Where are the Indigenous specialists? Call for colleges to address under-representation

Medical politics

By Megan Howe

2 Dec 2020

Specialist colleges need to provide more cultural support and flexibility for Aboriginal and Torres Strait Islander doctors-in-training if the ongoing paucity of Indigenous doctors in Australia is to improve, the Australian Indigenous Doctors Association (AIDA) says.

The AHPRA Annual Report for 2019-20 shows that just 0.4% of medical practitioners identified as Aboriginal and/or Torres Strait Islander (just over 500 doctors) – well short of the 3.3% Aboriginal and Torres Strait islander representation in the general population.

The figures come after AHPRA this year launched a five-year Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy which aims to eliminate racism from the health system, and which includes an aim of increasing Aboriginal and Torres Strait Islander participation in the registered health workforce.

The AHPRA report shows that apart from Aboriginal and Torres Strait Islander Health Practitioners who all identify as Aboriginal under the profession’s requirements, the highest proportion of Indigenous health professionals is in paramedicine (1.6% of the workforce) followed by nursing and midwifery (1.3%).

AIDA President Dr Tanya Schramm said that despite there having been a significant increase in the number of Indigenous doctors over the past 20 years, the latest figures showed achieving parity was very difficult.

Indigenous doctors still faced a number of barriers to entering and completing specialist training, said Dr Schramm, a GP in Hobart and senior lecturer in Aboriginal and Torres Strait islander Health Education at the University of Tasmania.

Unlike many other medical graduates, they often didn’t have connections in medicine or career mentors to guide and support them.

And some junior doctors were deterred from pursuing specialist careers by systemic racism within the hospital and health system.

“That can be really difficult to deal with as an Aboriginal and Torres Strait Islander doctor…. and some people choose to step away from the hospital [system],“ Dr Schramm said.

She said there was also a lack of cultural support by colleges, for example, there was little understanding of Indigenous trainees’ family commitments including around ‘sorry business’.

“They are not understanding of who we are and what our needs might be – some training programs are very inflexible,” she said.

Indigenous junior doctors also often had significant financial burdens and family commitments, after starting university as mature-age students, or having children during their medical degree.

“It is sometimes hard to find the money to sit exams,” she said.

Lack of Indigenous specialists

Australia’s first Indigenous neurologist, Dr Angela dos Santos, said she suffered racism from the time she entered university as one of six Aboriginal students in Western Sydney University’s first cohort of medical students in 2007.

“There was a feeling amongst the non-Indigenous students that the Indigenous entry program into medical school was not ‘fair’ and that we had taken the spot of more deserving high school students that had worked ‘harder’,” she said.

Dr dos Santos, who now works as stroke specialist and neurologist at Alfred Health and Royal Melbourne Hospital, and lectures in First Nations health at the University of Melbourne medical school, said AIDA was an “incredible support” during her medical degree.

She was drawn to neurology as a hospital trainee and received an Indigenous Health Scholarship from the Royal Australasian College of Physicians, which enabled her to attend the college’s annual congress during her training.

But she says it is only now that she’s been given the cultural support and guidance she needs as a specialist, after meeting Professor Luke Burchill, an Aboriginal cardiologist in Victoria.

She suggested the low numbers of Indigenous non-GP specialists also reflected the fact that most Indigenous doctors wanted to make the greatest contribution to their community possible – and many felt the best way they could do that was through general practice.

While selection for speciality training was currently being revamped by the RACP, barriers including unconscious bias, nepotism and racism needed to be addressed to encourage more Indigenous doctors into specialty training, she said

Dr Schramm said AIDA’s “Strong Futures” project was focused on guiding specialist colleges in how to better support indigenous trainees.

Research conducted as part of the project showed that a lack of academic support, poor access to mentoring, financial issues and systemic racism were all issues that deterred Indigenous doctors from entering specialty training.

“Anecdotal evidence indicates that there are a growing number of medical graduates for whom the transition to training and careers beyond medical school had not gone smoothly., the Strong Futures report states.

There were believed to be up to 40 Indigenous doctors who, by choice or necessity, had not completed Fellowship training, it states.

The report outlines a number of recommendations, including that training programs are flexible so that diverse familial and cultural circumstances of trainees are accommodated and supported—for example, ensuring part-time training options, extended familial, cultural and bereavement leave.

AIDA now aimed to develop a set of standards based on those factors, which it hoped could be implemented across all medical colleges to grow number of Indigenous specialists, Dr Schramm said.

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