James Cook University's rurally orientated medical school selection process: quality graduates and positive workforce outcomes

Twenty years ago the Commonwealth government allocated an additional 25% medical student places to primarily major city universities that were to be given to students from regional, rural and remote communities. The aim was to increase the number of medical graduates working in rural and remote towns as GPs. James Cook University (JCU) was the first, and for a long time only, rural university to get rural medical places. JCU took a completely different approach to its city counterparts to recruiting and educating medical students for rural and remote general practice. First, it admitted the majority of its students from rural and remote areas, while city universities admitted most of their students from major cities. Second, it did not require rural students to get an ATAR of 95-99.9 as city universities currently do, opening up medical education as a real opportunity for rural kids. Third, 100% of the education and training provided by JCU is undertaken in rural and remote areas, compared to city universities where the bulk of education and training is done in cities, or by academics based in cities. Fourth, JCU introduced a rural-specific curriculum that identified the positive opportunities of working rurally as a GP, while most city universities continue to struggle to present rural practice as a positive career pathway. As a result of this approach, more than 65% of JCU graduates move into medical practice in rural and remote towns, compared to other universities where more than 90-98% move to metropolitan cities (and some to regional cities). This research is critical for rural and remote people to understand. To be successful in growing the rural medical workforce, rural medical programs must have all 4 elements of the JCU approach. But most universities have cherry-picked elements to give the impression that they are delivering programs to grow the rural and remote GP workforce. For example, they may base students at rural clinical schools, but these students may be primarily from major cities. No medical school has abandoned ATAR, which is a discriminatory measure that excludes rural and remote students who lack the subject choice at rural schools to be able to compete with city students. The evidence overwhelmingly shows that all 4 components must be present in rural medical programs, or the programs will fail to deliver medical graduates into rural practice. This means, of course, that rural medical programs should be delivered by rural universities that are under a performance obligation to educate doctors for rural general rural. There are only 2 programs in Australia today known to conform to best practice in rural recruitment and retention - James Cook University in Queensland and Charles Sturt University in NSW. If the best practice approach was consistently applied, rural and remote doctors would be a thing of the past. But it would also result in significant amounts of funding flowing out of major cities and into the bush to create jobs and opportunities, which is why such an approach has been forcefully resisted by universities and governments for decades. Until these policies are changed, rural and remote people need to question regional universities that have received rural medical student places to hold them to account for the outcomes of their programs. Just because a medical program is based in a rural town does not mean that it has been designed to support rural GP workforce growth. One rural program, for example, enrols 80% of its students from major cities. Rural and remote communities need to challenge rural universities in particular about how many students from rural and remote communities they admit each year, how their curriculum is different to city curriculums, how they ensure 100% of training is done rurally, and why they are using ATAR which is known to discriminate against rural and remote kids. Holding regional universities accountable is essential if the billions of dollars spent on rural medical workforce programs is not to be wasted growing the medical workforce in our cities.