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May the workforce be with you

How the pendulum swings. It doesn’t seem so long ago that fears of an over-supply of doctors led to a cutback in medical student numbers. Then it was realised that our medical workforce was only being sustained through immigration of doctors who had trained overseas, especially in regional and rural Australia and our public hospitals. This led to a huge expansion in medical student places and new medical schools. The stated focus of some new courses was to ‘fix’ the under-supply of doctors in general, regional and rural practice.

19 Aug 2012

How the pendulum swings. It doesn’t seem so long ago that fears of an over-supply of doctors led to a cutback in medical student numbers.

Then it was realised that our medical workforce was only being sustained through immigration of doctors who had trained overseas, especially in regional and rural Australia and our public hospitals. This led to a huge expansion in medical student places and new medical schools. The stated focus of some new courses was to ‘fix’ the under-supply of doctors in general, regional and rural practice.

Now the students attracted into the expanded medical courses are graduating in increasing numbers. Even though it is still early days for an expanded Australian medical workforce, cracks are starting to show in the planning and policy settings needed to ensure that Australia’s best and brightest students become the fully trained medical workforce Australia needs in the future.

Late last year there were concerns that there would not be enough intern places for all our medical graduates, but finally the pieces fell into place with jobs for all. Now the story is repeated. There are estimates that, nationally, the number of intern places could be as many as 500 short of the number of medical graduates.

I have faith that a way will be found to balance the numbers, but this shouldn’t be an article of faith. The number of medical graduates is predictable, within narrow limits, years ahead. Coordinated planning by the nation’s health ministers needed to start at least three years ago, and should not have been left to the last minute.

One of the risks of last minute planning is that it will result in taking easy options. The easiest, especially in an era of constrained financial resources for health services, is to cannibalise medical posts currently filled by postgraduate year two and postgraduate year three doctors. Apart from the adverse effect that would have on the skill mix available within medical teams, it will just move the problem on a year and potentially create a jobs shortage further down the career pathway. The other easy option is the creation of ‘jobs’ with little educational or experiential value.

Those on committees responsible for the accreditation of intern posts have a heavy responsibility to ensure all intern posts meet their standards and not bow to external pressure in the interests of expediency. Fortunately, these committees include colleagues with high standing within the profession, and I have faith that they will continue to apply the high standards that have always applied.

The number of doctors passing through the postgraduate training pipeline is monitored by the Medical Training Review Panel (MTRP). The Panel was established by statute and includes representatives from the Commonwealth, jurisdictions, postgraduate medical committees and medical colleges, as well as the Australian Medical Students’ Association, the Australian Salaried Medical Officers’ Federation and the AMA. Each year it produces a report detailing postgraduate training numbers – a vital resource for workforce planning and to assist doctors in making informed career choices. The composition of the MTRP also positions it well to advise on policy directions that will address Australia’s medical training and workforce needs.

Most estimates from Health Workforce Australia indicate an impending shortfall in available vocational training positions. Policies and commitments by all Australian governments are needed to ensure we provide the opportunities for Australian graduates to complete their training. This will require a significant expansion of quality training places in general practice and other specialties in both our public hospitals and private healthcare system. It will not be cheap. However, it is an essential component of following through on previous policy directions set to provide the medical workforce Australia needs while increasing our self-sufficiency.

How ironic that even now, while health ministers are still bemoaning the shortage of general practitioners, only 1138 places are available within the Commonwealth-supported Australian General Practice Training program for a reported 1510 applicants. Yes, there has been an increase in GP training positions, but much more is needed.

With over 3200 medical graduates, maintaining a balance between general practice and other specialties suggests over 1600 GP training positions will be needed, especially to follow through on medical school education that has emphasised the primacy of general practice. That means not just increased support for training places and their supervision, but investing in general practice infrastructure.

As the medical workforce pendulum swings away from shortage, there will be new challenges. A risk as Australia moves towards increased self-sufficiency is that the doctors trained overseas who have filled the deficiencies in our health system will be abandoned. Many of these are on 457 visas. If they lose their job, they lose their visa. The AMA will be alert to their needs. They have helped Australia when we needed them, and to abandon them now could only tarnish Australia’s international reputation.

We now have more medical graduates than ever before. Health Workforce Australia is giving us more information on our medical workforce than ever before. Now these need to be combined to plan and create policies for the medical workforce of the future.

 


Published: 19 Aug 2012