1493601807598 - Dr Nigel Murray: Rural healthcare crisis won’t solve itself

Dr Nigel Murray: Rural healthcare crisis won’t solve itself

OPINION: It’s been 50 years since the last medical school was created in NZ, and this decades-old model of medical education is now struggling to meet the health needs of all New Zealanders.

We have a growing healthcare crisis in our provincial and rural towns, revealed by shockingly poor health statistics and the preventable diseases in many of these communities.

The lack of innovation in medical education is contributing to this problem.

As the chief executive of one of the largest and most rural district health boards, it’s my job and my duty to take direct action to address this problem. Tinkering on the margins of the status quo is not good enough. Fundamental reform is needed with a radically new approach.

When I first started my training as a doctor at Otago Medical School in 1979, we were encouraged to look up to the hospital-based specialist. We were taught and raised in the culture of the hospital and community-based training was limited and certainly not part of the academic culture.

Unfortunately there has been little change in the existing two programmes since I began my career. Although a few more community placements have been more recently introduced into the curriculum, the academic cultures of Otago and Auckland schools are effectively the same hospital-dependent institutions.

The existing medical schools have made huge contributions to the health of our society, but now this custom and practice of our existing medical universities must embrace something new and disruptive. It is time for a radical change in who we select for medical training, how we train them, where we train them, and where they go when they finish training.

That’s what our Waikato medical school will do.

The tragic testimony to this problem is in our emergency departments. Access to primary health services is significantly limited in our rural areas and people are disproportionately suffering from poorer health outcomes. As a doctor and district health board CEO, I am deeply troubled when patients come to our Emergency Department with later stage symptoms of cancer, to be diagnosed for the first time and often too late.

By recruiting doctors from rural and provincial communities, training them in small hospitals and primary care clinics across the region and linking them to pharmacists, community-based nurses and midwives, and other social agencies we can breathe new life into these healthcare facilities.

Not only will it improve people’s health and wellbeing but it will also strengthen the economy in the region, bringing new health professionals into towns.

Our Waikato Institute of Medicine and Health, which provides the framework for the medical school, will also attract research development funds and bring world-class staff to the Waikato.

We can also train doctors to be leaders in using the latest advances in technology such as virtual health. These innovative approaches will allow clinicians to mentor and provide peer support to colleagues at a distance, reducing professional isolation. It will also allow us to deliver care closer and even into people’s homes, putting the patient at the centre of their healthcare.

And ultimately that is what our medical school is all about – putting the patient first.

We need a more socially responsive healthcare model – one that responds to what the population wants and needs, not how and where it is convenient for health professionals to work. Doctors also have a responsibility to work where they are needed.

Without a community-engaged graduate-entry medical school, we are losing a generation of young people who could be training as doctors but aren’t doing so because what the current medical schools offer isn’t for them or excludes them.

This new breed of modern doctor will be trained and equipped to provide healthcare for a population that is suffering from more complex, chronic diseases. A new breed of doctor from the local community for the local community.

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