The Hon Colin Barnett MLA Premier 1 Parliament Place WEST WA 6005 Via email: [email protected]

10 February 2014

Dear Mr Barnett,

The medical school proposal

We are writing on behalf of Medical Students’ Association (AMSA), the Western Australian Medical Students’ Society (WAMSS) and the Medical Students’ Association of Notre Dame (MSAND) to express our concern with Curtin University’s proposal to open a new medical school in the eastern suburbs of Perth. Our organisations collectively represent over 17,000 medical students in Australia, and our concerns stem from a pragmatic assessment of the predicament faced by the current medical workforce.

Our specific concerns, and the background to those concerns, are outlined below. In summary, the Curtin University proposal is unlikely to meet ’s need for doctors. Rather, a more likely outcome is that an increase in medical graduates without a commensurate increase in postgraduate training positions will drive medical students who have completed their training in Western Australia interstate, or even overseas. Furthermore, Curtin University’s proposed rural background entry student intake is well below the 33% that is reflective of Australia’s demographics, and thus it is unlikely that a Curtin medical school would directly address the maldistribution of doctors in Australia. In the current climate, the total number of medical graduates should be carefully regulated to ensure that any growth does translate into doctors for rural and remote communities, and furthermore to ensure that growth does not compromise the quality of clinical education being delivered.

In the view of our organisations, investment intended to increase the number of doctors in Western Australia should be focused not on the

Page 1 of 4 establishment of new medical schools, but rather on supporting pre-vocational and vocational training opportunities for medical graduates.

1. Internships and postgraduate training

In the last ten years, the number of medical graduates in Australia has almost doubled. In Western Australia alone, numbers have nearly tripled, increasing by 193%. In the same time period, eight new medical schools have been added, including the medical school at the University of Notre Dame’s Fremantle Campus. Since the first University of Notre Dame cohort in 2008, there has been an increase in Western Australian medical graduates of 38% over 5 years. This surge in medical schools and medical student numbers was triggered by the community’s need for doctors - a need which certainly still exists - and achieved the goal of significantly boosting Australia’s output of medical graduates.

What was lost in the policy to increase medical student numbers was the need to match this increase in numbers with a sufficient number of internships and prevocational training places. The ‘internship’ is a compulsory year of training, following graduation, that is necessary to continue practicing in Australia and gain general registration. The subsequent years of prevocational training are designed to produce competent doctors who can practice independently.

Despite warnings, lack of workforce planning and commitment to a sustainable supply of trained doctors has meant that the issue of unemployed medical graduates is now a reality. In 2013, two Western Australian medical graduates were unable to be placed by the State government. With increased graduate numbers in 2014, this situation is set to worsen. Further down the training pipeline, RMOs (registered medical officers) in Western Australia have been left unemployed, and, in 2013, there were 2000 applicants for specialist training (including generalist training) in Western Australia for only 700 positions available. The bottleneck makes little sense for Australia, given Health Workforce Australia’s Health Workforce 2025 report suggested that Australia may suffer from a shortage of doctors in 2025.

Australia needs more doctors, not more students who are not yet qualified to practise medicine. And yet if the Curtin University proposal for a new medical school goes ahead without State and Federal governments committing to solve the postgraduate training bottleneck, that will be the final result. The funding placed into a new medical school, and in training an increased number of medical graduates, would be better redirected into providing more prevocational training places. Mr Barnett, our organisations urge you and the WA State Government to ensure that the response to the Curtin University medical school proposal is well grounded in the realities of Australia’s health workforce, and furthermore to work with the Commonwealth in establishing a sustainable solution to the internship crisis and postgraduate training bottleneck.

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2. Rural and remote communities

The maldistribution of doctors, and the over-reliance on overseas-trained doctors to fill workforce shortages, are widely acknowledged concerns with current health workforce projections. These concerns were also acknowledged in the aforementioned Health Workforce 2025 report.

Curtin University’s proposal, in its current form, makes few inroads into addressing these needs. The two factors most consistently shown by evidence to predict future rural practice are rural background and positive experiences in rural settings during medical school (for example, through rural campuses or rural clinical schools). Curtin’s Perth-based medical school is likely, based on its own admission, to have a lower proportion of rural background medical students compared to the University of Western Australia and the University of Notre Dame Fremantle.

It would make far more sense to invest in improving the rural clinical school experience at existing universities, than to open a new medical school with limited aspirations to address Australia’s rural health workforce shortage. Furthermore, the Western Australian State government could contribute to resolving the maldistribution of doctors by investing in specialty training positions in regional and rural areas. There are medical graduates who are willing to pursue rural training but are unable to do so because of a lack of investment in prevocational training - addressing this would be simpler and far more cost-effective than establishing a new medical school.

3. Quality of medical education

Finally, the increase in medical student numbers nationwide has placed stress upon the clinical teaching system. Medicine is taught by the bedside, with students gaining significant experience from exposure to real clinical situations. In some areas, access to clinical teaching and infrastructure to support undergraduate training has been lacking, leading to compromises being made in the quality of education received by medical students. Rural health services, tertiary hospitals, GP practices and other metropolitan health services in Western Australia are saturated with students. The Curtin University proposal must address these issues before being granted support by the State government.

Conclusion

AMSA, affiliated medical student societies, the Australian Medical Association (AMA) and Medical Deans Australia and New Zealand (MDANZ) have all expressed opposition to the creation of new medical schools. The rationale behind this opposition is multifold, but is linked chiefly to the ongoing internships crisis and the capacity issues

Page 3 of 4 faced within medical training facilities. Medical graduates are currently missing out on internships, and junior doctors are subsequently missing out on training positions, including training positions within general practice. The Curtin University proposal will exacerbate each of these issues, without addressing the needs of Australian communities. Our organisations urge you, Mr Barnett, to ensure that the Western Australian State government’s approach to this issue is in the best interests of the community, and supports sustainable health workforce planning. If the Western Australian State government is looking to address issues surrounding the distribution of doctors in Western Australia, the solution lies within funding of prevocational and vocational training, not new medical schools.

Yours sincerely,

Jessica Dean Kunal Luthra President Vice President (External) Australian Medical Students’ Association Australian Medical Students’ Association Email: [email protected] Email: [email protected]

Sebastian Leathersich Molly Kehoe President President Western Australian Medical Students’ Society Medical Students’ Association of Notre Dame Email: [email protected] Email: [email protected]

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