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12 Dec 2016

At the recent AMA Medical Workforce Committee (MWC) meeting I was reminded that 20 years ago the Federal Government was pushing the idea that Australia had far too many doctors. This was driving widespread over-servicing of patients and sending health spending out of control by hundreds of millions of dollars, or so we were told.

Though there was never any hard evidence to justify these claims, they drove the Government’s conscious decision to restrict the growth in medical student numbers and make it harder for foreign doctors to work in Australia. For most of us in the profession it was clear, even then, that the country was facing a big shortage of doctors.

Successive governments have listened to the profession and the public and acted to address workforce shortages by increasing the number of medical student graduates from 1500 a year in 2004 to an estimated 3700 by 2018. The most recent Health Department data shows there are nearly 17,000 students training in our medical schools at the moment. Indeed, I understand that we are now graduating more doctors than most other OECD countries.

What is patently clear, even to the most casual observer, is that for this large cohort of new medical students coming through our university system, post-university training needs are more acute than ever.

It makes no sense to ratchet up the levers on entry training without a commensurate focus on the postgraduate training pathway - a pathway needing not only an increased number of accredited training positions, but also positions with sufficient flexibility and geographic  spread to cater for an increasing diversity of training requirements and trainee needs. 

Australia’s substantial investment will be wasted, and the desired future medical workforce outcomes lost, unless complemented with comprehensive workforce planning arrangements and extra training places for these graduates once they have finished their courses.

What especially worries the MWC is the lack of attention being paid to improving vocational training capacity and ensuring this larger workforce is evenly distributed by location and specialty so it can meet the expected community demand for medical services.

Let’s look at the problem in more detail. Health Workforce Australia’s final medical workforce report made projections to 2030. These made it clear that Australia is struggling to provide adequate numbers of training positions for junior doctors. For specialist training positions, HWA’s modelling said that by 2018 there would be a shortfall of 569 first-year advanced training places, worsening to 689 places in 2024 and to 1011 places in 2030.

Too many people think medical training ends at the university gates.

Policymakers and the public have failed to recognise the magnitude of the problem, and not enough effort is going into finding the required vocational training places.

The situation is not being helped by the performance of the National Medical Training Advisory Network (NMTAN), the Commonwealth’s main medical workforce advisory body.

It was due to deliver a snapshot of workforce status in almost a dozen craft groups by the end of this year. Currently, only two have been formally released (anaesthetics and psychiatry), with another two very close to release. General practice has been delayed to at least the end of 2017. 

NMTAN’s vital workforce modelling program is well short of what is required, and the organisation is being diverted from delivering on this core function by irrelevant activities imposed on it by the Department of Health. There is an increasing belief that timeframes for delivery of the reports will blow out significantly, making meaningful planning very problematic.

This is something we are actively and robustly taking up with the Minister. Vocational training will continue to be a significant high priority for the MWC.



Published: 12 Dec 2016