Is There A Doctor on the Island?

The authors, David Watters of the University of Melbourne and David Scott of the Royal Australasian College of Surgeons, say that these poorer nations, which have much younger populations based mostly in rural areas and around 20 times fewer doctors per head of population than Australia and New Zealand, can spend only a fraction of what their wealthier neighbours spend on health.

Although the majority of doctors working in the Pacific have been trained in the Pacific, the capacity of these countries to increase the medical workforce and improve doctor-to-population ratios is limited. There are not enough places in the two medical schools in the region and insufficient funds to recruit large numbers of doctors from elsewhere.

The current medical workforce in the Pacific region includes doctors who have completed a Bachelor of Medicine and Bachelor of Surgery at the University of PNG or the Fiji School of Medicine; graduates of the Pacific Basin Medical Officers Training Programme (run by the University of Hawaii from 1986 to 1996); and doctors from Europe, the Indian subcontinent, South-East Asia and Australasia.

Shortage of specialists across the Pacific results in other Island States recruiting their neighbour's skilled workforce, for example, the Marshall Islands, Tonga, the Cook Islands and Fiji have all employed surgeons trained in PNG in recent years.

The loss of local doctors to the private sector or to overseas countries is a major problem in some areas. For example, 30 per cent of doctors in Fiji are expatriates, as a result of the high attrition rate of local doctors. In the past five years, 40 per cent of Fijian graduates have gone into private practice or left Fiji. Many Fijian doctors have gone to Australia or New Zealand, their residencies being supported by citing an "area of need". As Australia is short of junior doctors and of doctors willing to work in rural and remote areas, governments and departments of health are only too happy to recruit well qualified overseas doctors to fill the local void, regardless of it being a case of "the rich robbing the poor", say the authors.

Once these doctors leave their countries it is always difficult to return home, with other countries such as Australia and New Zealand offering better salaries and better education opportunities for their children.

Visiting specialist teams currently complement the improving standards of local specialists, who will eventually be the real experts in providing specialist care in their own countries, with the support of aid programs for equipment and consumables.

"However, as there will be a manpower shortage for decades, Pacific-based specialists will be limited in how much specialist care they can provide elsewhere. Visiting teams will be comprised mainly of Australian and New Zealand specialists for some time to come", say the authors.

CONTACT Professor David Watters 0418 316 552/ 03 5226 7899

Judith TOKLEY, AMA Public Affairs, 0408 824 306 / 02 6270 5471