Growth in Aboriginal and Torres Strait Islander GP numbers to continue

In 2020, there were a total of 404 Aboriginal and Torres Strait Islander students – 121 of whom were first year students – enrolled across Australia’s medical schools.
 
That represents 2.7% of all domestic students, and is a substantial increase from 265 in 2014, according to findings from the 2020 General Practice: Health of the Nation report.
 
Dr Olivia O’Donoghue, RACGP Aboriginal and Torres Strait Islander Health Censor, believes it is the groundwork laid at a secondary education level to build awareness and encouragement that has helped lead to the increase.
 
‘There is a greater engagement of universities with high schools to recruit into health-related degrees and improvements in entry pathways to ensure university readiness for Aboriginal and Torres Strait Islander students – one of the barriers for [this population] undertaking any university degree,’ she told newsGP. 
 
‘Strategies that support leadership and resilience will benefit students, new graduates and specialist trainees to navigate challenging training and work environments, competing priorities and manage expectations.’
 
In addition to universities showing a commitment to delivering an Aboriginal and Torres Strait Islander health curriculum with integrated support systems, Dr O’Donoghue says collaboration with other Aboriginal and Torres Strait Islander Health students through training pathways, such as the Australian Indigenous Doctors Association (AIDA) and Indigenous General Practice Registrars Network, is also a contributing factor.
 
Dr Tim Senior, a GP and medical supervisor at the Tharawal Aboriginal Medical Service, agrees that support through education and mentorships is an important foundation.
 
‘AIDA have done excellent work in schools to encourage Aboriginal and Torres Strait Islander students to believe they can study medicine, and so to apply,’ he told newsGP.
 
‘Most medical schools now have good support for Aboriginal and Torres Strait Islander medical students, which overcomes the barriers they frequently face in getting into medical school, and completing the course.
 
‘There is also now a cohort of excellent Aboriginal and Torres Strait Islander doctors who act as role models and mentors for Indigenous medical students and junior doctors.’
 
Although Health of the Nation maps the positive news that there are more Aboriginal and Torres Strait Islander GPs than other medical specialists, with general practice the preferred specialty among this cohort of graduates, the cohort remains significantly under-represented in the health workforce.
 
Dr O’Donoghue believes student recruitment and retention rates contribute to this under-representation.
 
‘Graduating numbers have been rising slowly but there is still a fair way to reaching population parity with the overall medical student graduation numbers,’ she said.
 
‘There are still quite high withdrawal rates and longer durations needed to complete medical degrees.


RACGP Aboriginal and Torres Strait Islander Health Censor Dr Olivia O’Donoghue.
 
‘The systems that support Aboriginal and Torres Strait Islander students to progress throughout their medical degrees to being able to successfully graduate need constant review and improvement.’
 
Dr O’Donoghue says this under-representation of Aboriginal and Torres Strait Islander people in the health workforce potentially contributes to reduced access to health services for the broader Aboriginal and Torres Strait Islander population.
 
‘Having more Aboriginal and Torres Strait Islander medical and health professionals working in the health system will improve health and wellbeing for everyone, across all areas of medicine,’ she said.
 
‘Many Aboriginal and Torres Strait Islander doctors are motivated to pursue a career in medicine to improve health outcomes for our people, some due to our personal or family experience, or through our sense of social justice just as other health professionals may also be motivated to embark on a career in Aboriginal and Torres Strait Islander health.
 
‘More Aboriginal and Torres Strait Islander GPs working in this area will improve the cultural responsiveness of health service delivery to our people and ensure services remain accountable to the needs of communities. There will also be a positive impact on the delivery of tertiary health services by having Aboriginal and Torres Strait Islander medical professionals across all specialities.’
 
Dr Senior recently witnessed this first-hand, by having a number of Aboriginal and Torres Strait Islander GPs in training at Tharawal.
 
‘The relief felt by patients when they realise they are seeing an Aboriginal doctor has been clear,’ he said.
 
‘It’s not that they don’t trust the other doctors, it’s that there’s a sense of relaxation, of not having to explain or justify your circumstances, of a shared understanding and outlook.
 
‘So many Aboriginal and Torres Strait Islander patients have had poor experiences in the health system that this becomes the expectation, and there is a sense of relief each time they meet a practitioner who ensures they are heard and understood.’
 
According to Health of the Nation, Aboriginal and Torres Strait Islander primary health services employ about 4500 full-time equivalent health staff with almost half (47%) identifying as Aboriginal and/or Torres Strait Islander.
 
In 2018–19, the most common type of healthcare worker employed by these services were nurses and midwives (1208), followed by Aboriginal and/or Torres Strait Islander health workers (961) and GPs (568).
 
Both Dr Senior and Dr O’Donoghue agree that growing the Aboriginal and Torres Strait Islander GP workforce is a fundamental part of closing the gap in life expectancy and health outcomes for Aboriginal and Torres Strait Islander people.
 
‘We need to actively aim to redress the balance. It won’t happen by accident,’ Dr Senior said.
 
‘We need to really listen to the experiences of Aboriginal and Torres Strait Islander doctors and students, and the barriers they face throughout a medical career and then seek to dismantle those barriers, both as a system, but also through supporting individuals to overcome those barriers.
 
‘Mentoring can certainly help with this.’
 
Barriers that progress through general practice training can include significant family and cultural commitments that limit flexibility or ability to travel, issues relating to health and previous trauma, and an experience of racism during school, university and employment, Dr Senior notes.
 
‘[These can] sap energy and confidence, making the whole experience that much harder,’ he said.
 
‘With more Aboriginal and Torres Strait Islander doctors across all health services, patients will be more confident of a health system that is responsive to their needs.
 
‘Importantly, this isn’t just about seeing Aboriginal and Torres Strait Islander doctors – we become better as a profession if we have more Aboriginal and Torres Strait Islander doctors working with us.
 
‘It’s much harder for us to stereotype Indigenous people when they are our colleagues, and we become more routinely exposed to Indigenous worldviews and ways of working with patients.’
 
Dr O’Donoghue said the future Aboriginal and Torres Strait Islander GP workforce relies on integrated models and ongoing efforts to address underrepresentation in the health workforce.
 
‘Wrap around supports are needed that value Aboriginal and Torres Strait Islander knowledge, cultural connections and spirituality,’ she said.
 
‘The holistic approach that Aboriginal and Torres Strait Islander people inherently have towards physical, social and emotional wellbeing is beneficial to the health of all peoples.
 
‘A health workforce that is reflective, understands and takes ownership of its own cultural nuances and biases, and modifies its own attitudes and behaviours to be more culturally responsive and inclusive [can help to address underrepresentation].’
 
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Aboriginal and Torres Strait Islanders GPs in training Health of the Nation