Med school hits back at claims it's 'unwanted'
Tempers exploded when the new Curtin Medical School was announced. But what do its teaching staff and students think?
If you were to listen to the main medical lobby groups, you would think that the production line for making doctors was malfunctioning.
A few years back, the problem was about poor output: Australia wasn’t churning out enough doctors, with the result that the country was importing thousands of IMGs to fill the workforce holes — often from countries whose need for their skills and expertise was far, far greater.
Today, the complaint is that the doctor factories — the medical schools — in response to massive demand from students for a career in medicine are overproducing in vast numbers.
Those complaints have focused on one doctor factory in particular. Last week, the $49 million Curtin Medical School in WA started operating, with 60 students beginning their arduous journey to become doctors.
When the school was first announced in May 2015, doctor groups were swift to condemn the move.
Then AMA president Professor Brian Owler called it a “calamitous captain’s call by Captain Chaos”, referring to former prime minister Tony Abbott, who flew into WA to announce the plan.
Worse, according to Professor Owler, this was not about doctors and the medical workforce, but little more than a “political decision” designed to shore up flagging Liberal votes in the state.
Then AMA WA president Dr Michael Gannon was no less critical, describing it as a “shocker” and the “worst decision” in decades of medical policy.
A special school for WA
The 60 students, who, if you are going to be blunt, the medical industry says no one needs, are a select few, chosen from 1500 applicants.
The school’s dean, Professor William Hart (pictured left), rejects, in polite language, the views of the school’s detractors.
“Our students will be trained to the highest standards, ready for internships and future specialisation,” he says.
The school is needed, he says, and he has a sales pitch. Unlike the other medical schools across the country, turning medical students into interventional cardiologists or robotic prostate surgeons, his students are different. They will embrace general practice. They’ve been selected to become the state’s “GPs of the future”.
“General practice is the linchpin of a good healthcare system.
“I’m certainly very hopeful that there will be a way of making general practice a desirable career for students,” he says.
Curtin Medical School will emphasise that a career in general practice in an underserved community is a “worthwhile, interesting and fulfilling career”.
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Students in their fourth year will have a year-long joint attachment to a general practice and a hospital, so they are exposed to the interaction between GPs and hospitals.
“It’s a fact that more and more medicine is happening outside tertiary teaching hospitals. If a student’s experience of learning general medicine and surgery is in a tertiary teaching hospital, they get a very limited understanding of what medicine really is,” says Professor Hart.
“So we want them to have this full, 12-month attachment where they are seeing the patient’s journey from primary care to tertiary care and back again if needed.”
The other argument for the school is that the WA doctor workforce issue is unique. The debate about too many medical schools creating too many doctors is an “east coast issue”, a squabble that does not apply to WA.
The state has fewer GPs per head of population than the rest of Australia — 6.4 GPs per 10,000 people compared with the national average of 7.6. As a consequence, IMG doctors make up 38% of registrations in WA, compared with the national average of 26%.
Professor Hart becomes bashful when asked whether there are narrow political motivations behind the birth of Curtin Medical School. The much championed push for a Murray-Darling Basin School, for instance, did not receive any federal funding in the last budget, despite similar lobbying from universities.
“Every approval of every medical school is a political decision,” says Professor Hart. “Every time a medical school is approved, it’s a decision of the Federal Government. So it’s always political, isn’t it?” he quips.
“I’m not in the position to know or to comment on what influence politics, in the sense of the vote-gathering, had here.”
Curtin Medical School states in its admission guidebook that 25% of the cohort will come from socioeconomically disadvantaged backgrounds, 25% from rural areas, 5% from Indigenous background and the rest would be general entry.
But Professor Hart concedes the quotas mentioned are just targets. And this year’s cohort fell short. Just 8% of the student intake came from socioeconomic disadvantage, rural or Indigenous backgrounds.
Professor Hart also says 43% of this year’s cohort came from interstate. It’s more than he had expected, especially as he says the course is meant to appeal to WA school leavers who normally relocate to other states if they wish to study undergraduate medicine.
“We’re happy with the intake we’ve ended up with, but we have to tweak our selection process to get the right balance of academic achievement and focusing on those with educational disadvantages.”
He says the school is now analysing the reasons why it attracted very few rural applications, particularly when the rival state medical school at the University of WA welcomed 105 rural students in this year’s cohort.
He suggests the short turnaround time to advertise Curtin Medical School’s degree may be to blame. The school only gained Australian Medical Council accreditation in October 2016, around the time students were submitting applications to universities.
Another looming problem —again a problem that only Curtin’s critics believe exists — is that fundamental question around jobs after graduation. What about the intern places?
The cry from the Australian Medical Students’ Association (AMSA) (one it has repeated over the years, even before Curtin was a glimmer in a WA politician’s eye) is that the numbers of doctors is such that hundreds of graduating medical students will be spending their first few years outside uni driving taxis.
Australian Doctor asked Professor Hart if he could guarantee Curtin Medical School graduates would get internships, given that nine graduates missed out this year in WA alone.
Yes, he says. But he declined to go into the specifics of how, despite being pressed on the point.
However, he notes that the nine graduates in the state who missed out on internships this year were international students, who are never guaranteed internships under the priority ranking system used by Australian hospitals.
“The WA Government has guaranteed internship positions for all domestic graduates from medical schools. Curtin Medical School is not having international students,” he says.
Professor Hart’s optimism is not shared by current AMA president Dr Gannon.
He welcomes the new cohort of students and says he hopes they will thrive in the new medical school. But the goodwill does not change his concerns about the way Australia is dealing with its record-high medical student numbers and what happens further down the training pipeline.
To put numbers to this concern, last year there were 17,100 medical students enrolled. Ten years before it was 10,000. Last year, there were 3614 applicants vying for 3314 state and territory internships. The year before, there were 20,069 vocational medical trainees, almost three times the number of trainees in 2000.
“It’s absolutely imperative that the government and National Medical Training Advisory Network start to look at where we actually need doctors. We cannot let medical workforce decisions be driven by short-term political considerations,” says Dr Gannon.
Those calls have been echoed by AMSA’s current president, Rob Thomas.
The association lobbied Assistant Health Minister Dr David Gillespie, at a recent meeting into medical training, urging no more medical schools be built.
They got no promises. But Dr Gillespie did announce a stocktake of medical training places, with the review expected in April.
What happens if the review finds medical schools have flooded the doctor market doesn’t seem to have been much discussed.
Despite AMSA’s long campaign against Curtin, it is still keen to reach out to its students.
Mr Thomas visited the students during Curtin University’s Orientation Week and encouraged them to sign up to his organisation.
He says AMSA can’t turn back time and undo the decision, but they will continue to push for an increase in training places in the hospital system and campaign against new medical schools.
“Across the country, it is getting harder to get internships.
“Essentially, our strong position is that we don’t want to see any more medical schools being opened as we don’t see the need for it, particularly with any increase in medical student numbers,” says Mr Thomas.
“We have to work together to ensure the maldistribution is addressed without flooding the system with too many medical graduates.”
The student view
While the debate over medical student numbers continues to play out in the political arena, Shivangi Gupta (pictured above) is enjoying her first classes at Curtin Medical School.
The 18-year-old, who graduated from high school with an ATAR of 99.90 and scored 90% in the UMAT test, is one of those 60 students accepted for the first cohort.
And no, her choice was not a last resort. Ms Gupta turned down a scholarship from the University of Melbourne to study at Curtin. Curtin was her first choice.
“It was a five-year course as opposed to a seven-year course at the University of WA and some other universities, and it was the only undergraduate course in WA. It’s a new school, so the facilities and learning spaces are good,” she says.
Ms Gupta was born and raised in New Delhi until the age of 15, when she moved to Perth with her family. She later became an Australian citizen.
Witnessing the huge disparity in healthcare access in India sparked her interest in medicine, especially general practice.
“General practice is interesting to me because it has an aspect of continuity of care for patients,” she says. “It’s more diverse with a variety of scenarios and more learning opportunities.”
Ms Gupta is nonplussed about the debate over medical student numbers and whether the existence of Curtin Medical School will exacerbate the problem.
“I’m very excited to go to Curtin Medical School,” she says.
“I think there has to be a proportionate increase in training positions because there is a bottleneck, but we definitely need more medical students in WA. It is such a big place and they need a lot of junior doctors.
“I’m pretty sure I’ll get an internship somewhere that doctors are required, even if it’s outside the city.”
As for Professor Hart, he is confident that despite the cool response from the medical community, the school will succeed, particularly in its attempts to boost doctor numbers in underserved communities.
“We can plant those seeds to show our students the good role models in general practice, in mental health and aged care.”
And to make crystal clear Curtin is a doctor factory with a difference, he adds: “To succeed [in medicine], it’s not necessary to aspire to be an interventional cardiologist.”
Rachel Worsley is an Australian Doctor Group reporter.