Martin Van Der Weyden: School evidence needed

THE campaign for a new medical school at Curtin University in WA highlights the soft evidence underpinning such proposals.

The US has 137 medical schools serving a population of 312 million (one school per 2.3 million population); the UK has 35 medical schools serving 59 million people (one per 1.7 million) and in Australia there are 21 such institutions for a population of 22 million (one per 1.04 million).

It is also interesting to note that more than half the current Australian medical schools have been founded during the past 10 years, with predictions that the so-called tsunami of graduates seeking internships is set to peak in 2012–2014.

This makes it even more surprising to see Curtin University proposals to establish yet another medical school.

Among the many reasons cited in support of this initiative is the perception that there is a shortage of doctors, particularly in rural and remote communities. Leaders of the health faculty at Curtin University argue that the pressure exerted by the appropriate selection and graduation of more doctors in the system will drive their movement into rural and remote districts to meet this perceived need.

And yet the evidence for this conclusion is not clear, irrespective of the seeming sophistication and conviction with which the cause has been prosecuted.

The debate surrounding the Curtin proposal has been largely conducted in WA, where it is opposed by both the medical profession at large and the AMA.

More recently, the debate has entered the national consciousness through the Australian Medical Students’ Association.

The students highlight their very real concerns about the capacity of the current training programs within the medical postgraduate sector to accommodate not only increasing student numbers, but also recent graduates. So far the federal government is funding the extra training places, but for how long?

It is crucial that the student voice be heard and their disquiet addressed.

At the same time, the Medical Deans of Australia and New Zealand voiced their reservations. President Professor Justin Beilby said in a media release: “There has been a significant increase in the number of medical students in recent years, and it is essential we do not increase that number until we have a proper, detailed workforce plan”.

All this friction is not without precedent. Past proposals to establish new medical schools in Australia have usually caused a ruckus. This has invariably reflected the lack of readily accessible evidence informing and underpinning such proposals from a national perspective.

Significantly, such bids are usually prosecuted by individuals and universities in pursuit of the prestige which inevitably comes with the foundation of a new medical school. There is also considerable secondary gain in attracting increased federal funding.

Certainly, no one would deny the centrality of funding in any debate about university education. When considering the current suboptimal financial support of universities, particularly medical faculties, we may be better served by simply enhancing the capacity of our current 21 medical schools through increasing their shoestring budgets. It should not be beyond their collective wisdom to devise a system which is flexible enough to accommodate fluctuations in student numbers geared to changing needs.

It is time to bring some semblance of evidentiary rigour to the process of developing a national policy for meeting projected workforce requirements.

We also need an independent and informed body to address all proposals for new medical schools and oversee their establishment.

After all, we would be loath to repeat the British experience and graduate too many medical practitioners, who subsequently struggle to find clinical places to complete their training.

Such a cavalier approach to our next generation of doctors is to be avoided at all costs.

Dr Martin Van Der Weyden is Emeritus Editor of the MJA.

Posted 30 April 2012