Transcript: Dr Andrew Pesce, with Leon Delaney, 2SM Radio

Subject: Medical internships shortage

LEON DELANEY:Some time ago it was determined that we were confronting a shortage of doctors, along with some other professionals as well, and there were efforts to increase the number of training places at universities to train more medical students. But now we're apparently confronting a situation where there's a severe shortage of intern places in Australia's hospital and health system.

President of the AMA, Dr Andrew Pesce, good morning.

ANDREW PESCE: Good morning Leon.

LEON DELANEY: How are you today?

ANDREW PESCE: I'm very well thanks.

LEON DELANEY: Okay. Obviously the numbers of the health workforce is a difficult calculation to make, and that's why there was a miscalculation in the past as to just how many doctors, and nurses for that matter, we might actually need to service the needs of our population. But we're still struggling with the fallout from those decisions, aren't we?

ANDREW PESCE: Well, we are. As you said, it was recognised some time ago that we really needed to boost the numbers of doctors and nurses training, and the current problem is evidence of that dysfunction that we've often talked about and that - the split responsibilities between the Commonwealth and States has meant that we've now got a complete dislocation between the number of medical students that are being trained in universities and the facilities and infrastructure which is available to train them once they graduate and get into the hospitals.

So we've increased the numbers of training medical students, and that's needed and that's great, but we haven't seen a commensurate improvement in the ability to train the increased numbers coming through the system.

And now we've got, you know, double the numbers of medical students that we've had coming through a few years ago, without there having been any significant improvement in the ability to train the increased numbers in our hospitals.

And, as you would and your listeners would understand, the main clinical training of a doctor actually really commences once they graduate from university and they start doing their clinical training in the teaching hospitals.

LEON DELANEY: Yes. So, as I understand it, we're confronting perhaps 1200 to 1300 medical students who will graduate in a couple of years time who won't have an internship to go to because there aren't enough places.

ANDREW PESCE: Yes, so far the State governments, to their credit, have committed to try to increase the numbers but they're really - unless there's some fundamental resolution of this, they're going to struggle to have intern places to guarantee each medical student an internship. And, more importantly, remembering that an internship is just one year, it takes at least five or six years to really train a doctor in that clinical setting. And the problem is going to be moved on to the second year and third year and fourth year unless there's some fundamental way that this impasse is going to be broken.

LEON DELANEY: Yeah. This shortage of internship places, is that a direct result of cost pressures on State-run public hospitals?

ANDREW PESCE: Yeah. I mean, the States have had limited finances. They - obviously their primary obligation is of course to provide services to patients, and we always recognise that. And so increasingly, as they come under cost pressures and financing pressures, it's impossible to expand the training that's required to teach these extra doctors that are going to be needed to staff the health system in the future; and not just doctors, nurses as well.

So what we actually need is for there to be a really good fundamental sit-down with all the players around the table, recognising that there's a split responsibility between the Commonwealth and States, and to have a coordinated strategy to make sure that the effort is now put in to make sure that we can actually train these doctors and nurses that will be coming through.

LEON DELANEY: Obviously what might appear to be a cost saving measure today is actually, longer term, a measure which erodes the ability of the system to actually provide the services that it's supposed to be dedicated to providing.

ANDREW PESCE: Well, the ultimate irony of course is that, you know, we're in a position where we may have medical students graduating that can't be trained, at the same time that we're importing doctors from overseas to supply us with the workforce that we desperately need.

So, you know, it's obviously a nonsense that these things are happening at the same time. And what we should be doing is getting our act together, making sure that this country takes the responsibility for training the workforce that it needs when we've got - when we've certainly got the capacity to do that if we set our minds to it.

And, to that end, the Australian Medical Association is currently working on a letter to invite the - all of the stakeholders, the deans of the universities, the departments of health, the colleges, the medical students' representatives, and the doctors in training, to actually come and sort of meet and actually thrash out the key issues that need to be addressed, timelines of when they're going to be addressed, and how the funding is going to be met.

LEON DELANEY: And of course with the current Federal election outcome pending, swinging in the breeze as it were, we're not even sure what's going to happen with the whole hospital reform process at the moment, are we?

ANDREW PESCE: Well, that's true. And that's why the AMA has actually taken this lead because we can see that it's going to take a little while for us even to know who is going to form Government. You know, nothing gets done in caretaker mode.

This is something which has been hanging around for awhile. It really - you know, there's been opportunities if it was going to be fixed by the powers that be, that they would have been addressed much better than it has been at this stage. So we're going to see if we can take a lead and actually try and get the people together and get some forward movement on this.

LEON DELANEY: Yeah. Does it really matter who is actually running the hospital system, whether it's State or Federal? Or is it more a matter of how it's structured?

ANDREW PESCE: Look, certainly the fact that you've got States who have their own Budgets, then they decide how much of this is their responsibility and how much is the Commonwealth's. You know, you always get that blame-shifting; we've talked about this many, many times.

But, look, we've got the system that we've currently got. It's not something that's going to change in a hurry. We're not going to get a single funder for the health system for some time to come. And this is an issue that needs to be addressed now.

LEON DELANEY: Absolutely. Thanks very much for your time today.

ANDREW PESCE: Right. Thank you Leon.

LEON DELANEY: Thanks for that. Dr Andrew Pesce, the President of the AMA.

 

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27 August 2010

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