Community is key: building the future rural medical workforce

Jack Masson had an interest in health and medicine from a young age, growing up on a farm just outside of Wagga Wagga in NSW. His father is a local doctor, having graduated from UNSW Sydney’s medicine program.

“I expressed my interest in medicine to my school. We’re a pretty small school, so didn’t have much in the way of career advisors or anything like that. But we were able to get in touch with Professor Tara Mackenzie,” Jack says.

Professor Tara Mackenzie is the Associate Dean of Rural Health, as well as Head of Rural Clinical Campuses, at UNSW Medicine & Health. Having worked as a consultant respiratory physician and in medical education in Wagga Wagga for over 15 years, one of Prof. Mackenzie’s main goals is giving local students the opportunity to study medicine.

“Professor Mackenzie came to our school herself and gave a talk about medicine as a whole, doing it at UNSW, and particularly about doing it rurally here in Wagga,” Jack says.

Jack was also invited to a UNSW medicine information evening, and put in touch with first and second year medical students at UNSW. They were able to provide coaching and advice with the University Clinical Aptitude Test (UCAT), application process and admission interview.

“I would say that without that help, things would be really different… I’m not sure I would have continued through the whole process, or done so successfully,” Jack says.

Since starting first year medicine in 2023 at UNSW’s Wagga Wagga campus, things have been going well for Jack.

“I’m loving every second of it. It’s great to be here in Wagga, near my family, staying local,” Jack says.

“Looking towards the future, I see myself staying in Wagga at least through uni. And it’s a long way off, but for my career as well I’m looking to stay rural. Personally, I think there are benefits not just to rural medicine, but rural life in general and the balance you’re able to achieve.”

Attracting and retaining medical professionals, particularly general practitioners (GPs), is a major challenge for non-metro areas in NSW and the rest of Australia. Local students are key to the future of the rural medical workforce, according to Prof. Mackenzie.  

“One of my main goals is local students having the opportunity to study a world-class medical program locally, and then hopefully become our local doctors of the future… They’re more likely to stay local as they’re already a part of the community,” Prof. Mackenzie says.

“Therefore, I think that it is really important to engage with local high school students. Not just in year 12, but actually years 9, 10 and 11 so that you’re capturing them when they might be thinking about future careers.”

Reaching students in smaller schools and smaller towns outside of Wagga Wagga is a priority.

“We need to capture people who may have thought medicine is something they could never do – because it’s all too much, with needing to go to Sydney and so on,” Prof. Mackenzie says. 

“I send out a letter to all high school principals and career advisors in the region. And the letter gives them the option to ‘choose your own adventure’,” Prof. Mackenzie says.

Each school could engage with UNSW Medicine & Health in a different way. Their students could receive a visit from Prof. Mackenzie or current medical students, attend a UNSW medicine information evening, or come to campus for work experience. Some students have also visited the clinical skills lab on campus, to learn basic skills like using a stethoscope and measuring blood pressure.

According to Prof. Mackenzie, each school has a unique context and set of needs, so a one size fits all approach wouldn’t work. It is important that each school can select a mode of engagement that suits them.

“The response has been fantastic, particularly from the smaller schools… For example, Hillston is a town of about 1400 people. It’s three and a half hours from Wagga, right at the edge of our catchment area. They said: you’re the first university to come out here full stop. The first university to come out personally rather than just send some pamphlets,” Prof. Mackenzie says.

Attracting local students and giving them the opportunity to study medicine locally is just one part of building the future rural medical workforce. Prof. Mackenzie and her colleagues at UNSW are also working to encourage students to complete their study locally, rather than relocate to Sydney part way through.  

“We encourage the students to really engage in their local community. One thing we’ve done with our first-year students is link them in with the Wagga Wagga City Council, so that they can be involved in charities and local events. We’ve also got scholarships coming from the council to help first-year students with accommodation and other costs,” Prof. Mackenzie says. 

There are also initiatives under development to support young doctors to stay local after completing their medical studies.

The Single Employer Model (SEM) is a joint initiative by the UNSW Murrumbidgee Regional Training Hub and the Murrumbidgee Local Health District (MLHD). This program, developed by Associate Professor Paul Mara in collaboration with UNSW staff, Hub staff and the MLHD, provides a coordinated pathway for doctors wanting to become Rural Generalists. The SEM is a single five-year contract with seamless transition between hospital and GP training placements, making rural general practice a more attractive option for doctors.

After being trialled successfully in the MLHD, the SEM is being expanded throughout regional NSW. From 2024, the NSW Government is receiving funding from the Commonwealth Government to support up to 80 Rural Generalist trainees per year across the state.

“The trainees have a five-year guarantee. They can see a career pathway for themselves – rather than doing bits and pieces, constantly rotating, and not knowing where they will end up,” Prof. Mackenzie.

“Again, it’s about community. The SEM trainees are more likely to stay local, as during those five years, they can become a part of their community. They can learn what community means… At the end of the day, that’s what doctors are here for.”