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“THE Australian Dream is rooted in racism. It is the very foundation of the dream.” Stan Grant’s words have taken a permanent place in Australian identity.
In medicine, it is not just the health outcomes that demonstrate how far we are from that dream for Aboriginal and Torres Strait Islander people. Every year in graduation ceremonies across Australia, the lack of new Indigenous doctors walking across the stage has us questioning the health of the medical workforce itself.
In 2005, the Australian Indigenous Doctors’ Association authored the Healthy Futures report, setting out goals for building the Indigenous medical workforce in the years ahead. At that time there were just 160 Indigenous doctors across Australia, meaning that to achieve population parity the medical workforce required a further 1200 doctors to graduate.
In some parts of the journey, victories have been won.
In 2011, 2.5% of medical students starting medical school were Indigenous, equivalent to the 2.5% of the Australian population who are Indigenous. This 2011 milestone was a source of celebration, with a sense of hope for a more equal future.
Sadly, getting those students through medical school to graduation has proven to be another struggle entirely. Aboriginal and Torres Strait Islander medical students withdraw from medical school at far higher rates than non-Indigenous students, leaving the total enrolment of Indigenous students at just 1.8%.
- Related: MJA — Celebrating 10 years of collaboration: the Australian Indigenous Doctors’ Association and Medical Deans Australia and New Zealand
- Related: MJA InSight — Robert Parker: The personal touch
- Related: MJA — Partnership and leadership: key to improving health outcomes for Aboriginal and Torres Strait Islander Australians
By graduation, the proportion of graduating students who are Aboriginal and Torres Strait Islander is just 1.2%. As a result, in 2014 only 35 Indigenous doctors graduated throughout Australia, and the year before, it was half that.
Cultural differences, marginalisation and racism from within our cohorts, faculties and hospital environments make medical school a very isolating place for our Aboriginal and Torres Strait medical students. Fear of prejudice, the threat of being questioned about identity and tokenistic or stereotypical expectations contribute to emotional and moral burnout in our Indigenous colleagues. Combined with economic circumstances and a lack of academic support, these factors are a potent discouragement to continuing medical study.
Eighty-six per cent of Aboriginal and Torres Strait Islander medical students denote family members and role models as their biggest support in overcoming these barriers and pursuing medicine.
While Indigenous Australians are living 10 years less than the rest of the population, our ability to produce skilled Indigenous doctors to provide best practice is compromised. Aboriginal and Torres Strait medical students and their families are losing grandparents, uncles, aunties and elders who love and support them throughout the many years at university.
A challenge delivered in 2005 by then Aboriginal and Torres Strait Islander Social Justice Commissioner Tom Calma here too holds true. “It is not credible to suggest that one of the wealthiest nations in the world cannot solve a health crisis affecting less than 3% of its citizens”.
It is not credible to suggest that delivering effective support to 310 Indigenous medical students nationwide is a task beyond the purview of universities, government and the medical profession itself, led by the Indigenous community.
Related: MJA InSight — Lisa Jackson Pulver: Accentuate the positive
Related: MJA — History of the LIME Network and the development of Indigenous health in medical education
Universities need a firmer commitment to Indigenous student retention, and they need increased funding from the Australian government to do it.
Being Aboriginal or Torres Strait Islander is not just a risk factor, it is an identity; all too often, students see it portrayed solely as the former. Without the support of universities and the medical profession to counteract these stereotypes in medical education, we will continue to lose Indigenous students as a result.
Every day on the wards, the attitudes of their peers play a crucial role in creating an environment that either encourages Indigenous medical students to stay, or to leave.
Stan Grant’s speech was an indictment on the Australian dream. Every corner of our nation has its part to play in redefining that dream as one that innately supports our First Australians.
The 310 Indigenous students have put in the hard work to launch their dream of being a doctor. Let’s give them what they need to make that dream a reality.
Kersandra Begley is the student director of the Australian Indigenous Doctors’ Association and Elise Buisson is the president of the Australian Medical Students’ Association.
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The point of the article is clearly reinforced by the preceding comments.
Medicine is a competitive world. It only takes the best (and the brightest) to deal with other people’s lives. Indigenous students are offered preferential treatment along the way. From lower entry requirements and guaranteed quotas, to bursaries/scholarships/financial support and small group mentoring – one cannot deny that the path of indigenous medical students is a luxury compared to non-indigenous counterparts. They are even guaranteed a job (internship) after graduation, with NSW even going further by offering them the training network of their choice – most of them choosing city/metropolitan hospitals to train at – a luxury that is not available to Australian non-indigenous domestic graduates or Australian-trained full-fee paying students I’m not entirely sure what else can/should be offered. Elise, as President of AMSA, are you suggesting that we should perhaps create a new medical school which will focus entirely on training indigenous doctors? Seems a bit ridiculous
You may begin your article with Grant’s offensive assertion, but you should not expect that it will be accepted at face value: the accustaion is entrely unproven and the tone it sets for you is one of belligerence.
When I saw the article title and the authors’ photos, I initially assumed it was about locally-born (i.e. indigenous) students complaining about the influx of fee-paying Asian students. If you mean Aboriginal and Torres Strait Islander (ATSI) students you would be as well to say so.
The authors seem entirely at ease levelling accusations of ‘marginalisation and racism on campus and in hospitals’ to explain ATSI drop-out rates. It does not seem to occur to them that any ATSI students who have been selected by quota because they are ATSI students, without having reached identical academic standards, will find any medical course more gruelling. This will not be solved by a “firmer commitment to ATSI student retention and more funding”: it will be brought about be ensuring that all ATSI students have the same access to high quality education in their prevocational years so they can meet the admission standards in their own right, independent of any ‘identity’.
The aim of training ATSI students is in part in the hope that they will return to their communities after they graduate. To retain them if they fail the standards in medical training will simply ensure that they perpetuate a substandard health care provision to ATSI patients (and their own form of apartheid) by being graduates not quite up the standard that would be accepted otherwise.
When they are treated equally in all respects will we have a fair society. Equal selection criteria, equal support throughout the course, and equal treatment by all others in the population (both medical and otherwise) – this I can fully support. However, continuing to single them out, both in positive and in negative ways, only perpetuates problems, and should be avoided.