A doctor, medical educator and former MAPAS student talks about the importance of the scheme, not just for the Māori and Pacific students, but their communities and the nation as a whole.

I started medical school in 2005. There were about 150 students in my class then and maybe 15 to 20 of us were Māori and Pacific Admission Scheme (MAPAS) students at the University of Auckland. Today, the medical school has grown to more than 300 students, including more than 100 Māori and Pacific students.

When people look at the scheme, they often only see the admission part. But it is much more than that. I came through MAPAS myself, graduated in 2011, and now work across clinical practice, medical education, research and Māori health governance. I’m a senior lecturer in medical education at the University of Auckland’s School of Medicine and my PhD looked at what motivates Māori, Pacific and non-Māori and Pacific students to study medicine.

Across those different parts of my mahi, I keep coming back to the same question of who our health workforce is there to serve, because we still have enormous inequities in health. Māori experience a life expectancy gap of around seven years and greater barriers to accessing healthcare. At the same time, Māori make up less than 6% of the medical workforce, despite making up around 18% of the population. Pacific representation among doctors is even lower.

We still have a long way to go and when you look at where Aotearoa is heading, the argument for growing the Māori and Pacific health workforce becomes even stronger. Our Māori and Pacific populations are young and growing. In the coming decades, a much greater proportion of our tamariki will be Māori.

This isn’t the time to take our foot off the gas. We need to go faster and further.

There’s a basis for us being here

When I was at medical school, the arguments about Māori and Pacific admission programmes weren’t new. You’d hear the kōrero, particularly in those early years. Sometimes it came from other students. Sometimes it came through the media.

Why should Māori and Pacific students get a separate pathway? Is that fair? Did somebody else miss out because you’re here? Twenty years later, we’re hearing versions of those arguments again. For a young Māori or Pacific student entering medicine, that can have an impact. That’s why I’ve always thought it was important that our tauira understand why they’re there.

And there is a basis for us being here. The first part is equity: if we’re going to address inequitable health outcomes, we need a health workforce that reflects the communities it serves. But there’s also an argument based on te tiriti that doesn’t get talked about as much.

The Waitangi Tribunal’s principles for healthcare include equity, options and tino rangatiratanga. Options include access to culturally appropriate services and hauora Māori models of care. If we want those services to exist, we need a Māori workforce capable of delivering them.

Our own whānau tell us that too. Through my work in Māori health governance, we hear communities saying they want Māori clinicians serving their communities. So this isn’t simply an argument about university admissions, it’s about what our health system looks like and who it works for.

There’s another idea I think needs challenging: that somehow Māori and Pacific students admitted through MAPAS graduate to a lower standard. We don’t. We’re all doing the same exams and meeting the same standards. Māori and Pacific students graduate with distinction. Some are among the best students in their classes.

But there’s also a bigger question about what actually makes a good doctor. People sometimes say they just want the best doctor doing their surgery, which is fair enough. But the best doctor doesn’t just mean the person who entered university with the highest grades. Academic performance matters. Grades coming into medical school can predict academic performance, particularly during the earlier, exam-heavy years. But medicine isn’t just exams. As students move through clinical training, other qualities become incredibly important: communication, interpersonal skills, clinical performance, the ability to build trust and the ability to actually work with patients. That’s why medical selection doesn’t simply ask who has the highest marks.

Medical schools are publicly funded. Ultimately, they’re there to train the workforce New Zealand needs. So the question isn’t simply who has the highest grades, it’s asking what kind of doctors our health system needs.

Māori doctors tend to come home

My PhD research looked at why people choose medicine. There were similarities between Māori, Pacific and other students. People wanted meaningful careers, stable jobs and they wanted to help others. But there were differences too. For the Māori and Pacific students I interviewed, the health experiences of their own whānau were particularly important. They talked about values such as tikanga, manaakitanga and aroha. They wanted to serve their people.

That fits with what we see after graduation. Māori doctors are more likely to stay in Aotearoa, work in general practice, work in rural communities and work near the places their whānau come from. That matters when some of the communities with the greatest health needs are also the places that struggle to attract doctors.

But representation can start making a difference long before somebody becomes a doctor. I was the first person in my whānau and hapū to go to medical school. Just recently, I was talking to some tauira at Okaihau College about medicine. Part of my job at that moment was simply helping them believe there could be a place for them there.

There’s a whakataukī I sometimes use: kotahi tangata, he rōpū tangata – from one can come 100. The benefit isn’t limited to that one person becoming a doctor. They become someone their younger cousins can look up to and somebody their whānau can call when they’re struggling to navigate a complicated health system. They can mentor the next person coming through. And a profession that once seemed completely foreign starts becoming imaginable.

One of the most important things people misunderstand about targeted admission programmes is that it’s not simply about getting people into medical school. It’s about creating an environment where they can succeed once they’re there.

Having pastoral support matters, as does having other Māori and Pacific students around you and somewhere you feel you belong. For me, that part of MAPAS was beautiful and it didn’t finish when we walked out of the lecture theatre. Those relationships followed us into clinical placements and our careers. Over 20 years later, many of those people I studied alongside are now part of the Māori medical workforce.

Being understood can change the care you receive

Representation isn’t only about making people feel good when they see a Māori doctor. It can affect healthcare itself. Greater cultural competency can improve patient satisfaction. And when patients feel understood, they’re more likely to trust the person treating them.

Think about what follows from that. If I trust my doctor, I’m more likely to tell them what’s actually happening in my life and I’m more likely to give them a complete history. That gives them better information to make a diagnosis. And if I trust the treatment plan they give me, I’m more likely to follow it.

So when somebody says they simply want the best doctor, cultural competence shouldn’t be treated as something separate from quality. It can be part of quality.

The good news is the Māori and Pacific medical workforce is growing, particularly among younger doctors. That means the challenge is changing. When I was coming through, so much of the focus was on getting Māori and Pacific students from high school into medical school and that’s still incredibly important. But we’ve now got increasing numbers graduating. We’re now asking ourselves how we get those doctors through specialty training and into senior positions? How do we grow Māori surgeons, physicians and specialists. Because Māori and Pacific doctors aren’t only going to treat Māori and Pacific patients – we’re going to treat everybody.

MAPAS has been around for more than 50 years. Of course, a programme that’s existed for that long can be reviewed. Feedback is important, as is continual improvement. The government should release the review, look at the evidence, and use its findings. But don’t confuse reviewing a programme with deciding its purpose no longer exists.

The inequities still exist. Māori and Pacific people are still underrepresented in the medical workforce. Our communities are still telling us they need more Māori clinicians. And we’re still seeing the benefits when our tauira become doctors and return to serve their communities.

The public debate will come and go. Politicians will come and go. Media stories about targeted admission schemes will come and go. I’ve heard these arguments before, but the mahi remains. We’re not there yet. So let’s not take our foot off the gas, let’s go faster and further. Because the need is still there.

– As told to Liam Rātana