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Monday, 9 December 2013
Page: 2078


Dr GILLESPIE (Lyne) (13:23): I am delighted to speak in support of this motion on rural clinical schools. We have seen real benefits from this initiative. As a medical specialist myself, and having spent the last 20 years in the regions, I have seen what rural clinical schools can deliver.

This initiative was introduced by the federal government back in 1999, and the aim was to decentralise medical training. Now we have 17 rural clinical schools, established by 16 of the 19 universities with medical faculties. In our electorate we have a campus of the University of New South Wales School of Rural Health, in Port Macquarie, and in the Manning, in Taree, we have the University of Newcastle Department of Rural Health and Rural Clinical School. They have both delivered great results. There is a lot of evidence showing the benefits of this rural clinical schools program. The likelihood of a doctor ending up in rural practice once they have finished their training doubles if they come from a rural background. Another factor that helps is having a partner who went to high school in a rural location. But there is something else that will help, and that is rural postgraduate training, as rural clinical schools and universities only turn out half-cooked doctors. They graduate with a degree but the gestation period for producing a clinician who can practise safely and competently takes at least another four years.

Since 2003 we have had a massive increase in the number of medical undergraduates. It has gone from 1,266 to 3,185 graduating in 2015. But Australian cities have 370 doctors per 100,000 people, and some of the inner city areas have even greater concentrations than that versus 200 per 100,000 people in the rural and regional areas, and even less in the remote areas. But at graduation, most of the people leaving the rural clinical schools expressed a great desire to go into rural practice. In fact, at the University of Sydney rural clinical school, 80 per cent said they wanted to go into rural practice, and at the University of New South Wales rural clinical school, that figure was 72 per cent.

How do we convert this into a doctor who decides to live and work in a rural location? The answer is to keep this system going and then support it, because we have half the recipe there; we just need the rest of it. The remaining part of the recipe is to get post-graduate training expanded in these rural locations, because it is during this extended gestation of producing a skilled doctor that people set down their roots. They partner off, they make real estate purchases, they have children, they have developed social networks and all of this is lost if they are forced back into the cities to do their post-graduate training. As the head of the Australian Medical Students Association said the other day:

Medical graduates can't fix a rural workforce shortage if there aren't rural jobs to go to. Without an expanded rural training capacity, the new doctors would be forced to return to the cities—

Just as I was outlining:

There, they would likely settle down.

My case rests, even the students have recognised that.

Evidence that rurally-based post-graduate training delivers results is striking. The statistics of the professor of General Practice and Education Training Limited indicate that if you have had GP training in a rural location for half your time, there is a 46 per cent chance that you will stay practicing in a rural location for at least five years. That is a pretty good strike rate; 46 per cent—a cricketer would be glad if he had a strike rate like that, let alone producing a doctor.

In my own little patch we turned the Port Macquarie Base Hospital from the humble Hastings District Hospital into a post-graduate teaching centre and examination centre. We have a rural clinical school and twelve or more advanced trainees—baby specialists. After converting it into a training centre, we now have two specialist cardiologists, one specialist chest physician, one specialist dermatologist, one specialist A&E physician and one infectious diseases specialist residing in Port Macquarie. That is not a bad strike rate out of the medical registrars that we trained in Port Macquarie. (Time expired)