Matthew Scott
Whangarei, March 2, 2024
Voices in the health sector are questioning whether a new Medical School plan will address potential pipeline issues in training but say that it could be an opportunity to improve conditions for medical students.
An agreement between the Ministry of Health and the University of Waikato was signed earlier last month to explore the viability of a third Medical School via a feasibility study and cost-benefit analysis.
While the memorandum was non-binding and the new school remains theoretical for now, it is a concrete step towards providing a third source of homegrown talent to solve the health workforce shortages that have plagued the country in recent years.
The University and the government are now developing a business case, aimed at a first intake of 120 students in early 2027, which Vice-Chancellor Neil Quigley called to Health Minister Dr Shane Reti, “a present to you to start your second term in government.”
National’s first bid
That email was sent in March 2023, with freshly launched policy a keystone in National’s bid to get the health sector “back on track.”
It was not the first time that National had backed a Medical School in Waikato.
The Party backed a 2016 joint bid between Waikato University and the former Waikato District Health Board to establish a school.
A clear National victory last October would have been good news for Quigley, who could reasonably expect a promise on the estimated $280 million the Crown would cover of the school’s total $380 million price tag.
But the promise came with a caveat once the three-Party leaders emerged from 40 days of coalition agreement negotiations.
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Cost-Benefit Analysis
One of Act Leader David Seymour’s asks appears to have been that a full cost-benefit analysis be conducted on the Medical School before any binding handshakes.
While on paper that proviso may just reflect a desire to quantify the investment before diving in headfirst, sceptics in the health sector are hoping it will create an opportunity for the University and Crown to answer some key questions.
Concerns that a new Medical School would overload already highly competitive specialist training were raised last year when the Policy was announced.
While the programme of work to create the business case promises to explore “health and education sector dependencies for the establishment of the Medical School, such as supervisory and training capability and capacity, safety, and accreditation,” it remains unclear how training bottlenecks could be averted.
Building human resources
Association of Salaried Medical Specialists Policy and Research Director Harriet Wild said that while the Association was supportive of new doctor training places, there needed to be a plan for where those students would go once they graduated.
She said that a lack of senior staff limited how many junior doctors could be taken on in a supervisory or training capacity.
“It is about all parts of the system working together. We are a small country at the bottom of the South Pacific with a global workforce shortage, so we are competing with the likes of Australia and Canada. We have to make sure we are holding on to the people we are training,” she said.
Keeping the training pipeline unimpeded means making sure that there are enough experienced doctors to step in, and that they are not under pressure that they cannot spare the energy.
Ms Wild said that workforce shortages could be solved by both immigration levers and stemming the tide of young doctors going abroad in search of better conditions.
“We need to hold onto the doctors that we have and stop the drain. We have senior medical officers who are already burnt out. We have to create ways and means to keep people here,” Ms Wild said.
New Zealand has the highest reliance on overseas-trained doctors within the OECD (about 44% of doctors trained overseas) as well as high levels of locally-trained doctors leaving.
So, is a new Medical School like turning on a new tap without fixing the leak in the bucket?
Ms Wild said not if something was done to make the sector a safe and sustainable place to work.
“There is no better time to start planning than right now in terms of supporting those medical graduates that will come through into a sustainable workplace. That is going to take all parties, and the players in this system are many,” she said.
Policy changes needed
Divyashri Thakkar, Advocacy Vice-President of the New Zealand Medical Students’ Association, said that while the Association had no formal stance on whether the Medical School was a good idea, increasing the number of graduates would require changes in other areas.
“If we are increasing the number of graduates, it is putting a bottleneck at the Postgraduate Vocational Training (PGY1 level), because currently there are not enough spots. Unless they change that system, you will end up with more medical graduates but not more doctors,” she said.
Ms Thakkar wants to see some changes to conditions for medical students which were not currently spelt out in the agreement between the Crown and the University, although according to her, this could provide an opportunity to find some solutions.
The Association advocates for increasing the number of PGY1 positions and ensuring the financial wellbeing of medical students.
“If we are looking at potential solutions, our priority is students and their wellbeing, something that should be thought about ensuring that there are enough spaces,” she said.
Another question that she raised was the source of medical teaching staff.
“We do not have much on this, but they cannot just be from the University of Otago and the University of Auckland because this would affect the other schools,” Ms Thakkar said.
A Graduate Entry Programme
The Waikato Medical School has been pitched as a graduate entry programme, meaning that it would pack the usual Medical School curriculum into four years for students who have already completed a three-year undergraduate degree.
Ms Thakkar said this meant more focus on alleviating challenges faced by older students, especially those with children.
“As the number of postgraduates increases, so does the need for more childcare,” she said.
Medical students without children to care for were already struggling, with student living cost payments not rising to match inflation, she said.
“But it becomes hard on parents who are trying to graduate. Parents in medicine are already struggling to finish their degrees. If there is a new Medical School, we do hope that it is an opportunity to address all of these problems,” she said.
Last year’s Health New Zealand workforce plan suggested that shortages could be eased by long-term changes to how doctors are trained.
“Our education pathways will need to be more deliberately designed to reflect the realities of people’s lives and to acknowledge that health training is often a full-time job, which can impede people training without the right support.”
The graduate-entry nature of the proposed school could help by providing a wider suite of options for people looking to study medicine.
According to the University of Waikato, research shows people who study in a regional location and work in primary care are also more likely to stay there.
Matthew Scott is a Reporter at Newsroom writing on inequality, MIQ and border issues based in Whangarei, Northland, New Zealand. The above Report and pictures have been published under a special agreement with Newsroom.
