Dr Mukesh Haikerwal discusses COAG and increased medical training places

This apparently comes off the back of warnings and complaints that just basic anatomy training is inadequate for doctors and that training on dummies and the like isn't really doing it, that these trainee doctors need access to real patients in order get them up to speed.

Doctor Mukesh Haikerwal is joining us now, Federal President of the AMA.

Doctor Haikerwal, good morning.

DR HAIKERWAL: Good morning Virginia?

VIRGINIA TRIOLI: Do you think it's a good idea?

DR HAIKERWAL: Look, we have been calling for increased medical school training places for some time. The Prime Minister came through with additional places in previous announcements and obviously he did so with another *500 about six weeks ago.

What the concern really is, is that those 500 places and the allocation of them has to be done with some degree of common sense and collaboration between the universities and that, across the country, indeed across New South Wales, is a great example of where the other problems are. The people are clamouring for more medical school places.

You don't solve the medical crisis by chucking medical students at the problem. You've actually got to produce fully trained GP's and other specialists at the other end. So, for that to happen, not only do you need the medical school places, you also need the clinical training for the medical students.

You then need intern positions for those medical students to actually be fully registered doctors, but then to be able to practise independently, they need that additional five years to ten years to be GPs or other specialists and that requires places within the hospital system to get that training happening.

VIRGINIA TRIOLI: Now is that a State or a Federal issue, those places?

DR HAIKERWAL: It's a combination. What we see is obviously the universities are paid for by the Federal Government. The States pay for the local, the beds and so on in the State hospitals. State hospital beds are running at capacity plus, and therefore there's not much time for teaching and not much time for those sorts of research and other activities that make for an academic environment. So, you know, it's important that the capacity is increased to allow that teaching to happen, that registrars and doctors are allowed to have time to teach the next generation. And, indeed, there are beds that are occupied by people, you know, within the hospital system, which of course, is a problem.

VIRGINIA TRIOLI: I understand that the AMA has written to every single Member and Senator of the Federal Parliament, I think. I think you've had the stationery very, very busy. State Premiers, State Education and Health Ministers on this issue, so you've really been pressing for it.

DR HAIKERWAL: It's just so important. We certainly believe that we need to increase our capacity of the doctors. The people that are retiring are coming up. The baby boomer generation's coming up for retirement, and therefore the numbers will actually drop before they increase.

Also, the new generation of doctors aren't working stupid hours that we used to work, or the people before us used to work. So, it's important that we actually have more than we currently have to fill in the spaces that are required. But, also, we need the academic teachers for the doctors that are there, the ones we need to be doing the teaching.

The University of Wollongong will be doing a lot of teaching outside of hospitals in the community in general practice and in private consulting rooms, and that needs to be properly planned for.

We need to make sure that the people who are doing that teaching outside of the hospital setting aren't compromised by doing that. And so it's important at the end of the day that we get a good clinical experience that doctors continue to be as good as they've ever been, that the public can have the same standard and expect the same standards and achieve the same standards as they always have had, but that requires good planning.

It requires collaboration between the State and Federal parts of the equation and it certainly means that the clinical teachers need time to get up and do the teaching.

VIRGINIA TRIOLI: I guess it also means then that even while it might sound good that these new places will be offered to the States, and they'll be funded by the Federal Government, that if the States don't kick in with matching money then for the training, and for what goes on in the hospitals, as you're saying in a clinical part of their training, then the whole idea just falls away.

DR HAIKERWAL: That's exactly right. And what we've seen for instance in the west of Sydney with the University of Western Sydney starting, and that's again a very …(inaudible)… school. It's a similar place that would otherwise have been used by a New South Wales University and Sydney University are now being used by New South Wales, by University of Western Sydney. So, it's important that they do that in a collaborative way and not actually cannibalise one set of university places and that will compromise the teaching of another.

We wouldn't want to see a situation where University of Sydney or University of New South Wales, which are very well established, actually cut the number of places, because there's so many new medical school places or new universities out there. So, we've got to use what we've got and use it wisely, increase the capacity of what's there, and as the capacity is there we need to make sure it's distributed well and in collaboration, rather than a mad grab.

VIRGINIA TRIOLI: Is there a basic curriculum problem here as well in the States where the fundamental teaching of anatomy has actually fallen away?

DR HAIKERWAL: There is a concern that the pendulum's swung a bit too far away from basic studies like anatomy and physiology and...

VIRGINIA TRIOLI: And towards what instead?

DR HAIKERWAL: They are there, but the amount is... the proportion drops off and there's more things around, some of the social sciences. They're important too, so it's important that we get the balance right.

The reason we've got long courses is because there's so much to do, and if people click the courses, you've got to ask, which bits don't you want us to know? Which bits don't you want us to learn?

And that's a very important thing - that we actually want fully capable, competent doctors who can empathise and can discuss things well with the patients, but also have an understanding of what they're discussing, so they actually need to know the nuts and bolts of the body and how it works and make sure they understand the ease of these processes, but also the prevention and the health benefits that come with that new approach. So, the new and old need to come together, and I think that, you know, we've got to get the pendulum swinging in the right direction.

VIRGINIA TRIOLI: That's right. In all of these cases it's pressing on all of the levers at the same time with the right degree of pressure, I guess.

DR HAIKERWAL: That's exactly right and, at the end of the day, I think we've got an excellent system with excellent people within it and we'll continue to maintain that excellence. It just requires goodwill and collaboration between the levels of government and actually at the proper dollar amount, funding these places, what we see is universities being charged for some places to teach in hospitals and so on.

They're not having the lecture rooms or any sorts of tutorial rooms and the doctors aren't there to do the teaching because they're too busy doing service work and therefore the system will fall over. From the day of, one of the greatest things we can do is teach our next generation. We, as doctors, are very keen to do that. We want the right environment to do that.

VIRGINIA TRIOLI: Yes, well look we're short of time and I just quickly want to go to Jeff who's called in.

Jeff, good morning.

CALLER JEFF: Good morning, Virginia.

VIRGINIA TRIOLI: Go ahead, just quickly.

CALLER JEFF: For Doctor Haikerwal, my son who's just qualified to do medicine next year and he has to go for an interview at one university. He's only allowed one interview at one university. If he fails that interview, he can't go for a second interview at another university, unlike any other course that you can do.

Can Doctor Haikerwal enlighten me on why they've got this policy?

VIRGINIA TRIOLI: Explain that. What's the reason for that, Doctor Haikerwal?

DR HAIKERWAL: I'm not sure why it would be one interview only and certainly the whole interview process and the selection process is also under the microscope, because there seems to be some degree of social engineering going on around that, and whereas people who have previously got in on aptitude and ability aren't able to get in...

VIRGINIA TRIOLI: I think the sense is that they're trying to get people who would not only be good clinicians, who are good at, who have the brain, but also have the emotional intelligence to communicate well with patients.

DR HAIKERWAL: I see the whole of that stuff, it is important that we do get that right, but you know, these are young people that have got several options open to them and basically if people are put through too many hoops and hurdles and made to suffer, they still walk away, and then they walk away either when they're doing the training or after they've finished, and I think what they've got to understand is that we've got to make sure that people are enticed into medicine and enticed to stay there because they want to, and not under any kind of duress and service obligations, because it's a great career to be in, which it is, not to be damaged.

VIRGINIA TRIOLI: Doctor Haikerwal thank you for your time. We'll leave it there and we'll talk again. Thank you.

*Announced by the Prime Minister on 8 April 2006 - 400 HECS places, with a potential 25 per cent full fee paying places on top.