Abstract
IntroductionMedical schools are in general over-represented by students from high socio-economic status backgrounds. The University of Western Australia Medical School has been progressively widening the participation of students from a broader spectrum of the community both through expanded selection criteria and quota-based approaches for students of rural, indigenous and other socio-educationally disadvantaged backgrounds. We proposed that medical students entering medical school from such backgrounds would ultimately be more likely to practice in areas of increased socio-economic disadvantage.MethodsThe current practice address of 2829 medical students who commenced practice from 1980 to 2011 was ascertained from the Australian Health Practitioner Regulation Agency (AHPRA) Database. Logistic regression was utilised to determine the predictors of the likelihood of the current practice address being in the lower 8 socio-economic deciles versus the top 2 socio-economic deciles.ResultsThose who were categorised in the lower 8 socio-economic deciles at entry to medical school had increased odds of a current practice address in the lower 8 socio-economic deciles 5 or more years after graduation (OR 2.05, 95% CI 1.72, 2.45, P < 0.001). Other positive univariate predictors included age at medical degree completion (for those 25 years or older vs those 24 years or younger OR 1.53, 95% CI 1.27, 1.84, P < 0.001), being female (OR 1.26, 95% CI 1.07, 1.48, P = 0.005) and having a general practice versus specialist qualification (OR 4.16, 95% CI 3.33, 5.19, P < 0.001). Negative predictors included having attended an independent school vs a government school (OR 0.77, 95% CI 0.64, 0.92, P < 0.001) or being originally from overseas vs being born in Oceania (OR 0.80, 95% CI 0.67, 0.96, P = 0.017). After adjustment for potential confounders in multivariate logistic regression, those in the lower 8 socio-economic deciles at entry to medical school still had increased odds of having a current practice address in the lower 8 socio-economic deciles (OR 1.63, 95% CI 1.34, 1.99, P < 0.001).ConclusionWidening participation in medical school to students from more diverse socio-educational backgrounds is likely to increase the distribution of the medical workforce to ultimate service across areas representative of a broader socio-economic spectrum.
Highlights
Medical schools are in general over-represented by students from high socio-economic status backgrounds
Excluded from the study were 19 graduates with either an international or no local correspondence address recorded at medical school entry, 194 either not currently listed on the Australian Health Practitioner Regulation Agency (AHPRA) 2016 database, suspended in 2016 or failed to re-register in 2016, 7 who were deceased and 100 who were either overseas or registered as currently non-practicing leaving 2829 graduates in the final analysis (89.8% of the total cohort)
27% were from the lower 8 Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) deciles at medical school entry (N = 749) and 73% from the upper 2 IRSAD deciles (N = 2080) while for those who lived in capital cities, 92.5% (N = 2377) were from the inner metropolitan area and 7.5% (N = 193) were from the outer metropolitan area
Summary
Medical schools are in general over-represented by students from high socio-economic status backgrounds. Roeger et al [6] utilised the SEIFA Index of Relative Social Advantage and Disadvantage score to examine the equity of access to general practitioners in the capital city, Adelaide, South Australia, and found that residents in the outer suburbs and in those with lower socio-economic status (SES) appeared to be the most disadvantaged. They demonstrated an approximate linear relationship between SES and the mean population to general practitioner ratio, with the poorest areas increasingly underserved
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