Third medical school will not improve Māori health

13 June 2017
Dr Papaarangi Reid
Papaarangi Reid

Māori doctors are graduating at a rate greater than ever before. This is quite miraculous. The secondary education system fails to graduate a proportionate number of Māori with excellent Level 3 NCEA qualifications in the science subjects required for successful medical study. After significant investment and comprehensive initiatives, there are currently 373 Māori medical students studying at Otago and Auckland. Between us we graduated 79 in 2016. So the Māori medical workforce is young and rapidly growing.

What we don’t have is a pool of appropriate Māori graduates waiting around for another medical school to open. The University of Waikato has proposed a third medical school with a focus on producing graduates for provincial New Zealand. Waikato states in its business case that it “represents an opportunity to engage higher proportions of Māori students in medical training and to focus them on returning to provide primary care in their communities”.

Māori graduates who want a career in medicine already apply to our programmes. If they have a strong degree with good marks, they are usually accepted. We also provide alternative pathways for those who need additional support. It is at best naïve to think that the medical programmes at Auckland and Otago, with leadership from their senior Māori medical academics, have not given full consideration to this group of potential applicants.

The Waikato proposal will simply transplant the same Māori applicants from Auckland and Otago into a programme focussed on General Practice. Yes, meeting the medical needs of rural communities is a priority. However I object to the idea that Māori should be trained solely for careers in General Practice.

Māori doctors are needed in every speciality. Training Māori doctors only to work in areas where others don’t want to work is discrimination. We need Māori doctors to wake up every morning passionate about going to work. During medical school and as junior doctors, our early ideas of possible specialisation develop. With our careers lasting about 40 years after graduation, it’s important for both career satisfaction and patient outcomes that Māori doctors are in a specialisation of their choice.

The existing medical programmes already deliver the full scope of clinical specialisations, alongside comprehensive rural and regional training. For more than a decade we have provided year-long training experiences for senior medical students in regional and rural areas. These are now showing positive signs of graduates wanting to return to regional areas for junior doctor experience. In the coming years these new graduates will be seeking places and specialities in which to work. These great training experiences seem to be influencing their decisions and highlight the regional focus already in place within the existing programmes.

What we really need is investment in the infrastructure of regional and rural general practice to support more practices to become safe learning environments for students, junior doctors and specialists-in-training. Furthermore new iterations of general practice need to be developed so that a doctor can move between rural and urban practice in a flexible and financially viable way depending on family commitments and lifestyle preferences. We also need to rescope how rural health can be optimised in a rapidly changing world taking full advantage of innovative use of new technologies and extended scopes of practice for our colleagues in nursing, pharmacy and community health. Investment in these areas would be more productive for Māori health than building another medical school.

Associate Professor Papaarangi Reid (Te Rarawa) is Tumuaki and Head of Department of Māori Health at the University of Auckland's Faculty of Medical and Health Sciences.