Hospitalists and non-vocational doctors - 2008. Revised 2017

The AMA acknowledges that the commonest medical training pathway following graduation from medical school is to become a provisionally registered medical practitioner, complete the requirements of provisional registration, complete supervised medical practice in so-called “Pre-Vocational Training” positions permitting increased experience, decision-making and responsibility, often goal directed towards a vocational trajectory of, broadly, medicine, surgery, generalist or administrative management, prior to applying for limited and competitive Vocational training positions. 

Definitions

 Pre-Vocational Training doctors (Doctors-in-Training)

Prevocational Training doctors have provisional or general medical registration, are typically in the early post-graduate years following medical school graduation, are not trainees in a specialist medical training program, but intend to become trainees with a view to obtaining specialist registration.  These medical practitioners have not yet determined a personal final career objective. 

 Non-Vocational-Training doctors

A Non-Vocational-Training doctor is any medical practitioner with general medical registration who:

a)      is beyond the traditional medical internship;

b)      does not possess a specialist qualification;

c)      is not currently a trainee with any of the medical specialist colleges;

d)      receives remuneration for medical work undertaken; and

e)      may seek training towards a specialist qualification in the future.  

Hospitalists

The AMA acknowledges the emergence of a unique Australian Hospitalist model which has been trialled in Australia for about a decade, and specifically notes the fact that it is very different from the Hospitalist model used in other nations, particularly the United States of America.  In Australia, the Hospitalist is generally a Generalist medical practitioner whose principal focus is the provision of clinical care to patients in hospitals and who is not, and does not intend to be, in a specialist training position or working towards Fellowship of a specialist Medical College.  It is acknowledged to be a defined subset of Non-Vocational Training doctors. 

A Hospitalist is a medical practitioner with general medical registration who:

a)      is beyond the traditional medical internship;

b)      does not possess a specialist qualification;

c)      is not a trainee with any of the medical specialist colleges;

d)      is employed by a hospital employing entity; and

e)      does not intend to ever seek a specialist qualification.  

 Career Medical Officer

A Career Medical Officer is a medical practitioner with general medical registration who:

a)      is beyond the traditional medical internship;

b)      does not possess a specialist qualification;

c)      is not a trainee with any of the medical specialist colleges;

d)      is employed by a hospital employing entity; and

e)      does not intend to seek a specialist qualification at the current time.  

 Specialist Medical Practitioner

A medical practitioner with specialist registration has postgraduate qualifications and appropriate clinical experience in at least one of the medical specialties recognised by the Australian Medical Council. 

 The AMA’s position

 The AMA respects the right of doctors to choose the Hospitalist/non-vocational pathway and acknowledges the contribution and the unique nature that these roles may play in Australian hospitals. 

 The AMA considers that the creation of in-hospital positions in either the Hospitalist or Non-Vocational model, should provide ongoing training and education to offer a career pathway and professional development for doctors not wishing to undertake previously traditional medical specialty training. 

The AMA’s opinion is that the Hospitalist/Non-Vocational role is not dissimilar to the category of hospital doctor employees known as Career Medical Officers (CMOs) or Service Registrars.  The AMA considers that any distinctions in the Position Descriptions for any advertised role encompassing these employment roles needs to be clearly enunciated in recruitment, pre-requisite training requirements and employment arrangements of doctors in these roles. 

Related to matters of quality training and provision of good clinical care, the AMA considers that such employment positions must be subject to relevant and appropriate clinical governance with clearly defined lines of responsibility and accountability for clinical and other agreed outcomes. 

The AMA considers that, notwithstanding the introduction of the Hospitalist/Non-Vocational model sought by some registered medical practitioners, the overarching existing model of generalist Pre-Vocational training followed by specific Specialty training to produce a highly trained Specialist medical workforce for the provision of health care in public hospitals must be maintained and supported. 

With regard to Hospitalist and Non-Vocational positions in public hospitals, the AMA considers:

1. the role of any of these positions must be well described prior to their establishment, including the way in which they provide complementary services to the existing specialty medical and allied health teams;
2. consultation with representative organisations with whom Hospitalists and/or Non-Vocational doctors will be working, including Specialists and Doctors-in-Training, must be undertaken before the introduction of new positions, and at regular intervals following their implementation;
3. these positions must not be used purely as a cost-saving alternative to the provision of adequate specialist services;
4. creation of these positions must consider the potential impact on provision of training for Doctors-in-Training, and must not undermine the accessibility of or quality of teaching, or the specialist training experience for Doctors-in-Training, particularly in light of Health Workforce Australia’s projections of future bottlenecks in training places;
5. training of Doctors-in-Training must not be undermined or compromised in any way, or in any specialty, because of the introduction of Hospitalists and/or Non-Vocational doctors into positions traditionally occupied by Doctors-in-Training;
6. Hospitals and Health Departments must ensure that these positions are supported with appropriate supervision, accreditation, and pathways for career enhancement and structured training commensurate with the requirements of the position;
7. that if the Hospitalist/Non-Vocational role develops, employers must give appropriate acknowledgement to the role in any negotiations of industrial instruments, and allow for its specific industrial needs;
8. that the identification of the capabilities required for the Hospitalist/Non-Vocational role must be clearly identified, in consultation with professional bodies, to inform and provide for relevant training/education components;
9. that any expansion of the Hospitalist/Non-Vocational role should only be undertaken by Health Departments in consultation with relevant stakeholders including the AMA, ASMOF and the Learned Medical Colleges;
10. the uniqueness of the Australian Hospitalist model should be maintained as a basic model, and only developed in consultation with the medical profession;
11. training pathways for the Hospitalist/Non-Vocational role must be clear and robust and developed in consultation with relevant stakeholders including the AMA, ASMOF and the Learned Medical Colleges;
12. that Hospitalists and Non-Vocational doctors must not be required nor encouraged to perform duties for which they do not have appropriate expertise, or that would usually require specialist qualifications;
13. that the Hospitalist and Non-Vocational doctors roles should allow for appropriate career development and experienced-based, time-in-the-role promotion within health systems.
14. that Hospitalists and Non-Vocational doctors should not be considered for appointment directly to specialist positions without appropriate specialist training and credentialing;
15. that Hospitalists and Non-Vocational doctors’ positions must be supported by way of supervision, accreditation, pathways for career development and structured training. 

Approved 2008

Revised 2017