New medical school not based on policy
Kiran Narula, Kate Nuthall
Tuesday, December 1st, 2015
The Australian Medical Students’ Association (AMSA) is the peak representative body for medical students in Australia. AMSA connects, informs and represents students studying at each of the 20 medical schools in Australia by means of advocacy campaigns, events, community and wellbeing projects, and the production of a range of publications.
The Abbott Government’s announcement of a third WA medical school has been met with disappointment from medical students nationally. [1,2] It will exacerbate the bottleneck in medical training whilst doing little to help rural Australia. The decision seems to be more concerned with politics than any real plans to shape a sustainable workforce.
You may consider us hyperbolic, but there is significant truth to our words. Since 2001, medical student numbers have increased dramatically through the establishment of ten new medical schools and the expansion of places at existing schools.  In 2013, there were 3,441 medical graduates, over double the 1,400 graduates in 1999. This in turn led to the internship crisis in 2012; for the first time, some locally trained graduates were unlikely to be offered an internship.  Through a large #interncrisis social media campaign, and political pressure from opposition political parties, the fated outcome was avoided.  Each year since, the Australian Medical Students’ Association, in conjunction with their state affiliates, have had to advocate strongly to ensure locally trained graduates are able to secure an internship.
The swell in medical student numbers is having flow-on effects to resident medical officer and specialist training positions. There are too few positions, and those that do exist are heavily oversubscribed.  It is therefore disingenuous for the Government to purport that increasing student numbers will somehow solve Western Australia’s GP shortage when they have not also funded training positions. 
There is a looming bottleneck in the system, with the time taken to become a fully qualified consultant after graduating medical school increasing.  From anecdotal evidence, we suspect that this ballooning time is due to an accumulation of junior doctors stuck in their residency unable to enter a speciality training college, including general practice. Unfortunately, there is little data to support this, which is why the AMA Council of Doctors in Training is advocating for a National Training Survey to highlight this likely problem. 
Given each of these difficulties, we find it incredulous that the Government has sought to increase student numbers further by opening a new medical school. The previous expansion of medical student numbers was so rapid and effective that the 2014 Health Workforce Australia report on doctors recommended that “no change should be made to the total medical student intake in 2015”.  The Government is ignoring its own Department’s advice for political gain.
Curtin’s proposed medical school is also unlikely to solve the rural doctor shortage.
Australian research has shown that the most effective method of encouraging local doctors to work rurally is to train medical students through a Rural Clinical School (RCS) – a program whereby students spend a year training in rural areas. [11,12] Students who participate in the RCS are twice as likely to work rurally upon graduation. [11,12] Curtin has no plans for a rural clinical school. Instead, the university intends to recruit 20% of their medical student intake from country WA.  This however falls short of the WA average (25%), and even shorter of the proportion of population that lives rurally (33%). 
There are better fiscal alternatives to promoting rural medicine than opening a new medical school. The Federal and Western Australian State Governments should direct their expenditure to expand the number of RCS places. In Western Australia, there has been unprecedented interest in the RCS with applications to the school exceeding positions two to one.  Similarly, rural pathway places for general practice training should also increase. Ensuring that the yearly intake of medical students reflects the rural proportion of the general population could also direct further benefits to rural Australia.
Curtin has put forward the same proposal for a medical school to fix WA’s doctor shortage for the past 7 years, yet each year the Federal Health Department has knocked it back as it did not address key concerns. Why has the Government now ignored its own Department’s advice and supported it? Let us examine the state and federal electorates in which the new school will be built.
The Federal electorate of Hasluck is held by the Liberal MP Ken Wyatt by a marginal 4.3%.  The State electorate of Midland is held by Labor by a mere 24 votes.  It begs the question, is the Curtin Medical School about sound health policy or instead votes at the next election?
While the new medical school is slated to open in 2017, it is time we removed politics from the policy planning regarding our future medical workforce. We have described some of challenges to the long- term viability of the medical training pipeline in Australia, and these
need to be carefully considered to ensure its longevity for all medical graduates, including those from Curtin Medical School.
 New medical school will worsen medical workforce crisis [Internet]. Perth: Western Australian Medical Students’ Society; 2015 May 17 [cited 2015 Jul 28]. Available from: http://www.wamss.org.au/blog/2015/05/17/new-medical-school-will-worsen-medical- workforce-crisis/
 Media Release: NSWMSC concerned by the establishment of a new medical school [Internet]. New South Wales Medical Students Council; 2015 May 17 [cited 2015 Jul 28]. Available from: http://www.nswmsc.org.au/blog/media-release-nswmsc-concerned-by- the-establishment-of-a-new-medical-school
 Department of Health. Medical Training Review Panel – eighteenth report. ACT, Australia; 2015. Available from: http://www.health.gov.au/internet/main/publishing.nsf/ Content/work-pubs-mtrp-18
 National Internship Crisis. Australian Medical Students’ Association; 2012 [cited 2015 Jul 28]. Available from: https://http://www.amsa.org.au/advocacy/internship-crisis/
 Cadogan M. The Intern Crisis. Life in the Fast Lane; 2012 [cited 2015 Jul 28]. Available from: http://lifeinthefastlane.com/the-intern-crisis/
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 New Medical School for Curtin University. Canberra, ACT: Commonwealth of Australia; 2015 May 17. Available from: https://http://www.pm.gov.au/media/2015-05-17/new-medical-school-curtin-university-0
 McNamara S. Does it take too long to become a doctor? Med J Aust. 2012 [cited 2015 July 28];196(8):528-530.
 AMA Council of Doctors in Training. AMA CDT Strategic Plan 2014-16. ACT: Australian Medical Association [cited 2015 Jul 27]. Available from: https://ama.com.au/article/about-ama-council-doctors-training
 Australia’s Future Health Workforce – Doctors. Canberra, ACT: Health Workforce Australia; 2014 August.
 Playford DE, Evans S, Atkinson DN, Auret KA, Riley GJ. Impact of the Rural Clinical School of Western Australia on work location of medical graduates. Med J Aust. 2014;200:1-4.
 Kondalsamy-Chennakesavan S, Eley DS, Ranmuthugala G, Chater AB, Toombs MR, Darshan D, et al. Determinants of rural practice: positive interaction between rural background and rural undergraduate training. The Medical journal of Australia. 2015;202(1):41-45.
 Curtin Medical School. Frequently Asked Questions. Curtin University. Available from: https://healthsciences.curtin.edu.au/teaching/med-faqs.cfm
 House of Representatives Division First Preferences: WA Division – Hasluck [Internet]. Canberra, ACT: Australian Electoral Commission; September 2013 [cited 2015 July 27]. Available from: http://results.aec.gov.au/17496/Website/HouseDivisionFirstPrefs-17496-305.htm
 2013 Midland District Results [Internet]. Perth, Australia: Western Australian Electoral Commission.; 2013 [cited 2015 Jul 28]. Available from: https://http://www.elections.wa.gov.au/elections/state/sg2013/la/MID