‘In tears daily’: Calls for more rural medical training ramps up

Clinicians are breaking down in tears daily over pressures they are facing from staff shortages, a rural healthcare manager says.

He is among those desperate to see rural medical training programmes increase.

Dave Ireland, who runs GP practices and health clinics in Dannevirke, Pahiatua, Woodville and Norsewood, said he has half the number of staff needed for the 14,500 patients on the books.

He said clinicians were working 20 hours over full-time just to keep up.

"I have staff crying regularly because of this situation, they feel at times they are letting the community down."

The operations manager at Tararua Health Group said three long-standing rural GPs have retired in the past 18 months and he cannot find new hires.

While a number of medical students were being trained in the district, he said not enough were coming through the pipeline.

"This year, for example, we don't have a registrar that's come here through the college, that makes it very difficult to attract people to get involved in rural GP practices and the community and maintain them, it's really hard."

University of Otago research shows that students who undertake rural immersion training are five or six times more likely to go back to rural medicine.

The university has 35 rural immersion training places per year as part of its six-year medical degree - ten extra places were funded by Health NZ for this year with small groups of students training in rural hospitals for 12 months.

Auckland University will start a rural immersion programme next year for 15 students.

University of Otago medical school's acting dean, Professor Tim Wilkinson, said the rural pathway costs double of a standard medical student pathway.

He wanted to increase the number of rural placements, but said it depended on the government lifting the cap on medical students.

"We know what to do to increase the number of people interested in rural, we know what to do and how to do it. We just need to be allowed to do it," Wilkinson said.

Waikato University's proposal for a third medical school could take 120 post-graduate medical students over four years.

A spokesperson from the university declined to provide any comment to RNZ while the business case for the medical school is still under review with the Ministry of Health.

But vice-chancellor Professor Neil Quigley told RNZ in May that after one year on campus, students would do two years of different placements in regional and rural hubs, and also one full-year immersion course.

"Our plan isn't to move thousands of students to Hamilton for eight years, and then at the end tell them their doctors and they can go practice anywhere they want. Our plan is to have them here for one year and then get them out doing things in locations where we have built the capacity to train them."

They were now considering training hubs outside of the Waikato region.

Whanganui District mayor Andrew Tripe said he has been in talks with Waikato University to facilitate the programme in his district.

"In the latter years of a medical student, they would come down to Whanganui, and work as GPs in regional New Zealand and rural New Zealand and some people prefer that - they don't want to go to the big city they want to live in the regions and they realise the opportunities here for a lifestyle are often much better than a big city."

Te Whatu Ora national clinical director for primary and community care Dr Sarah Clarke said local government could take an important role in encouraging young rural doctors.

"We really want the community to get in and wrap around them, find the right job for their whānau, find the right job for their kids, get them involved in the local sports team," Clarke said.

Clarke, who is also a rural doctor at Kaitaia Hospital, admitted there was not enough staff in rural areas but said work being done was changing that, including in a boost in funding for the numbers of rural admissions at medical schools, and giving an extra $9100 to those doing their GP practice training if they live within 30 kilometres of a rural practice.

"I think we need to be seeing a lot more of the same, I think there's a whole lot of good stuff that's happening and we are seeing the pipeline increasing and we are seeing people coming back who were our students."

But she said when people were mainly trained in big cities, the overwhelming majority built connections in their formative years which made it difficult for them to move to rural areas.

She said she did not have a view on the prospect of a third medical school.

"I guess it doesn't matter to me how we go about training more people who want to work in rural places, and more doctors who want to be GPs. It doesn't matter to me if that's a third medical school or something else, I just want to have a few more colleagues."

RNZ requested an update from Health Minister Dr Shane Reti about when the business case for the Waikato medical school would be completed, but no date was given.

The minister also did not confirm whether he was considering scaling up numbers on the Otago and Auckland university medical degrees.

"The government recognises the high-quality education the University of Auckland and the University of Otago provide and the significant contribution they make to medical education in New Zealand.

"Under the National-ACT coalition agreement, we have committed to completing a cost benefit analysis for the proposed medical school at Waikato University, which the Ministry of Health is progressing with support from key stakeholders.

"I expect the ministry to engage with the universities of Auckland and Otago throughout the process."

In Dannevirke, Ireland said the solutions seem too late, and too far away.

"Obviously the medical schools are saying they are going to increase the numbers. But we're at that point those things should have been done 10-15 years ago."

Ireland said the pressure of finding staff remains constantly on his mind.