

There’s a lot of experience now around good strategies for the retention of medical students and a real commitment from the Medical Deans Australia and New Zealand to share that information, to make sure retention numbers reflect and improve the really good recruitment number we now have.

At AIDA we put a lot of work into a number of collaboration agreements with peer organisations to increase medical student numbers, to better support our doctors when they graduate, and to ensure good quality education about Aboriginal and Torres Strait Islander health throughout medical education.

Our longest standing agreement is with Medical Deans and in the last couple of years we have signed agreements with the Confederation of Postgraduate Medical Education Councils (CPMEC) and also the Committee of Presidents of Medical Colleges which means we have efforts in place across the whole spectrum of medical education.

Q. What would help increase the numbers? What are the key barriers? What role can governments play in increasing numbers? What role can universities and medical schools play in increasing numbers?

It’s important to have scholarships for Aboriginal and Torres Strait Islander medical students, particularly if the cost of a degree is going to rise as significantly as we think, but supporting students is not only about finances, it’s got to be part of a suite of things that ensure they get support from pastoral care, and from the community and academic point of view.

I’d rather not name names, but the universities that are getting good results are the ones who look from a more holistic point of view, that think about community, academic and financial supports as part of a tailored package. Some of the smaller universities find that difficult to do, although a number have set up good programs.

The types of support that is effective include having a campus Aboriginal and Torres Strait Islander support office, with support workers who are not necessarily connected to the academic programs but can help with any issues that arise, anything from isolation from family to the financial stresses that come from being a slightly older subset of students and having to support your own families while getting your medical degree.

There are issues of culture and cultural safety: universities and medical schools are not particularly culturally safe environments: a lot of education about Aboriginal and Torres Strait Islander health has been framed negatively for a long time, so, for example, case studies are often fairly negative in connotation. Also, there’s a tendency to expect every individual Aboriginal and Torres Strait Islander person to speak ‘on behalf’ of the whole culture: that’s also a very unsafe position to be in.

We still also encounter racist attitudes from some lecturers and medical staff. I like to think that’s decreasing but it is still something that our students report.

Another focus of AIDA is making sure that people are aware that medicine is an option: our Board tries to go out at least once a year on community visits. It’s not unusual for us to go to schools where students have never seen an Aboriginal or Torres Strait Islander doctor, so that role modelling, getting the word out there that these are options for our kids, is important.

Q. What difference does it make to have a growing number of Indigenous doctors? For the health of Aboriginal and Torres Strait Islander people, as well as for getting change within the health system?

I think it makes an enormous difference, in everything from child health up. Some of that comes from our aim to provide culturally appropriate healthcare, but it’s also important for role modelling. It is also good for the health system because it challenges negative stereotypes when you have a cohort of Aboriginal and Torres Strait Islander doctors who are not just verbally challenging stereotypes and prejudices but are providing a positive story themselves.

And I think it is important for health care generally. Associate Professor Papaarangi Reid, a Maori doctor, once said Maori doctors are not good for Maoris, they’re good for all of New Zealand. I think Indigenous doctors do tend to look at things more holistically and that’s good for all health outcomes.


Q. What is your background, what led you to becoming a doctor and what helped and hindered you on the path? What do you love about your job? What do you least like about your job? If you could offer your teenage self some advice, what would it be?

I’m a Palawa woman from the west coast of Tasmania. I grew up in a very strong Aboriginal family in a small community. I had really good teachers in primary and high school, all of whom really pushed the message that I could go and do whatever I wanted to do. I also have a mum who is particularly strong and was keen we be educated and do whatever we could with our lives.

I went to college and did career counselling where I was encouraged to do engineering, which I started but didn’t like because it wasn’t dealing with people. At that time, my grandmother got sick and one of her doctors ultimately made me think that I could become a doctor – not, unfortunately, because of any positive inspiration but because I thought if he could do it, I surely could. He didn’t have a good bedside manner at all, and I figured I probably liked people a little more than he did!

I was told about the fabulous medical course at Newcastle University where they had lots of other Aboriginal and Torres Strait Islander students, so I decided to apply. I felt welcomed there from day one, met really lovely community people.

It was a real struggle being so far away from home, but the uni support network really worked well to see me through. I lived in an Aboriginal Hostel, I had tuition and other support through the medical school’s Aboriginal liaison unit, there was always someone there who I could chat to, get support from. I graduated in 2003 and undertook my internship at Gosford hospital.

Since then, I’ve married and we have three children, and I currently work in a mainstream general practice. We are the only practice in town, so we have quite a large cohort of Aboriginal patients, who make up about 2.5 per cent of the local population. Interestingly, I do see a larger percentage of Aboriginal patients than the other doctors in the practice: I did an audit recently, and on one day about 20 per cent of my patients were Aboriginal and Torres Strait Islander people.

What I absolutely love about my work is that I get to be very involved in people’s lives. I’m a doctor to patients who come and tell me stories that often they haven’t told anyone else. I love the fact that I have their trust and they share their lives with me.

The advice I’d give to my teenage self would be to hold onto the dream and go with it. I allowed myself to be swayed by other people’s opinions about what I might be good at (engineering) and that really just delays the inevitable. Trust your instincts: that’s good advice for a number of things in life.

Q.What are the implications of the Government’s plans for deregulation of higher education for the Indigenous medical workforce?

I think it is very concerning that medical degrees may cost upwards of $250,000, I think we should all be concerned about that, particularly given we do not currently have adequate numbers of Aboriginal and Torres Strait Islander doctors as it will further add to the barriers we face.

The rationale that doctors earn higher incomes once they are qualified so can afford to pay higher fees is not so simple with Indigenous people as we tend to enter medicine later in life, so our careers are shorter anyway, but we also come with a lot more financial commitments already in place, responsibilities to our own family and extended families etc.

Once we finish the degree, the higher income is there, but it’s being spread a lot more thinly than the typical non-Indigenous doctor’s income.  In addition our families don’t tend to have inter-generational wealth and support behind them – and this also affects our educational outcomes and career planning.

Q.  What impact are the Federal Government’s cuts in health and elsewhere having upon Indigenous doctors?

It’s been a very concerning period of time for Indigenous health and Indigenous doctors, with the announcement of a suite of upcoming changes without detail about when and what is going to happen.

We have seen the impact of that, for example, with a lot of patients who already believe the GP co-payment has been introduced so they are not turning up for health care. Our work on chronic disease prevention and management will suffer from the loss of funding to smoking cessation programs that were delivering really good primary health care.

The lack of certainty around funding for Aboriginal health services also means a lot of anxiety for doctors around their ongoing employment, incomes etc.

Q. What issues are you looking to explore at the conference? Can you provide a few details on why your keynote speakers have been chosen and what they will address?

The theme of the conference is: Science and Traditional Knowledge: Foundations for a Strong Future.

One of the keynote addresses will be delivered by Ngangkari traditional healers: Toby Baker, Clem Dalby, Tinpulya Mervyn, Josephine Mick and Maringka Burton. They work with the Ngaanyatjarra, Pitjantijatjara and Yankunytjatjara Women’s Council program that supports a dynamic group of Ngangkari who are also highly respected artists, teachers and health workers with immense cultural authority.

The Ngangkari have over 60,000 years of healing tradition to share with us – that’s something we value as an organisation, to help us keep our cultural ties to country. They are also seeing a role for Western medicine as well, so the bridging the gap comes from both sides.

Professor Helen Milroy, who is one of the Commissioners for the Royal Commission into Institutional Responses to Child Sexual Abuse, is another keynote speaker. As the first Indigenous doctor in Australia to graduate, she will also help to keep the conference focus on culture and tradition. She’s just the most wonderful speaker, I always go away after hearing her speak feeling enthused and inspired. She really is a fabulous role model and has such a strong connection to culture while excelling in her chosen medical field.

On the science aspect of the theme, we are bringing a much stronger research focus to the conference. We are really excited to have a number of doctors, researchers and medical students present their own research.

We really hope over time to continue to develop that space at the conference for research and knowledge sharing, and to help promote the role of Indigenous medical researchers. Currently there are only a very small number of Aboriginal and Torres Strait Islander researchers, despite the fact that there is a significant amount of funding each year, which is earmarked for Aboriginal and Torres Strait Islander health research.

Q. How important are the conference workshop sessions and what influenced their focus this year?

The workshops play a vital role in the way the conference comes together, providing opportunities for various specific learning opportunities for our members. They’re developed in direct response to membership requests for training and professional development.

This year we have Australian College of Rural and Remote Medicine (ACRRM) offering an Advanced Life Support workshop to meet the needs of junior doctors and GPs in the management of common emergencies faced in rural practices.

Another session this year will be the Mentoring Workshop, facilitated by AIDA’s new CEO, Kate Thomann, who, as a senior Commonwealth public servant, supported a number of key federal Indigenous health initiatives, including the Standing Council for Aboriginal and Torres Strait Islander Health; the National Indigenous Drug Advisory Council; the National Indigenous Health Equality Council and the National Aboriginal and Torres Strait Islander Health Council.  The workshop will discuss how to make the most out of a mentoring relationship.

Of particular importance is our Associate Members workshop.  This workshop will provide an opportunity for Associate Members to express why they joined AIDA – and to discuss the type and level of engagement they would like to have with the organisation.

We are really excited that the workshops have been approved by the Royal Australian College of General Practice (RACGP) for Continual Professional Development (CPD) points, which means AIDA members will be able to access practice incentive payments which makes it easier and more valuable for them to attend.

Q. What did you think of the Prime Minister’s visit to Arnhem Land and where would you like him to visit next?

I was very happy to see the Prime Minister spend time in an Indigenous community: it’s good for the community and good for the Prime Minister and I hope his visit created the opportunity for a two-way dialogue.

For where he goes next, it could be anywhere from Broome to Hobart: the Aboriginal and Torres Strait Islander population is so diverse across the country. But I hope he does not just focus on rural and remote areas.

• You can track Croakey’s coverage of the conference here.

• On Twitter, follow #AIDA2014 and

@WePublicHealth   (Read more here about this week’s WPH tweeters: @DrAliciaV @natahliajoy)

@AIDAAustralia

@TammyKimpton

@mariemcinerney


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