New report makes strong case for Murray Darling Medical School

Charles Sturt University and La Trobe University have been championing the MDMS proposal for the past five years while urging the federal government to invest $54 million over four years to help get it off the ground.

That funding would help to install the necessary medical training equipment and re-purpose specialist educational facilities based at Bendigo, Orange and Wagga.

The proposal also involves setting-up about 16 clinical training locations throughout the Murray Darling region to boost the program’s underpinning aim of educating undergraduate doctors in the regions to ultimately work there, to help overcome ongoing chronic doctor shortages.

Another vital aspect of the proposed rural medical school is a request for the federal government to back an initial allocation of 120 Commonwealth supported medical student placements per year from 2018, rising to 180 by 2020.

Proponents of the MDMS also want 80 per cent of those positions - or Commonwealth Supported Places (CPS) - to be reserved for students coming from regional, rural, remote and indigenous backgrounds, believing that approach best serves the outcomes focussed program’s core policy goal of filling regional doctor shortages.

The new study into the MDMS’s potential social and economic impacts was conducted by PPB Advisory and commissioned by Charles Sturt University and La Trobe University.

The report released today said the medical training facility would help solve doctor shortages in regional NSW and Victoria by providing around 90 doctors each year once fully operating.

The favourable findings are being publicly released ahead of the May 9 federal budget.

But Charles Sturt University Vice-Chancellor Professor Andrew Vann said despite strong political support from the Nationals - especially leader Barnaby Joyce and deputy leader and regional Development Minister Fiona Nash - there was no guarantee the $54 would be delivered.

Professor Vann said there were several where places the money could actually come from - some of which may require explicit budget approval and some that may not - but he would now wait to hear back from those sources.

However, Professor Vann believes the PPB Advisory report emboldens the case for taxpayer dollars to be spent on opening the MDMS to deliver more doctors into regional areas.

The report says in relation to the policy goal of increasing the number of doctors based in regional Australia, the MDMS was likely to be more cost effective than current approaches.

“Specifically, relying on the ‘sticky’ effect of regional medical education is more cost-effective than conducting medical education in the cities and then subsidising or otherwise encouraging doctors to move to the regions,” the report said.

“Using the mid-case as an example the MDMS anticipates it will be able to achieve a post-graduate doctor regional retention rate of 50pc out of an annual cohort of 180.

“Metropolitan universities would typically be required to train 692 doctors to achieve the same annual number of regionally retained doctors.

“The difference in CSP funding to achieve the same annual number of graduated regionally based doctors is $144 million in net present value terms over the 2017 – 2050 period of this analysis.”

Professor Vann said throughout the campaign, MDMS proponents had stated there was a long-standing problem with the maldistribution of doctors and the government had spent a lot of money on many programs over many, many years to try and solve regional shortages but “it’s still a problem”.

The report said the extent of maldistribution was “somewhat masked” by the heavy reliance on international medical graduates, which comprise 40pc of the doctor workforce in regional and rural areas.

“We have a proven policy solution that’s efficient and effective, based on the experience of our universities in health and based on the experience of other Australian universities like James Cook University and international schools,” Professor Vann said.

“This report really shows the economic value of the MDMS both as a health investment and a regional development initiative.

“We’ve been talking very closely to the government about the MDMs and think we have a great solution here.

“The report that PPB has done is really just kind of putting the bow on it from our perspective, in terms of demonstrating how good it is from a financial perspective.

“We’d really love to see this funded now and to start being able to make this contribution to our communities.”

Professor Vann said the PPB Advisory report’s economic modelling made a conservative estimate that the MDMS would deliver about $2b in value over the 2017 to 2050 period, based on direct expenditure and the additional jobs it created, in the NSW and Victorian regions it was located.

He said the analysis also showed the program was three times more cost-efficient in terms of expenditure on student places than trying to train doctors in metropolitan areas “and that’s the core of what we’ve been saying”.

“An awful lot of money has been spent trying to fix this problem and it hasn’t worked and the reason it hasn’t worked is you need to train doctors in the actual places where they’re going to practice,” he said.

“The core proposition of having a regional university is that you keep human capital in the places where it’s needed which is just common sense and the same applies in medical training which is why we’re making the case.

“At the moment, if you’re from NSW and you want to be a doctor you basically have to do most of your training in the city and if you spend five years in Sydney we all know you’re very likely to meet your future partners through student networks.

“The likelihood is that when you get to the end of your degree, you’ve got a life and relationship and family in the city and it’s very difficult to get them back to the regions.

“A key part of the MDMS program is having a pipeline of people from the regions studying in the regions who want to continue working in the regions.”

Professor Vann said the MDMS was actually quite a small initiative, in the overall scope of medical education in Australia.

“We’re not saying no one should be trained in the cities but what we’re asking for is very, very modest in terms of the numbers of people who live in regional Australia,” he said.

“The case we’re making is that this is an efficient investment and it’s a good way to train people from a health policy perspective and a health expenditure perspective.

“And it’s good from a regional development perspective and actually quite a small initiative in the overall scope of medical education.

“We’ll always argue investing in regional universities is important but this is a very good way to invest in regional communities as well because it will bring additional professionals and it will bring extra students and encourage others to study courses that are pipelined into medical education.

“It’s a good way to strengthen those communities overall.”

Professor Vann said the idea of looking at cross-university collaboration, to fill regional doctor shortages, came about when Simon Crean was the Regional Development Minister in the Rudd/Gillard/Rudd Labor government.

But he said most of the policy and funding discussions had been held with the current Coalition government since they’ve been in power, after the 2013 election.

The MDMs also has the “full backing” of Mr Joyce, he said, but the Greens and other political groups had a different set of political priorities, given its proposed locations in conservative based electorates.

Professor Vann said medical placements were the only part of the Australian undergraduate education system still capped but they were needed in order to actually run the MDMS program.

“We think there will have to be a reallocation of existing places, if no new places can be created,” he said.

La Trobe Vice-Chancellor, Professor John Dewar said the report proved the MDMS, based on the very successful James Cook University medical training model, would solve existing doctor shortages.

He said currently, only 10pc of doctors trained by city universities go on to practice in rural and regional Australia – but under the MDMS model, at least every second doctor would work in the bush.

“Rural students who undertake extended periods of training in a rural area are four times more likely to work in rural practice,” he said.

The report said one of the main social impacts expected from the MDMS was improved health and well-being outcomes across the wider Murray Darling community.

“For example, our mid-case estimates that around 1889 new doctors will be practising in the region by 2050,” it said.

“Studies linking doctor/population ratios and avoidable death rates estimate the increased number of doctors in the region will reduce the number of avoidable deaths in the region.

“A better regional health workforce and associated services is also expected to increase the attractiveness of the region for non-residents and may help to drive increased population growth.

“In general, vibrant and diverse rural and regional communities are likely to benefit all Australians.

“Other forecast impacts include a further 'attraction dividend' or 'halo effect' resulting from anticipated growth in student numbers studying allied medical disciplines; as well as regional investment derived from increased numbers of doctors graduating and working in the region.”

Professor Vann said many communities based around his university “struggle” because they don’t have the support of a local GP.

“It’s one of the biggest issues that I hear about when I drive around regional NSW,” he said.

“If you can’t get proper health care or medical support it does undermine communities and makes it much tougher for those regional communities to thrive.”