Programs to support students on placement need careful design

We need to sound the alarm on a looming critical shortage in the health workforce or Australians will suffer an increase in avoidable deaths from many illnesses including cancer, mental health problems and heart disease.

Already those living in rural and remote areas are 1.5 times more likely to die of many conditions than those in major cities, due to several factors including longer wait times to see doctors, nurses and specialists.

We have a growing and ageing population, and the Universities Accord estimates more than 500,000 new healthcare and social assistance jobs will be needed by 2033, only nine years away, to meet our needs.

So how do we ensure we are training this workforce pipeline?

The Accord proposes that part of the solution to the skills shortage can be found by addressing the financial burden, or “placement poverty”, faced by students.

“Placement poverty” should be addressed as an equity measure, providing means-tested financial support for students who face ­severe financial pressures when undertaking compulsory training placements.

The financial support could include a bursary system as well as a bonded scholarship scheme for ­allied health, dental, oral health, nursing and pharmacy students which could help address the critical health workforce needs in rural and remote areas.

But we should not mistake these placements as “unpaid work” and require that all placements be paid.

They are not employment, but a mandatory part of a health student’s education and training. They are practice-based training completed in a supervised setting.

Known as “work-integrated learning”, they ensure students develop the technical skills and knowledge required for registration in their health profession and are compulsory to ensure that when health professionals graduate they are safe practitioners – able to deliver care at the standard required by the Australian public.

Introducing across-the-board “paid placement” threatens the ­integrity of the training – raising potential conflicts of interest when it comes to assessment of healthcare students and conflict between the priorities of the “employer” and the learning needs of the students.

A better financial support model would be a bursary system – jointly funded by the commonwealth and the states – similar to the UK’s National Health Service-Learning Support Fund. That fund applies to specified healthcare courses and includes training grants, funding for travel and temporary accommodation, and a fund for students experiencing ­financial difficulties.

Employers should also make reasonable contributions to the costs of supporting placements as they benefit from the pipeline of qualified graduates. And universities can play their part, such as through top-up university bursaries to help get more low SES ­students to university in the first place.

There is a place for government policies to encourage financial support from philanthropy, as well as from business, to address student placement poverty across the health professions.

Such co-ordinated action under a new decade-long national health workforce strategy can ensure our universities continue to train a health profession workforce of excellence, as well as diversity in the numbers and in the areas necessary to meet the needs of all Australians, wherever they live.

But we should be careful not to misdiagnose the problem and ­develop the wrong solution and treatment plan.

This article was first published as an opinion piece in The Australian on 3 April 2024. It is authored by Professor Robyn Ward, Executive Dean and Pro Vice-Chancellor of Medicine and Health at the University of Sydney.