He says health outcomes for people in rural areas aren’t as good as those in the bigger centres, hence the need for skilled professionals who have the ability to do a little bit of everything but can also recognise when their patients need more specialist care.
Dannevirke Community Hospital.
On the problems in the health system, especially in rural health, James says the subject is a growing area of academia and research often shows inequity between urban and rural areas.
Basically, if someone comes from a rural background, their baseline health could be worse because of barriers in accessing care, such as having to travel longer distances to get to a hospital.
“There is certainly discussion happening about the why and what we do about it.”
James says the Rural Health Strategy, introduced last year, has “shone a bit of light” on rural health, meaning a greater focus from central government, but since the latest changes in the system, the future of that strategy remains uncertain.
Another issue is that fewer people are coming from rural areas than urban areas to enrol in medical schools.
James says both Otago and Auckland universities do try to actively produce doctors who are representative of Aotearoa New Zealand as a whole.
“This is good in that medical students from a rural background are more likely to return to a rural area.”
While he can’t say whether it’s still the same, he says when he studied at Otago 10 years ago, the university had a special entry category for students with rural backgrounds and there were deliberate rural health rotations.
“There is additionally medical student-run rural health clubs which have traditionally visited high schools around the country to try and encourage high school students in applying.”
James believes there is also an element of the system in the issues with rural healthcare, although he admits to some bias.
He says the amount of dollars going to health overall should be higher than it currently is and that the “slice of the pie” that rural gets should be proportionately larger.
“Although the pay that health workers get has been making incremental changes over the years, when compared to international/Australian numbers, there is still a significant gap.”
James says he’s heard of many colleagues who have had offers from Australia that come with a higher salary and a lower amount of work, which would be tempting.
“Anecdotally, the overall workforce shortages are not just rural, but also urban. However, when there is a shortage in a smaller team, there is less flexibility to adjust or make do, making it seem that much worse in the rural sector.”
