Rural medical schools and regional placements helping address doctor shortages in country Australia

Article Courtsey : Landline / By Bill Ormonde

Maggie-Kate Minogue was seven when she realised she wanted to be a doctor.

Complications with her sister’s birth were the catalyst for an early interest in health and helping people.

But growing up in a country town of 80 people meant after high school she had to move hundreds of kilometres to Sydney, to study medicine at the University of New South Wales (UNSW).

After two years in the city, she discovered UNSW’s rural medical school in Wagga Wagga, near her hometown of Murrumburrah.

In 2014, students were not able to complete their full degree there, but Dr Minogue was able to transfer to the school to finish her studies as a general practitioner and rural generalist.

A white woman with brown hair and glasses listening to a woman speak. — Maggie-Kate with a patient, at the medical practice where she now works in Gundagai.(ABC Landline: Bill Ormonde)

“There’s just something quite magical about small towns that I don’t think you could get in a city,” she says.

Dr Minogue is one of dozens of doctors trained in regional Australia who are choosing to study and work remotely post-graduation.

She believes rural medical schools could play a critical role in overcoming doctor shortages in country areas.

“There is a lot of optimism about future training pathways and encouraging the upcoming high school and university students to embrace rural culture and to stay rural while training,” she says.

It is part of a cultural shift being witnessed by UNSW Associate Dean of Rural Health Tara Mackenzie.

A woman with short dark hair sitting at a desk with x-ray scans on a computer screen behind her. — Tara Mackenzie has seen changing attitudes towards rural medicine in recent years.(ABC Landline: Bill Ormonde)

Professor Mackenzie fell in love with Wagga on a placement 20 years ago, but was told if she stayed, she would be throwing her career away.

“Now, nothing could be further from the truth, but when you’re hearing that as a junior doctor, unfortunately that can also influence where you go,” she says.

Aspiring doctors could not study a full medical degree rurally in NSW until 2017, but now there three locations that offer the course regionally.

“[In the past] many students went through all of their university degree and never got a chance to experience rural life,” Professor Mackenzie says.

A white woman with blonde hair at the UNSW rural medical school in wagga listening to a presentation. — The majority of the medical students in Wagga Wagga grew up in regional areas.(ABC Landline: Bill Ormonde)

GP and doctor shortages

Pam Ellerman has lived in Deniliquin, about three hours west of Wagga Wagga, for 54 years.

The town of 7,000 seems to be well-resourced.

But Ms Ellerman, who has served on hospital auxiliaries for decades, says the town’s GPs are not always available.

“There’s probably three [GPs] in one [clinic], four in another, two in another but those doors are locked,” Ms Ellerman says.

During a recent inquiry into regional health in New South Wales, many witnesses from rural areas spoke of waiting weeks and months to see GPs and specialists.

The Deniliquin Hospital in the early hours of the morning in Autumn. — A recent inquiry found people living outside cities had “significantly poorer health outcomes”.(ABC Landline: Bill Ormonde)

Ms Ellerman does not mind using telehealth and accepts having to drive several hours to Melbourne or Wagga Wagga to see a specialist.

However, she believes the concept of rurally based medical schools filled with country kids could improve healthcare in regional Australia.

“If we get homegrown … it’s gold … I think it’s going to be a win-win for all communities,” she says.

An older white woamn with blonde hair and glasses smiling at the camera on the street. — Pam Ellerman is a passionate regional health advocate.(ABC Landline: Bill Ormonde)

Rural placements doing their part

As well as rural medical schools, other universities are also encouraging student doctors to undertake placements in the bush.

Growing up on Adelaide’s outskirts, Sebastian Baker had not considered a career in rural Australia.

“At the start of the year I was thinking of going into physician training — so like, doctors that work in the hospitals on the wards,” Mr Baker says.

Now in his fifth year of study with the University of Adelaide, he has been based in Broken Hill with various health services, including the Royal Flying Doctor Service (RFDS).

“I didn’t really think of it as a serious option until I came up here and now … I’m thinking that might be my career,” he says.

A young man with brown hair and a blue hoodie at the Broken Hill University Department of Rural Health — Sebastian Baker, a student from the University of Adelaide, has trained in Broken Hill.(ABC Landline: Bill Ormonde)

Research by the University of Queensland in 2023 showed those medical students who completed a 12-week placement with a two-year training program were “around seven times” more likely to end up working in a small rural or remote location.

Mr Baker’s classmate, Amos Lee, grew up in Melbourne and wants to become a rural psychiatrist.

“I want to be there to help with that change and really help the mental sphere in rural and remote places,” Mr Lee says.

A young female doctor wearing a green sweater and a stethoscope stands next to her male counterpart — Marni McFarlane and Sebastian Baker both spent time at Broken Hill’s RFDS medical clinic.(ABC Landline: Bill Ormonde)

For fellow student Marni McFarlane, a year in the outback has given her direction post-graduation.

“I’m already looking at applying remote, rural … I don’t think I would even consider working in Adelaide,” Ms McFarlene says.

“Doctors are more willing to give you a go at things, to be a bit more hands on, but so are the patients.”

UNSW’s students in Wagga Wagga also cited more hands-on work as a reason for their growth.

An Aboriginal woman wearing a pink and purple shirt standing in the middle of the footpath. — Nola Whyman has experienced plenty of challenges finding GPs to work in outback NSW.(ABC Landline: Bill Ormonde)

Challenging old narratives

Nola Whyman, director of operations for Broken Hill-based Aboriginal health service provider Maari Ma, has decades of experience.

“We’ve had a concerted effort to get GP’s out here and diverted to a regular fly-in fly out [service, so] there’s continuity for our patients,” she says.

“What’s really important is having students come out here.”

A doctor with a stethoscope listening a patient breathing — GP Maddison Kane returned to Maari Ma after her placement.(ABC Landline: BIll Ormonde)

GP Madison Kane started at Maari Ma as a student and returned to work there almost two years ago.

Dr Kane believes rural medical schools and increased clinical student placements outside the big cities are important ways to encourage the next rural generation to study medicine.

“The pathways for a rural person to become a doctor has become more streamlined in recent years through various access initiatives, as well as the establishment of rural clinical schools,” Dr Kane says.

But Professor Mackenzie in Wagga, believes more change is needed to improve specialty training.

Only psychiatry, general practitioner and emergency medicine training can be completed rurally, which she says is a contributing factor to the doctor shortage in regional areas.

“If they could do eight of their 10 years in a rural or regional place and just go back to the metropolitan [hospitals] for the part they need, then that is when you’re going to see people stay,” she says.