Reports from 2001 and 2004 identified 90 Aboriginal and Torres Strait Islander medical doctors and 102 Aboriginal and Torres Strait Islander medical students in the medical education system. Since this time, and in response to the gross health inequities experienced by Aboriginal and Torres Strait Islander Australians, significant effort has been made to increase the number of Aboriginal and Torres Strait Islander doctors within the medical workforce.
Commitment to the ongoing growth of Aboriginal and Torres Strait Islander doctors was formally established in 2006, when the Australian Medical Council (AMC) revised the Standards for Assessment and Accreditation of Primary Medical Programs. Since these revisions, substantial progress has been made by primary medical programs in recruiting and developing the Aboriginal and Torres Strait Islander medical workforce. Many Indigenous and non-Indigenous organisations have been pivotal in this process and advocated for effective partnerships with Indigenous communities, organisations and individuals; curriculum coverage of Indigenous health and culturally competent communication and care; and recruitment of Indigenous students and staff.
Whilst this is a positive development from a decade ago, further effort is required to recruit and retain Aboriginal and Torres Strait Islander medical students through to College training and fulfil the objectives of the Commonwealth Agreement ‘Partnering for Good Health for Aboriginal and Torres Strait Islander Australians’, and National strategies including the ‘National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework 2016-2023’ to ensure that the diversity of Aboriginal and Torres Strait Islander communities is appropriately serviced through a culturally and professionally competent workforce
- Many of the issues identified in medical school training were likely to apply to specialist training. For example, Aboriginal and Torres Strait Islander medical students withdraw from medical school at far higher rates than non-Indigenous students. Barriers to completing training have been found to include; “cultural differences, marginalisation and racism from other students, faculties and hospital environments resulting in a fear of prejudice, the threat of being questioned about identity and tokenistic or stereotypical expectations leading to emotional and moral burnout.”
- Currently, no central database exists which monitors the progress of Aboriginal and Torres Strait Islander students and graduates. Anecdotally, there are up to 40 Aboriginal and/or Torres Strait Islander doctors who, by choice or necessity, have not completed Fellowship training. Ten of this cohort agreed to be interviewed for the Strong Futures Research. A summary of findings and recommendations from these interviews, and a further five undertaken with Aboriginal and Torres Strait Islander Fellows, is outlined in this policy brief.
- Juggling family and cultural commitments (including Sorry Business and attendance at funerals) particularly around exam times contributed significantly to the stress of training. Some participants had a strong commitment to Aboriginal health with over half working in Aboriginal health. Doctors working in Aboriginal communities noted the challenge in prioritising exam preparation over the complex patient issues and holistic Indigenous understandings of health.
- Initiatives need to be introduced to ensure that Aboriginal and Torres Strait Islander doctors are retained in the medical workforce and supported to complete specialist training and/or career progression. Colleges and Training organisations also need to become more accountable for the success of Aboriginal and Torres Strait Islander trainees by monitoring their progress and providing any necessary support.
- Training programs should be flexible so that diverse familial and cultural circumstances of trainees are accommodated and supported. This includes ensuring part time training options, extended familial, cultural and bereavement leave.