Seleq S, Jo E, Poole P, Wilkinson T, Hyland F, Rudland J, et al. The employment gap: the relationship between medical student career choices and the future needs of the New Zealand medical workforce. N Z Med J. 2019;132(1506).
Commentary from Associate Professor Garry Nixon
In a nutshell. 20.7 percent of meds students are interested in GP at graduation. But 37.4% need to be in order to maintain the current workforce. It’s bad news.
No attempt is made to differentiate rural and urban GP. There is a category called ‘rural and remote medicine’ which I assume is ‘rural hospital medicine’. The interest amongst students is 2.2% with 1.1% needed to maintain the current workforce. Better news but …
A rural view: Its critical that an attempt is made to differentiate the rural and urban workforce and workforce intentions (and be clear about terminology for rural scopes of practice). The last paper published by this group suggested that the interest in working in communities of less than 10,000 people was very low (and fell considerably between entry and exit from medical school).
The biggest limitation in this study is the assumption that we can base the future needs on the size of the current workforce, this ignores existing deficits, and risks perpetuating inequalities.
The whole thing needs a ‘rural lens’ applied to it. There needs to be at least someone, even just one person, with a rural background on the these sorts of studies. This is government funded work and such an approach would be consistent the promise to ‘rural proof’ government policy.
The authors know the solution; “students indicated that the atmosphere, work culture and the experience they have of a specialty during medical school are the most important factors influencing career decisions”. If their experience (and role models) is metropolitan hospital medicine then they will want to be metropolitan hospital doctors.
AIMS: To determine the career decision intentions of graduating doctors, and the relationship between these intentions and the predicted medical workforce needs in New Zealand in 10 years’ time.
METHODS: A workforce forecasting model developed by the Ministry of Health (MOH) has been used to predict the proportion of doctors required in each medical specialty in 2028 in New Zealand. The future work intentions of recently graduated doctors at the Universities of Auckland and Otago were collected from the Medical Student Outcomes Data (MSOD), and compared with these predicted needs.
RESULTS: Between 2013 and 2017, 2,292 doctors graduated in New Zealand, of whom 1,583 completed the MSOD preferences section (response rate 69%). Of these only 50.1% had decided on a future medical specialty. The most popular were surgical specialties (26.2%), general practice (20.7%), and internal medicine (11.0%). Compared to the MOH workforce forecast model there appears to be insufficient interest in general practice at the time of graduation.
CONCLUSIONS: To shape the medical workforce to meet forecast needs, multiple stakeholders will need to collaborate, with a special focus on the early postgraduate years, as many doctors have yet to decide on specialisation.