Making health equity a reality through research, education, policy and practice
Improving general practitioner recruitment in deprived and rural communities
Summary by Austin O’Carroll - 24.10.15
Widening Access (WA) in medicine has generated much interest recently. WA refers to increasing the number of medical graduates who come from backgrounds that are poorly represented in medical personnel e.g. people from socio-economically disadvantaged areas and certain marginalised groups. The arguments for WA include firstly, it is the equitable thing to do; secondly, it widens the pool of potential candidates and so would increase the chance of obtaining quality candidates; and lastly, that having representation from deprived areas and marginalised minority groups would serve to increase the level of care for people in those areas/groups. This argument postulates that such candidates are more likely to seek to work in those areas/with those groups and that they also would have a better understanding of how to identify health needs and deliver health care to those areas/groups.
Dowell et al conducted a postal questionnaire survey of 801 GP’s in Scotland to find out if GPs demographic status at application to medical school influenced the type of practice they ended up working in. They found GP’s whose parents did routine or semi routine occupations had 4.3 times the odds of working in a deprived practice compared to those from an managerial or professional background. They also found that doctors from a rural background were more likely to work as GP’s in rural areas though this only achieved significance for the most rural areas. They attributed this to small numbers in their sample. This evidence supports the argument that we should seek to encourage people from socioeconomic disadvantaged and rural areas to apply for medicine as it could possibly increase the number of doctors applying to work in these area.
In Ireland how this would be is achieved is not easy to see. We rely on the points system which seems fair. However, when one factors in the varying emphasis on education and access to extra tuition in wealthier areas the points system does militate against those from deprived areas or marginalised minorities. Ideally the creation of a fairer education system would provide a solution however in its absence medical schools could consider positive discrimination for applicants from these backgrounds or ring fencing a number of places for such applicants.
The full paper: Dowell J, Norbury M, Steven K, Guthrie B.Widening Access to Medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work. BMC Medical Education (2015) 15:165, is available at http://www.biomedcentral.com/1472-6920/15/165