24 LISTENER AUGUST 10 2019
GP CRISIS
R
ural practices are at the
sharp end of the GP short-
age. But Garry Nixon,
director of the rural post-
graduate programme in the
department of general practice at the
University of Otago, says the effects
of workforce issues on rural com-
munities aren’t measured because
health data is collected and com-
pared by DHB region, not the areas
within them. “In Ministry of Health
reports, you can find 17 different
ways of defining rural and they are
hugely variable. It means you can
compare nothing.”
Nixon, who’s been a rural hospital
generalist at Dunstan Hospitalin Clyde since 1991, says three things
improve students’ chances of ending
up in rural practice long term. The first
is picking rural students, the second is
giving them high-quality experience in
rural practice and the third is rural spe-
cialty training after graduation.
Auckland Medical School has a
regional-rural training programme,
Pūkawakawa, for fifth-year students that
began in 2008 and includes a six- to eight-
week stint in a small town as part of a
year spent practising in a regional setting.
Otago has a rural immersion programme
during which about 20 students (6% of
the class) spend their entire fifth year in
rural practice.
But plans to escalate rural GP training
were set back last year after the Govern-ment abandoned a proposal for a rural
school of medicine at the University of
Waikato. Then-Prime Minister Bill English
had announced in 2017 that the school
would be established by 2020 to address
the country GP shortage.
NZ Rural General Practice Network
board member and Waikato professor
Ross Lawrenson told the Listener the
university hasn’t given up on the idea.
With fewer than 2%
of medical students
wanting to live and
work in small towns,
and more than half of
GP trainees based in
Auckland, something
needs to change, he
says. But rural practices
are often staffed by
short-term locums,
who can’t supervise
trainees. About 40%
of doctors on the GP
training scheme are
international gradu-
ates who are more
likely to practise in
minor urban, rural and“If you can’t develop
a good rapport with
the person sitting in
front of you, you’re
likely to get 30-40%
less information.”Catering for rural
communities
Few medical students want to work in small
towns, so something needs to change.
Thames GP Marty
Mikaere (and above):
how a country doctor
dresses for work.