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12 Jul 2019

BY AMA VICE PRESIDENT DR CHRIS ZAPPALA, CHAIR OF THE AMA MEDICAL WORKFORCE COMMITTEE  

The annual AMA National Conference is always one of the highlights for the year. This year, I was fortunate to be the Chair of the Great Workforce Debate. The novel idea of two teams arguing why a statement is accurate (or inaccurate) was an intriguing way to discuss a very serious issue that profoundly affects us all. The topic of the debate was: Australia has an oversupply of doctors and the current model of medical school and vocational training is no longer fit for purpose in this context.

I would like to again thank our fantastic speakers: Associate Professor Susan Neuhaus, Ms Jacoba van Wees and Clinical Associate Professor Saxon Smith for the affirmative and Dr Chris Wilson, Dr Ines Rio and Dr Roderick McRae for the negative. From various stages of their careers and with unique perspectives on the specific issues around the model of education and training, the speakers were engaging and entertaining while debating the topic. While the affirmative won a slim majority of the audience at the end, they did lose support throughout the debate as a great credit to the negative team.  Initial score was 74 per cent agree and 26 per cent disagree with the topic statement – but after the debate this had shifted to 58 per cent agree and 42 per cent disagree. Interesting isn’t it?

The debate itself is worth watching. You can view it at:  <https://www.youtube.com/watch?v=-OrRlMUXOF4&list=PLRZ9-Pjsi3pv4vIZ2IkuOqC2N8yKTSdu7&index=8>

It covered many important issues such as the large number of early postgraduate doctors waiting for vocational training positions, and the current reliance on overseas trained doctors to fill specific workforce shortages and how the maldistribution of the workforce is creating numerous stresses. Interestingly, both sides tried to argue for a degree of system evolution and not revolution/upheaval – which suggests there is a reasonable degree of happiness with much in our system. This is always worth bearing in mind.

One of the most interesting outcomes of the debate for me was seeing the personal views of the debaters change during their preparation (they got very competitive as well). I spend a significant amount of time thinking about the issues of maldistribution, the increasing number of graduates and the structural challenges of vocational training and over-supply, but I sometimes have to take a step back and consider how I view these issues – there are so many different experiences and perceptions throughout our profession that it is clear we have a large task in gaining a consensus on the optimal plan to improve workforce disposition, training and diversity. 

This is now our great challenge: we need to stop looking at the threats to our own specialties or our own regions and step back to consider the whole workforce and the effects change has on others in the profession. We need to know what the Government’s goals are and how we can help them solve these problems in a fashion we are happy with. My rural and remote colleagues might say that this is easy for me to say – I don’t have to deal with the closure of the local maternity service or deal with the stress of not having someone to take over for me when I retire as the last doctor in town. But we need to view these issues not as individual problems to be solved simply by pumping more cash into the service; we need to view this as an issue which has emerged out of years of neglect and poor planning and a dire need to modernise the practice of medicine around what patients want/need. We need to look at who we are training, where this is taking place and what they are training in and ask if this is the best use of our resources. 

The Commonwealth is currently scoping a national medical workforce strategy and already there are early signs that the outcomes are being dominated by jurisdictions, Government and Universities and not sufficiently the medical profession.  For example, I am concerned about the suggestion that vocational change has in some way failed (or is failing) and the acceptance that over-supply is the price we pay for crippling maldistribution, despite the AMA being clear for many years on how this might be fixed.

The Minister for Health sent a video to National Conference thanking the AMA for the hard work we have done over the past few years and stating he looks forward to continuing that work. In his speech, he noted the recent Commonwealth Fund report which showed Australia is ranked first in the world for clinical outcomes, and that we have the second best health system in the world (maybe they had trouble jotting up the scores). Perhaps this is part of the problem – we don’t want to change a system which is delivering robust outcomes.

But it is not destined to stay this way. Convenience and cheapness are trump cards these days so our vision for medicine, for example, in regard to the 10 year primary care plan the Minister has announced, needs to avoid scratching about for small amounts of money and instead be truly aspirational and lock in medical-led care as the cornerstone of our system, that is nimbly and efficiently meeting patients’ needs and expectations.

We have not always had great success in coalescing the combined efforts and intents of all AMAs towards a single focus or campaign. Perhaps evolution of the medical workforce should represent a goal for us in this regard given the intricate involvement of all Governments in managing the medical workforce. We will hopefully do better if the messages and requests for change are heard simultaneously and loudly in the office of every Health Minister in the country.  There is much work to do in this space that has ramifications across medicine and daily practice – so a united approach and effort is critical.

 


Published: 12 Jul 2019