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Successes, but greater challenges await over the horizon

17 Dec 2013

The impending holiday season and accompanying slowdown, as political and departmental offices close for Christmas, provides time for introspection regarding the AMA’s (and the AMA’s Council of Doctors in Training) successes in the medical training arena this year.

After eighteen months in the Chair role, I am continually impressed by the broad scope of the AMACDT’s advocacy, and the gravity with which it is received by the various groups we work with.  With my impending departure from AMACDT, the final column for the year is an ideal opportunity to review the success during my term as AMACDT Chair, and preview the challenges that lie in wait for the Council next year.

Medical workforce remains a core issue.

The emergence and ongoing success of Health Workforce Australia (HWA), the bureaucracy primarily tasked with solving Australia’s health professional crisis, has been important.

It has overseen the slow evolution of medical workforce planning, with the publication of the Health Workforce 2025 volumes, the formation of the National Medical Training Advisory Network (NMTAN), and the impending production of five-year training plans, completing the transition from data collection to workforce planning.

While HWA was never going to be a panacea, the foundations have been laid for future successes.  The AMA has been a strong supporter of the role taken by HWA, and is heavily involved with NMTAN to ensure that it continues to meet these goals.

With more than 100 intern places funded by the Commonwealth Government each year for the next four years, the provision of internships for a greater proportion of international students has been one of  the best examples of AMACDT advocacy.

That the 2006 COAG agreement to provide internships for all domestic Commonwealth-supported medical students continues to stand, also demonstrates the power of AMA advocacy. The Australian Medical Students’ Association has worked hard for its members, and our partnership with them has been valuable for both organisations.    

On a more obscure note, the recent implementation of a suite of standards strengthening medical internships has been another success for AMACDT.

While these changes will not be immediately apparent to most interns, the creation of national standards for intern training programs, and the accreditors of intern training programs, will ensure that intern training is delivered at a high standard around the country.

The addition of outcome statements will also provide current and future interns with clarification regarding the professional goals that they should expect to achieve over the 12 month training period. The Australian Medical Council has had to toil to create this framework, and should be applauded for its persistence.

Finally, the AMA’s biggest coup for the year - scrapping the cap - has to be acknowledged as an enormous victory which has staved off significant financial disadvantage to members and non-members alike.

Junior doctors, as one of the groups that would have been most disadvantaged by this decision, must recognise the core role played by the AMA in reversing this terrible policy. 

Following on from these successes, a number of new policy fronts have opened up and created new challenges for both the AMA and AMACDT.

Junior doctor mental health and finding a solution to maldistribution are two external challenges, while boosting membership numbers to improve advocacy power will be a challenge internally.

Junior doctor mental health and wellbeing promises to be a crucial issue.

Reports have highlighted the parlous state of doctor mental health and demonstrated that the highest risk period occurs during the transition from medical student to junior doctor. Clearly, factors such as increased career stress, mandatory reporting, rapidly changing workplace expectations and a higher pressure clinical environment, are all exacerbating the already stressful transition from medical school to the workplace.

Some solutions are already in play, but a system-wide shift is needed to create a cultural change in hospitals to ensure that junior doctors feel valued in the crucial roles that they undertake.

Solving maldistribution will not be a ‘silver bullet’ exercise, but will require a range of strategies.

AMACDT’s role will be to ensure that these solutions create longer term increases in the rural workforce and undersubscribed specialties.

The key will be creating a medical workforce tailored to meet demand by crafting appropriate undergraduate experiences and opportunities for training in undersubscribed regions and specialties. Incentives may play a role, but any return to, or increase use of, policies that intend to conscript doctors must regarded as a retrograde step.

Of all the challenges outlined in this column, that of membership is most crucial.

Historically, the AMA’s success has relied upon its claim to be representative to the medical profession.

Similarly, AMACDT’s role as the peak junior doctor representative body in Australia has relied upon our reputation for representing large numbers of junior doctors.

In recent years our growth in membership has not matched the expansion of the medical profession, leaving the AMA and our advocacy efforts in a weakened position.

We need to think about a health system without an AMA.

Consider our victories. With no AMA, how many of today’s interns wouldn’t have jobs? How much would you be paying for your education? Think about this when you speak to non-member colleagues who have benefited from our activism, but fail to contribute to it.

This column marks my final contribution as Chair of AMACDT.

At the end of the year I stand down as I finish my doctor-in-training years and join the ranks of consultants.

The very able Dr James Churchill, a current intern and past AMSA president, will step into these shoes and continue to work to improve the health system for junior doctors around Australia.

I’d like to thank the AMA, the Council of Doctors in Training and the fantastic AMA secretariat for all their hard work and support during my time as Chair of AMACDT.

Will Milford

Follow Will (and now James) on Twitter (@amacdt) or Facebook (          

Published: 17 Dec 2013