AMC and the Colleges, are they part of the problem or part of the solution?
In early December, AMA New South Wales convened a regional Specialist Workforce Forum in Wagga Wagga. On a 40-degree day, the basic structural flaws bedevilling rural specialist workforce provision were laid bare by an excellent array of contributors. These included the NSW Health Minister Jillian Skinner, her relevant departmental advisors, and multiple College representatives.
Figures were presented showing that, without question, the wheel has turned too far toward the provision of sub-specialists rather than generalist specialists across the training spectrum. Our ratio of sub-specialists to generalists is now the world’s highest.
It was generally agreed that Australia now has enough doctors in the pipeline, and that the core issue now is not numbers but maldistribution.
The concept of a quality regional training continuum across all specialties was broadly embraced as a key part of any solution, with enhanced support for trainees and supervisors, and much better networking given the smaller numbers.
Stupidities galore were exposed, such as doctors in urban-based training positions receiving accommodation, relocation and travel grants for rural rotations, while those based in regional centres received no such grants on urban rotation.
A recurring concern was that the specialist Colleges do not see the rural and regional workforce crisis as being their concern. Nor do they see it being part of their core business to find and facilitate solutions for the provision of specialists to regional Australia.
The Australian Medical Council (AMC) was perceived to have washed its hands completely of any responsibility in corralling the Colleges, which it oversights and accredits, to ensure regional and rural specialist provision.
I would like to know how many members of the AMC Board are from rural and regional Australia, and what its constitution mandates regarding its geographic composition. Workforce standards are an essential of service provision, but so too is the geographic distribution of workforce if non-urban Australia is to be well served.
Any effective solution to the workforce crisis must involve State governments as funders of both training positions and regional training hospitals, Colleges as providers of education to regional trainees, the AMC as the accrediting body of Colleges, and the Federal Minister for Health in advising the AMC and Colleges of their responsibilities for supplying the workforce needs of Australia’s many regions.
This may mean redrafting the constitutions of some of these bodies if they are to continue to receive Commonwealth support and funding.
Additionally, the States must be funded to ensure regional specialist career paths are attractive, high quality, well renumerated, do not have overly onerous on-call responsibilities and do have a certainty of continuity.
What is needed is a champion for rural and regional health to get all the players involved working as a team.
If Darren “Boof” Lehmann can do it to win back the Ashes, then perhaps it is not asking too much for Senator Fiona Nash to deliver a similar miracle from Canberra.