Blenheim GP sees new degree as answer to doctor shortages in regions

Dr Emily Marfell has been a GP in Blenheim for close to 20 years.

Photo: Supplied / Civic Health

A Blenheim GP says a new graduate medical degree programme in which students spend at least a year of their clinical placement in regional primary-care practices will help to address doctor shortages in provincial towns.

The government has announced the country's first graduate-entry medical school programme. The University of Waikato programme will take 120 students in its initial intake in 2028.

Students will spend their first year studying at the University of Waikato Hamilton campus and their final three years based in either Waikato, Bay of Plenty, Taranaki/Whanganui, Hawke's Bay or Nelson Marlborough.

Dr Emily Marfell is a GP at Civic Health in Blenheim. Originally from Mid Canterbury, she has lived in the region for close to 20 years. She met her husband while working as a junior doctor, trained in the region as a GP registrar and has been there since.

"I'm very happy here but if you'd asked me as a medical student where I would end up, I wouldn't have put Blenheim on the list.

"It's a really nice size in that we've got a strong, highly functioning hospital but also really close links between primary and secondary care."

Marfell said recruiting GPs had been a continuing issue, with Civic Health staffed mainly by overseas-trained doctors.

While the region had Otago University medical students on placement doing rural immersion, Marfell said they spent a small amount of time working in primary practice compared with the time spent working in a hospital.

"There's very few that come through our system that are keen to do general practice to begin with and then it seems that there's very few that are keen to come to the regions, which is a real shame and it doesn't need to be that way."

Marfell said Marlborough was feeling the same consistent pressures in primary health as the rest of the country. These were driven by changing demographics, patients with complex needs and increasingly complex medical care, and it was not being matched by investment in the workforce.

"As GP clinicians but also as business owners, we're struggling to meet that need in terms of getting through the work and seeing the patients in a timely way."

Graduate-entry programme a first

The University of Waikato has established the New Zealand Graduate School of Medicine and a four-year degree pathway under which students will gain experience in rural communities in a bid to grow the frontline health workforce.

Pro vice-chancellor of health Professor Jo Lane said the model differed to what Otago and Auckland universities offered but was similar to the graduate-entry medical programmes at several Australian universities.

"We've got a national medical workforce shortage but some of those shortages are much more significant in regional and rural communities and in our primary-care specialties like general practice."

Students will spend about half their clinical placement in primary-care practices and the other half in a hospital-based setting.

In Nelson and Marlborough, that meant students would spend their second year at Nelson Hospital. The cohort would then be split in half across Nelson and Blenheim for the third year.

In their fourth year, students would be able to choose from a range of elective and selective courses at both Nelson and Wairau hospitals.

As part of the initiative, two community clinical learning centres would be established in Nelson and Blenheim. Lane said the university was finalising their locations.

He said the regions chosen were based on the health and workforce needs, the support available to students, the willingness of primary-care practices to support them and the capacity within hospitals.

There was strong evidence in medical education that coming from a regional or rural community was one of the strongest predictors of people wanting to stay and work in such communities long term, he said.

"We know we're seeking a health workforce that is driven by multidisciplinary care teams so it makes complete sense to us to be able to train students in those team environments, recognising that that's the workforce that they'll be going into," Lane said.

Health New Zealand national chief medical officer Dame Helen Stokes-Lampard said the emphasis in the Waikato Medical School approach on early community placements would better promote working in general practice and rural settings for New Zealand-trained doctors.

Dame Helen Stokes-Lampard.

Photo: supplied

"By providing a greater proportion of training in our provincial centres and in more rural settings, we can hope to have health professionals better equipped to provide care for these communities," she said.

The number of Waikato medical students training in Nelson Marlborough district was expected to grow from about 20 in 2029 to 40 in 2030 and 60 students annually from 2031.

Win for healthcare in Te Tauihu

Marlborough Primary Health chief executive Beth Tester said it worked closely with the Marlborough District Council, Te Whatu Ora, primary-care practices and iwi to put in a bid to be considered as one of the clinical placement regions for the degree programme.

Along with Nelson, it was the only South Island region to succeed.

Tester said it had become increasingly difficult to attract GPs to smaller provincial towns such as Marlborough. The region experienced persistent shortages of GPs, nurses and nurse practitioners despite the collective efforts of healthcare providers and the community to attract, support and retain workers.

"People tend to like the bigger centres and so it has been a real challenge. We have to try and get about six to eight doctors a year to Marlborough, and most of those have been overseas doctors in the last few years."

She said experience showed students who trained rurally and in provincial regions were more likely to practice there.

"They say this is the best, hidden, delightful place to live and they stay, and that's what we've had in the past as we get students come back and stay ... that's how we've been able to get our GPs over the years."

"This is exactly what we need in Te Tauihu to boost our future healthcare workforce and ease the increasing strain on our excellent but pressured hospitals and primary-care clinics."

Tester said that while Marlborough had hosted medical students from Otago University, it was for short placements

"This is quite a different model that cements them into the fabric of the community and makes it their home."

An Otago University spokesperson said Nelson Marlborough had been part of its training network for the last 18 years, with about 24 medical students training in the region each year.

There would continue to be pharmacy, nursing, radiation therapy, medical laboratory science and physiotherapy students working in the region.

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