Upping the number of Māori and Pacific in the health workforce is considered essential in the fight to eliminate health inequities. Teuila Fuatai reports on the role of those choosing our future doctors – and why they wholeheartedly support preferential entry for Māori and Pacific students.
About a decade ago, the number of Māori graduating each year from the country’s two medical schools – the University of Otago and the University of Auckland – could be counted on your hands.
It was ten, just ten Māori doctors from the whole country that year, Professor John Fraser, the Dean of Medical and Health Sciences at the University of Auckland, says.
Fast-forward to today, and things are looking a lot more promising. For example, in 2016, an “unprecedented” 80 doctors identifying as Māori celebrated the end of their medical school years.
Yet, the demographics of New Zealand’s doctors are still a long way from resembling those of the population. Fraser highlights the gap with another Māori example: only about three percent of the 10,000-or-so current medical practitioners are Māori, while Māori make up about 18 percent of the population.
Sitting alongside him is Professor Warwick Bagg, head of the university’s medical programme. Bagg – who has co-authored several articles examining the effectiveness of “targeted admission schemes” – explains the relationship between having more Māori and Pacific doctors and getting better health outcomes.
“It is often easier – where you’ve got choice – to be able to go to somebody who you feel comfortable with to be able to talk about your story – just like some women might not want to go see a male doctor, some groups of people might prefer to see [someone who shares their cultural background]. That’s why we have to have doctors, and all health professionals, that go right across the cultural spectrum of New Zealand.”
Fraser puts it more simply: “The Māori people of New Zealand want to see Māori doctors, just like Pacific communities want to see Pacific doctors. It strengthens the belief that health services are serving them.”
Questions from parents usually revolve around whether their child has been “pushed out by a Māori or Pacific student”
Each year, both men are part of the team that oversees entrance into the university’s highly competitive six year medical training programme. Only about one-tenth of students who apply make it through. To achieve better representation in the doctor workforce, the university aims to make 25 percent of those successful new-entrants Māori and Pacific. Students from rural areas are also given priority, with a target of about 17 per cent.
“We are unapologetic about our targets,” Bagg says. “They are targets that we recognise when we look at the workforce. About 25 to 30 percent of the urban population in Auckland are Māori or Pacific, so it seems sensible for us to be targeting that level.”
Despite that logic, “catching-up” with the health needs of the population using admission targets isn’t a universally-popular concept.
“There are other groups within society who feel that they’re being disadvantaged by the university or the faculty having a specific ‘quota’ on Māori and Pacific, or regional, students,” Fraser says.
“It is a recurring theme, and often becomes a political issue, around who is and who is not getting into medical school and why.”
“That is always the issue you face when you have a targeted admissions scheme. To offer places to Māori and Pacific [communities] means those places are lost to somebody else. Irrespective of who that person might be, there’s a sense that by doing that you are excluding equally qualified young people from entering a highly competitive programme, and it’s obviously a very desirable outcome for a lot of young people who come to university.”
But failing to address the significant lack of Māori and Pacific doctors perpetuates, and worsens, existing health inequities, Fraser and Bagg point out.
It has taken 20 years of significant investment just get to the number of graduates there are today and there is still so much work to do, Bagg says.
For the university, that investment involves working with schools and tackling some of the socio-economic problems that overlap with gaining quality education.
Not everyone arrives at university on an equal footing
“That’s often what people don’t understand,” Bagg says somewhat frustratingly.
“It’s that not everyone arrives at university on an equal footing. It’s what’s happening before they get to university, and we have put in systems to try and address the pre-university issues and then build on it as they go through university.
“We have to reach down into intermediate and tell the kids: ‘You need to aim to be a doctor, so you need to take the subjects that are going to enable you to do that.
“We’ll then bring you through a certificate programme…have a targeted admission scheme, and we’ll support you all the way through the programme. That takes lots of money and lots of investment.”
The results – like those shown by the Māori graduate numbers two years ago – prove it is working.
Retention rates for the targeted admission schemes are also hovering around the 94 percent, which means “they are surviving and doing very well”, Fraser says of the students gaining entry that way.
“They don’t get treated any different in terms of assessment – they are all expected to perform at the same level, so when we’re getting 95 percent retention rates, it means the programme getting them into medical school has been very successful.”
Anyone who questions the use of targeted schemes should also understand all students are scrutinised in the same way – irrespective of ethnicity or background, he adds.
“The difference between a target and a quota is that a quota suggests you take that number irrespective of how well they do, whereas a target indicates that you only take those who are competent to survive the medical programme.”
The targets are not always met because “we know if we take students who aren’t prepared, we’re setting them up to fail”, Fraser says.
“Training in medicine is not for the faint-hearted, so you’ve got to be capable enough to survive.”