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Will more doctors mean better health?

Some people have called it a tsunami; others argue that “a rising tide” is a more accurate description. Whatever methaphor you prefer, one thing is clear. Australia is going to be awash with medical graduates in the very near future.

According to some estimates, the number of domestic medical graduates will rise from 1,348 in 2005 to an estimated 2,442 in 2012. To date, much of the attention (as per these articles from the Medical Journal of Australia) has focused on the “major upheaval” that these extra numbers will cause for postgraduate medical training – and the health professionals and services involved in this training.

But what, I wonder, are the long-term implications for the country’s health? Will more doctors mean better health for all, or only for some?

There is an argument that if the extra numbers simply boost the might of the specialist sector, one of the major consquences may be an increase in health costs without a commensurate improvement in health (according to the argument that population health outcomes tend to improve with more generalists but to decline with increasing specialist:population ratios)

Will more medical graduates mean more doctors willing to work in rural areas, Indigenous health, general practice, and other under-served areas, such as mental health?

Or do we risk ending up with yet more subspecialist physicians and surgeons, whose specialisation equips them poorly to work outside major metropolitan centres?

So many questions and, as far as I can tell, we’re a long way from answering them yet.

Meanwhile, researchers from the Northern Rivers University Department of Rural Health, based at Lismore in NSW, have been examining whether future health graduates will be willing to work in the bush.

Their study, involving medical, nursing  and allied health students, is published in the journal, Human Resources for Health.

One of the authors, Hudson Birden, Senior Lecturer with the North Coast Medical Education Collaboration has filed this report:

“There has been great effort of late in health education circles in Australia to try to encourage young professionals to choose locations in regional or remote Australia as places to work.  Much research has been published, and many schemes hatched to compel or cajole students to do so.

We know that students who originate from rural communities are more likely to choose to work there, as are students who undergo rural placements and find them enjoyable.  This works particularly well if they meet that right someone in the town where they’re doing their placement.  Rural placement is especially attractive to generalist practitioners: nurses, General Practitioners, Physios, etc., but less so for specialists.

Like the cult classic TV series Northern Exposure, based on the trials and tribulations of a fictitious US medical school graduate who accepted that country’s scheme to work in the wilds of Alaska for a stretch of time in return for cancellation of his student debt, Australia has looked at a number of national incentive schemes. What has been lacking is a method of targeting such strategies to individual students.

A recent report summarised work that some of us have done surveying students to try to capture the complex mix of motivators and barriers that go into the decision of where to live, where to work.

We looked at nursing, medicine, and allied health students, and found that 10% of them wouldn’t think of working in a rural area, about 25% would consider doing so, and nearly half said they would want to start in a capital city first off while holding out the option of moving rurally later.

Older student were more inclined towards rural work than younger students, perhaps reflecting a divide between those seeking the comfort of raising kids in a safe, cohesive social environment and the compulsion/attraction of bright lights, big city.

Over half of students desired to work overseas in the first 5 years of their career, of concern perhaps to those who worry about the migration of top talent elsewhere.  Such worriers may or may not be consoled by the fact that some of our respondents, and a sizable fraction of health practitioners in training, came here because they like the country and want to stay.

If we want to increase the health workforce in the bush, we can look at the attractors that we know about (career opportunities, living environment, financial stability) and target incentives accordingly.  We found enough openness to possibilities in the students we surveyed to encourage us that there is lots of potential to assist health career students in making the decision that produces the best fit for them and the community they ultimately serve as professionals.”

Croakey continues: A few more interesting things about the findings: students of Asian descent were more likely to never want to work in a small town, and nurses seemed more likely than doctors to be interested in rural practice.

The findings also remind us of the importance of not talking about “rural” as if it is a single destination – students were more interested in going to some parts of the country than others.

They were far more likely to consider working on the north coast of NSW than other rural areas. Only two per cent of students said they’ d be happy to work in the northern region of SA; 17 per cent said they would work in the NT or the Kimberly in WA; and just four per cent were willing to work in the south-eastern corner of WA.

Comments 6

  1. TracyS says:

    To work independently as a doctor in Australia, medical graduates need to get postgraduate qualifications in the field they plan to work in (whether they plan to work in general practice or neurosurgery). The funding for postgraduate training positions is controlled by government. Unless there is adequate funding provided to increase the numbers of postgraduate training positions, the only result of all these medical graduates is a large number of doctors with basic qualifications who are unable to work independently and only able to work in supervised roles within hospitals. Considering the fact that most of the hospitlas large enoughto employ their own resident medical staff are either in cities of larger regional centres, it is hard to see how increasing the numbers of medical graduates is likely to improve the distribution of doctors within Australia, without an equivalent increase in postgraduate vocational training.

    If Australia wants more general practitioners, it needs to increase the number of general practice training positions. If it wants more specialist of a certain ilk, then it can increase the training positions for thos specific specialties.

  2. Ian Haywood says:

    It’s important to remember Australia’s medical schools have had inadequate intake for many years, much to the pleasure of the Feds as this kept Medicare costs down.
    The State hospital system survived by importing large numbers of overseas doctors, mostly from the subcontinent. Basically, this is the taxpayers of India and Sri Lanka cross-subsidising Australia’s medical education costs, this became morally and politically unsustainable and Howard had little choice but to finally bring medical training numbers in line with the last 20 years of population growth.
    It won’t have much effect on the total number of doctors as the Australian grads will barely replace recruiting of OTDs, plus the mass retirements as the boomer doctors start hitting 65.

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