Dr Pesce discusses medical training on ABC2 News Breakfast

Subjects:    Medical training

JOE O’BRIEN:    Now the Prime Minister has released the second part of his plan to overhaul the health system with a scheme to train five and a half thousand extra GPs, nearly 700 new specialists.

VIRGINIA TRIOLI:    But the Opposition leader Tony Abbott says if negotiations with the states over hospital funding are a guide, then Kevin Rudd will have trouble gathering support for this one too.  For more, Doctor Andrew Pesce joins us now from the AMA, the Australian Medical Association, in Sydney.  Andrew Pesce, good morning. Good to talk to you again.

DR ANDREW PESCE:    Good morning Virginia.

VIRGINIA TRIOLI:    Before we get down to the tintacks of this, can I just ask you for a moment just to step back for a bit, I guess, and read this politically for me.  Do you see this as part of the sweetener to try and get the states on board with a more generalised, a more complete health revamp?

DR ANDREW PESCE:    Well everyone's been asking for some extra detail to fill out the shape of the health reform agenda.  But this is much, much more than just a sweetener to carry the favour of the premiers.  The need to train an adequate medical workforce into the future is probably one of the most acute ones that we face.
For a long time now we just haven't been training enough and anyone who is trying to book in to see a GP for the first time, especially in rural areas, knows just how acute that shortage is. It's about a seven year lead time from the beginning of post graduate training, that means from the time that you come out of medical school as an intern.  It takes about seven years to train as a fully qualified GP so it's absolutely crucial that we get the ball rolling and start increasing numbers of training GPs.

VIRGINIA TRIOLI:    Yes and there has been that gap for quite some time while we've been moving a lot of students through the university system, those training places aren't there at the end.  But as far as I read the details of this, there's no particular sweetener to try and get or encourage those trainees into regional areas of Australia.

DR ANDREW PESCE:    Well I think that there's some commitment to ensuring that a lot of the training is done out in the regional areas and often your experience as a junior doctor tends to influence your choice of ultimate destination for the rest of your career.
But you're right, there's nothing at this stage, which makes it fundamentally more attractive in a professional sense to commit yourself to working in a rural area.

VIRGINIA TRIOLI:    And should this project have that?

DR ANDREW PESCE:    I think that it should.  I think that it's important to put the building blocks in place but finally there are a whole lot of reasons why it's difficult to choose a rural career and to overcome those difficulties you really need to put in some incentives that increase the attractiveness.

VIRGINIA TRIOLI:    One bit of commentary that I read this morning, analysis, is that where they were putting so much money and such a sudden rush into these training places, you run the risk of creating an '80s style boom and bust cycle, if you like, where within those figures there's an oversupply and those figures have to be pulled back later on, you know, say in about you know, 20 or 15 years time. Do you agree with that?

DR ANDREW PESCE:    Look, obviously there's always a chance of that happening but in this case I really think it's unlikely that we're going to overshoot the mark at all - let alone significantly.  There are lots of changes in the way that our heath system is running both from the demand side, with an increasing number of patients who need more complex care and therefore more time with their general practitioners … and a need to treat more illnesses and prevent illness in the community rather than relying on hospitals to treat illnesses once they’re established.  And you've got to remember the demographic of the workforce is changing as well with a lot of the undergraduates and medical students now, the majority being women, and they tend not to work as long hours, quite understandably, as they need to mix their life at work with their life at home and raise children and do all of those things.  So it's very, very unlikely that we're not going to have a significant increase in demand for general practice places. And I think that the Government's doing the right thing to increase the number of GP training positions.

VIRGINIA TRIOLI:    Now, if the states start to quibble about this particular proposal as well, what would you urge them to do?

DR ANDREW PESCE:    Well I'd want to know what they see that's a problem with it. Basically, the Government is putting in place a funding infrastructure to make sure that our junior doctors can move out of the hospitals, get into general practice, get some experience in their first few years before they've made up their mind where they want to train.  Whereas in the past they've tended to adopt specialist careers because that's what they see the most of in our teaching hospitals.  And the states will have the money to backfill those positions, increase the total number of training positions, so the hospitals aren't understaffed and the junior doctors can go offsite and get their experience in general practice.  

So it really is necessary for the states to come on board here, help that happen, and in the long run it will help the hospital system by increasing our ability to treat patients in the community rather than being in the hospital.

VIRGINIA TRIOLI:    And just finally, Andrew Pesce, right along with all these announcements that Kevin Rudd has been making, about reforming the health system, you've been almost universally praiseworthy.  Are you part of Team Rudd?  Are you being consulted on some of this, or all of this?  Are you inside the tent?

DR ANDREW PESCE:    No.  Well, we're inside the tent, but I don't think it's right to say we're Team Rudd.  We're looking at the proposals as they come through.  
At this stage, the announcements have been very positive and have helped increase our confidence that the Government is on the right track to improving the health system.  As more details come through, there will be some questions.
We are looking closely at the announcements.  Most of them, as I said, are very positive.  We still are yet to see an increase in capacity of the hospital system, which is needed to take up the unmet demand.  I'm still a bit anxious about the 60-40 split between the Federal Government and the states because I'm not sure that that's going to end the blame game, which is one of the built in failures of our health system.  That, you know, the person who's responsible isn't identifiable and one level of Government blames the other, but in general this is a very credible move forward.  It looks to be a good attempt to address the fundamental problems that have crept into the system, which is straining at the seams, and we have to assess all of the announcements and we will comment.

And no, we're not Team Rudd - we're Team Health.

VIRGINIA TRIOLI:     Andrew Pesce, good to talk to you this morning. Thanks so much.

DR ANDREW PESCE:    Thanks Virginia.

16 March 2010

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