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‘Captain’s call’ medical school won’t fix doctor shortage

Western Australia’s medical workforce is growing faster than almost any other in the country, underlining concerns that the resources-rich state’s medical training pipeline is already running at capacity even before the establishment of a controversial new medical school at Curtin University.

Data compiled by the Australian Institute of Health and Welfare show that although WA has fewer doctors per capita than any other State or Territory, its medical workforce expanded by more than 60 per cent in the nine years to 2013, with only Queensland growing at a faster rate.

But WA medical graduates are being forced to move interstate to get the training the need to become fully-qualified doctors

The figures add to warnings by the AMA, the Australian Medical Students Association, the Western Australian Medical Students’ Society and other medical groups that the Federal Government’s decision to help fund a new medical school at Curtin University is poor health policy.

“The problem with a new medical school is that we already have far too many medical students in the system,” AMA President Associate Professor said. “This year we have over 3600 applications for internship positions; there are only 3300 positions available.”

Prime Minister Tony Abbott said the Commonwealth was backing the Curtin medical school as a way to help boost the number of doctors working in WA, and is part of a massive expansion of undergraduate medical education in the past decade.

Across the country, there has been a huge 150 per cent surge in medical school places since 2004 – there are currently 3736 students enrolled – but A/Professor Owler said this had not been matched by a commensurate increase in the prevocational and vocational training places medical graduates need in order to become fully-qualified doctors.

The AMA President said that in Western Australia alone there was a shortfall of 84 training places for GPs, and a report by the now-disbanded Health Workforce Australia warned that, on current trends, the increasing mismatch between growth in the number of graduates and training places would result in a shortfall of 1011 places by 2030.

A/Professor Owler said that opening yet another medical school was not the solution.

“The issue is not the number of medical students; it is the training bottleneck,” he said. “We have a shortfall of training positions for those medical graduates that we are training now. Adding another medical school doesn’t make any sense without putting the resources in to make sure that we have the training positions available.”

A/Professor Owler this was particularly problematic because most post-graduate medical training was provided in public hospitals, whose Commonwealth funding was to be slashed by $57 billion in the next 10 year.

“How are these people going to be trained in our public hospital system when we are actually taking billions of dollars out of the system?” he asked.

Mr Abbott tried to reassure A/Professor Owler and the AMA, saying he had been given a guarantee by the West Australian Government that it would provide extra training places.

“I always that the AMA seriously. I have a great deal of respect for the AMA,” the Prime Minister said. “They’re absolutely right to be concerned about the consequent clinical training places, and what we’ve done is work with the West Australian Government to get a guarantee…that the clinical training places will be provided.”

Mr Abbott paid tribute to WA Premier Colin Barnett and lobbying by WA Liberal MPs including Ken Wyatt and Christian Porter in convincing the Commonwealth to commit up to $20 million a year to operate the 110-place school, which will be built with $22 million from the State Government and around $60 million from Curtin University.

But A/Professor Owler said the decision showed that politics had won out over good policy: “Satisfying a political requirement by investing in the whims of the local politicians doesn’t satisfy good health policy”.

“It’s a calamitous captain’s call by Captain Chaos. That’s the only way to describe it, because it’s going to cause chaos with the medical training of students,” the AMA President said. “Politics has taken precedence over good policy.”

His comments earned a rebuke from Treasurer Joe Hockey, who told the ABC’s Insiders program that the President’s language was “extreme, and certainly not fitting for someone representing a great profession. Quite frankly, I think his comments were out of order.”

But A/Professor Owler said he made no apology for using “colourful” language to describe the situation, particularly given that the health system was “still coping with the sort of policies that we announced in last year’s Budget. How are you going to train these people when Joe Hockey is taking $57 billion out of the funding system?” he told The Australian.

“Our job is to make sure we get the best health policy,” he said. “And when the Government does something that is bad for the Australian health care system, our job is to point that out.”

In addition to a bottleneck in the training pipeline, there is a maldistribution in the medical workforce, with doctors much more scarce in rural and remote areas.

Both the AMA and AMSA said that, rather than building yet another medical school, the Government should be investing scarce health funds into medical training – a point made by Health Workforce Australia in its Australia’s Future Health Workforce report released last year.

In the report it warned that unless there was a change in policy, the country would swing from a small oversupply of doctors in 2017 to a situation of under-supply, with a shortage of 2500 practitioners by 2025 and a shortfall of 5000 by 2030.

Instead of pumping out more medical graduates, the agency recommended the Government hold the medical school intake steady this year while devising long-term training plans.

Because of the long time it takes to train a doctor (at least 10 years), “adjusting medical student numbers is not an effective means to deal with short-term imbalances between supply and demand”.

Instead, it said, governments should use temporary migration to address immediate service gaps – in WA, which grew rapidly during the mining boom, more than a third of doctors are trained overseas – while devising and executing a clear, long-term plan to train the doctors needed to satisfy future demand.

A/Professor Owler called on the Government to reconsider its decision and “put the focus back on the training pipeline if they are serious about having the GPs and specialists that not only Western Australia needs, but the rest of the country needs as well”.

Adrian Rollins

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