Interview - Dr Mukesh Haikerwal, AMA Vice President, ABC 774 Radio 3LO, Evenings - Government push for doctors to regional areas; bonded medical school places

GUILLE: The Federal Government is praying for more doctors in areas where there just is not enough medical service being provided. And it believes that by proposing to offer 234 bonded medical places - this is all part of the big Medicare overhaul - it will do something, go some way to resolving the problem.

The idea basically is that medical school places would be made available to students who agree to work for at least six years in areas where there aren't enough doctors. Mukesh Haikerwal is the Federal Vice President of the Australian Medical Association. Mukesh, good evening, welcome.

HAIKERWAL: Hi, good evening, Derek. How are you?

GUILLE: I'm very well, thank you. Nice to talk to you again too, after your change of role from Victorian State President to now the Federal Vice President.

Look, Mukesh, how does the AMA feel about this idea of, if you like, going back to the old teacher bursary style of days?

HAIKERWAL: Well yes, and no. I mean we believe that there's a need for more doctors to be trained and that we need the 234 medical student places. And so we certainly welcome that.

But the way in which it is being rolled out has got major problems, and we certainly have major problems that we have expressed about it. Because it's not like the student places for teachers where they had a bursary and of course they'd go and get trained in the city and then go back and work in the country.

And it's not like the military scholarships where people go and be paid to go through medical school and come out and work for a few years on an army commission.

This is a scheme where people go into medical school - our brightest and best - 234 of them however are told you will have to go and work in an area of need. Not when you qualify, not when you do your intern year, but for six years after you've become a specialist. And for that you get nothing, apart from a place in medical school.

So there's no bursary attached to it. And there's no scholarship attached to it, just the big stick at the end to say in order to get this medical school place, you've got to go to work somewhere for six years after you've become a specialist.

GUILLE: Well the question is then, how do we go about making sure that those areas that are underserviced, don't continue to be underserviced. Even if we do increase the number of people at medical schools, there's no guarantee that they will go to those areas.

HAIKERWAL: Well I mean that's exactly right, and there's certainly been a lot of initiatives around, keeping people attracted to rural areas and indeed to the outer suburban areas. And we have some things about the scheme that we think we can actually make it certainly work better than is currently set out.

For instance, if people actually have the HECS paid, it's not an awful lot of an outgoing for the government. It's about $8,000 per student and it comes to about I think $2 million for these 234 people. And it means that, you know, some of their education is paid for. And then maybe they'll then have some responsibility to pay that back somehow by going to a specific area.

But that shouldn't be for six years. It should be for around four years, about the time that it takes now for the post-graduate courses in medicine. And it's sort of a more reasonable time scale.

And also that that time shouldn't start once you become a specialist which can be anything after 10, 15 years after you qualify and can cost $15,000 to $20,000 to become a specialist before you start paying it back. We think the best time to start working in the area is once you've qualified, done your internship, and do your training. If you do your training in an area of need, you're more likely to stay there, whether you're training to be a specialist or training to be a general practitioner. And you're more likely to make your contacts and your peers in that area and you know that would help you make the contacts and you'd want to stay there afterwards.

GUILLE: So the problem is that these 234 bonded places are not done in the same way that bursaries were. In other words I wouldn't be able to get into medical school unless I make that promise? That's...

HAIKERWAL: That's right, and there's nothing to go with it apart from the fact that you won't get a school place if you don't, medical school place if you don't do that. And we think that it's kind of conscription and it's sort of you know immoral and it's sort of putting our young people in a very difficult position at the age of 17, 18 to make decisions about themselves when they're in their early thirties at that stage. And we think that there are better ways of doing it and we're certainly enunciating that to the Senate Select Committee that's looking into this.

GUILLE: I'm wondering why - I'm trying to imagine what it would be like to a 17-year-old, 18-year-old who was looking at trying to get into medical school and, if the Government said to me, yes, you can get in; and yes, we will assist your schooling but only on the condition that you spend some time then working in a regional area or in an outer suburban area or somewhere where there's not enough medical provision, then I would probably jump at the chance just so that I could do the course.

HAIKERWAL: Look absolutely. I mean from my own experience, I was desperate to do medicine. It took me a couple of years to get in to do medicine and, having got there, I wouldn't have done anything else.

GUILLE: Yes.

HAIKERWAL: And of course that, you know, the wish to do that, to do your bit and to do good and to make a difference. But you know, we certainly think that that's an important aspect of it. And there's no reason why people shouldn't want to go and work in rural areas or outer suburban areas. But we think that, if you actually encourage them to do that by making the training in that area, and make them feel that the area is going to provide for them both socially as well as professionally, then that's important.

You know the urban regeneration and regional regeneration that needs to happen shouldn't be at the expense of professionals or anybody else. It should be something that governments do to make sure the areas are attractive for people to go and live there and want to live there.

GUILLE: Happy to hear from listeners shortly on this subject, usual numbers 94 14 1774, 1800 033 800. Is there not a vicious cycle here though? How difficult is it to provide medical training particularly to a specialist level in an area that is underserviced medically at the moment?

HAIKERWAL: Yes, I mean there is a bit of a vicious circle there. In Victoria we have good examples of the regionals, Monash's regional centre over in the Latrobe Valley and the Melbourne Medical School in Shepparton, which are getting legs now, and we've got specialists working in the area. And the catchment is quite large so that the exposure to patient contact and learning and good specialists coming in and living there, as well as those that are flying in, means that the expertise that we have in our regional centres is fantastic.

And I think that we need to be making those people in regional centres feel that they have the respect of the big city, tertiary centres and that they are on par. And I think that's happening now as they get university funded university places and lecturers and senior lecturers attached to universities.

GUILLE: So it really is a bigger picture that you would like to see put into place, and that provision that we're just talking about expanded into other parts of Victoria by way - using that by way of encouraging people to undertake their studies and, as we know, if people undertake their studies somewhere, there's a greater likelihood that they will stay there or close to there where the need exists.

HAIKERWAL: Yeah, I mean our national president, Bill Glasson, said that he felt the scheme, as it was construed, was immoral. But he can see that, if you actually provide for people to do their training in areas, they're more likely to meet their life partner there, then will actually make social contacts where they'd like to stay, and therefore when they're forming their practice and they're forming their professional life, it's done at that time and they're likely to stay.

If you do it after they're finished their training when they've become specialists, not only are they unlikely to stay, they're also going to be more able to afford to buy themselves out. And you know, if we're trying to encourage people to stay, we need to make it an environment where they want to go to.

And also other people living in the area, they don't want conscripts to come and work in their areas. They want people who want to be there. And we would like to encourage that, and encourage people to feel the will to stay and to work.

GUILLE: Well in which case is there an argument for lowering the entry points into universities, increasing the number of medical student places so that there are so many more doctors available that, if they want to make a living, they've got to go.

HAIKERWAL: It's certainly one point of view. We certainly feel that the bar is set high for medical school for a good reason because we need to have the best people coming into the career structure. It's a pretty arduous course and the need to get all angles of the profession or curriculum under our belts before we get going is important. So I don't think we need to lower the standard.

But you know the encouragement needs to be given to people to not feel that they're going to a less salubrious area or somewhere that's unpleasant, but somewhere they can actually made a good professional living, make good contacts and that the local society's structure can actually live up to their expectations.

And that's about regeneration of regional centres and rural centres and making sure that there is government infrastructure there. You know our very fast train project should get off the ground and then people would want to work away from town more then.

GUILLE: Well it might make a decision, that might make a difference. Mukesh, a number of listeners want to join us. Are you in a position to stay on or do you need to...?

HAIKERWAL: Yeah, very happy to.

GUILLE: Excellent, thank you. We've got Nick joining us to take a few points from some of our callers and then to get some response from Mukesh Haikerwal, Vice President of the AMA. Nick, good evening.

CALLER 1: Good evening. Hi. Look, how much does it cost for a degree, a doctor degree, sort of roughly, for four, five, six years of university.

GUILLE: That is a good question. What does a degree cost these days?

HAIKERWAL: I mean in terms of HECS, it's about $8,000 a year. But in terms of the cost to the taxpayer/Government, it's you know, we're looking at a quarter of a million plus, in terms of the amount of time and effort and facilities and so on that people get into and that high level of quality training.

GUILLE: So the students put in a certain amount and the government puts in the rest, yes. The point from that, Nick?

CALLER 1: Yes, there is a point here. Why not budget for say half the price for example, or three quarters of the price is to be deduced from this, and or that kind of a contract, you know, so that you finish university, so that you can go directly, you know, you go to places with a shortage of doctors, you know, for three or four years or something like that. Instead of paying all these millions and millions of dollars, you know, for all this patching things from all around the country.

GUILLE: Well part of the problem is of course that the costs are enormous no matter who's paying for them, to teach someone to be a doctor. The sorts of facilities you need in terms of educational systems are where those costs come in. So do you think a scholarship system, Mukesh, might be of assistance?

HAIKERWAL: Look, I think that the way - that there are rural scholarships, for instance, to attract you to rural areas. And you know, those things are certainly things we would encourage because we think that people should be given the carrot to go off and work in good areas, you know, areas away from where they would normally work. And scholarships certainly are offered by some people.

And people like the John Flynn Scholarships give some degree of support to people as well as the Commonwealth Government schemes. What the problem is with the present scheme the Government is talking about is you're bonded for six years after you've finished your post-graduate training and there's nothing - apart from the fact you got the medical school place - there's nothing else going in.

And we reckon that, you know for instance, they paid the HECS which is like eight grand a pop, a year. It's still going to cost two or $3 million dollars for that group of people. So it's not going to cost the Government an awful lot of money but there's some incentive to go and do that.

GUILLE: Nick, thank you. Barry's with us. Evening, Barry.

CALLER 2: Oh good evening.

GUILLE: Yes, go ahead.

CALLER 2: Yes, I think it's the most practical suggestion I've heard for a long time, to have doctors do that because teachers have had to do that for probably 20 years. When I was a TAFE teacher myself, we had to commit to work in wherever the Government dictated when you completed your student instructorship.

GUILLE: So a form of bursary, as we used to call them, didn't we I think?

CALLER 2: Yes.

GUILLE: And even a form of bursary, a medical bursary would make sense to you, which as Mukesh has been explaining is not exactly what's being suggested by the Federal Government in this instance. Okay, Barry, thank you.

Alan's here too. Alan, welcome, good evening.

CALLER 3: Yeah I think it's quite reasonable to ask doctors to work in the country but they should also be paying people to prevent the diseases and accidents and then you would need less doctors. Look, if the government gave me a quarter of a million dollars, I could certainly find out how to prevent a lot of the things from going wrong. For example, like the accident, you need people to collect a list of which things caused them, and then they design the devices that cause the accidents so that they don't happen.

GUILLE: Alan, that is an interesting point and I'll raise that with Mukesh in a moment too. Ash is our last caller. Ash, welcome.

ASH: Thanks, Derek. I just had a question first of all. How does the Government determine the 234 students who would be so-called sort of bonded? Is it - have they got to be students at the lower end of the so-called mark range or the entry level or are they going to be students that are surplus from the normal places that offer to students to study medicine at universities?

GUILLE: That's a good question, Ash. Can you explain again what the Government's proposal is with regard to who those 234 would be?

HAIKERWAL: No, we don't know the answer. And I think those are - Ashley has raised some very good questions because, you know, is it going to be on birthdays? Is it going to be on your HECS score, sorry on your score...

GUILLE: ...TER score...

HAIKERWAL: ...TER score or is going to be on flipping a coin. We don't know is the answer and that's another concern. We wouldn't like to see an underclass of doctors who, you know, our brightest people get into medicine. And then you say, of our brightest, you 234 are not our brightest, you're going to be the second-tier group of doctors and that's just not on.

GUILLE: And so there are some important questions, Ash, and you've raised one there. The previous caller, Mukesh, was talking about prevention rather than cure. And that is actually a very important point about how we cope with the medical shortages in much of Australia, much of Victoria. Is enough in your opinion, being - I know this is a side issue - but is enough being done to investigate the ways in which we can reduce our needs, our medical needs?

HAIKERWAL: Look, I think medical needs are - we're looking very much more at prevention being better than cure. We're seeing a lot more work been done in public health. For instance, my wife as a GP has gone into public health medicine.

But you know in general, we need to do more preventive work and it's very interesting and gratifying to hear the Health Minister talk about the fourth pillar of the medical system. There will be prevention. And hopefully that's something that we can develop with the Federal Government and the State governments because we do need to do more in terms of education and learning in the community to reduce our risks with smoking, alcohol, drugs, you know obesity, all sorts of things that we can do. And I would agree quite wholeheartedly that that's an important plank of health delivery.

GUILLE: Yes and one that we could do more work on. Mukesh Haikerwal, well thank you so much. We'll talk again soon.

HAIKERWAL: You're welcome, look forward to it.

Ends