Medical schools must make rural health a priority 

Where a person lives in Australia can greatly affect their quality of health. People in rural areas have far poorer health outcomes than those in metropolitan areas, including shorter lifespans and a higher burden of disease. There are several reasons for this, but perhaps the most important is that there just aren’t enough doctors and other health care workers in rural areas. Regional and rural Australia is home to around 30% of Australians but only around 20% of doctors, so there are fewer doctors per resident.

This problem is not new, and it is very hard to address.

It does seem that there is more to this problem than money alone. Despite government incentives, rural Australian towns are struggling to find doctors, particularly doctors trained in Australia. In some cases this has led to bidding wars for locums and to small towns offering huge financial rewards for a general practitioner to set up a local practice. Such approaches are not sustainable.

There is a considerable body of research that suggests the solution lies in the selection and training of medical students. We know that students with a rural background who spend long periods of their training in rural clinical settings are more likely to practise in a rural area, and it is these students who should be the focus of rural medical programs.

The University of Wollongong (UOW)’s Graduate School of Medicine was established in 2007 with a core focus on training doctors to work in regional and rural communities. To achieve this goal, UOW recruits students from rural backgrounds, has a rural focus in the curriculum, and has a significant part of its preclinical and clinical activities in rural settings. This approach requires considerable time and resources, so we wanted to know whether it has been successful.

In our work, published in the Australian Journal of Rural Health, we used the Medical Students Outcomes Database (MSOD) to compare the work locations between UOW’s medical graduates and the national cohort of medical graduates. The MSOD is owned by Medical Deans Australia and New Zealand, who have been surveying the preferences of medical graduates since 2005. Recently, the MSOD added a longitudinal aspect to the database by linking surveys to locations and specialties listed in annual Australian Health Practitioner Regulation Agency (Ahpra) registrations.

Using the MSOD, we showed that 28.8% of medical graduates from UOW worked in regional or rural Australia in 2022 compared with only 19% of Australia’s medical graduates. In addition, we found that 42% of UOW graduates specialised in general practice compared with 27.7% of all Australian graduates, which is unsurprising as general practitioners are more likely to work in rural areas than other specialties. These statistics suggest that UOW is fulfilling its purpose of training doctors for rural areas.

The MSOD data provide clues as to how UOW graduates differ from the national cohort. As might be expected, UOW graduates were more likely to have a rural background and train in a rural placement. UOW graduates were also more likely to be partnered and have dependents, which may influence career choices. Although family and carer circumstances are not typically considered in workforce research, our study suggests that perhaps they should be.

This study has several limitations. The MSOD exit survey is self-reported, and some graduates may classify themselves in a manner that may not agree with university or government methodology (eg, by rural origin). In addition, there are gaps in the data. Not every graduate has agreed to be part of the MSOD, and annual registration data don’t capture the contributions of doctors working in rural Australia for part of the year.

Despite these limitations, the MSOD is a powerful new tool in graduate tracking and workforce planning. We consider the MSOD to be the largest and best of its kind in the world, and the data used in our report are only a small portion of what is available. A similar database is planned for nursing and allied health which will provide further depth of understanding for the Australian health workforce.

There is growing recognition that the answer to the rural health crisis won’t be found in cities, but rather in rural populations themselves. Our study adds to the body of work supporting this idea.

Several Australian universities, including UOW, are now focusing on end-to-end medical education during which students complete all their training in rural Australia. In December 2023, the federal government announced $90 million in funding to support end-to-end rural medical training, including 80 new Commonwealth Supported Places for medical students annually. The money and placements were spread across universities with a strong focus on rural health, with UOW allocated 15 places and $16.3 million in funding. These new training positions are a step in the right direction, but more are required – for context, there were 3184 domestic medical graduates in 2023, so 80 new places is a relatively small change.

Although these new students will make a welcome contribution to rural health, there is a great deal still to be done. Our work shows that it is possible to address the shortfall of doctors in rural areas if medical schools make rural health a core priority.

Dr Colin H Cortie PhD is a Post-Doctoral Research Fellow at the Graduate School of Medicine at the University of Wollongong.