Issue 12 / 20 September 2010

BY ALL ACCOUNTS, our health system is in chaos.

We need more money, more hospital beds, more doctors and more nurses. General practitioners and some specialists are either in short supply or inappropriately distributed.

Strategies to remedy this parlous state have been proposed, but the will to institute these policies remains frustrated by political hesitancy or bureaucratic ineptitude.

A case in point is the uncertainty surrounding the training of junior doctors. In the past decade, we have seen an unprecedented increase in new medical schools and the number of domestic medical students.

The latter are projected to increase to 2920 in 2012, from 1544 in 2007.

Add to this the estimated numbers of international medical graduates (517) and Australian Medical Council graduates (146), and by 2012 the number of doctors seeking internships (some 3500) will easily exceed the number of positions available — currently about 2200.

This blatant mismatch is symptomatic of a lack of integrated forward planning, as interns are a state concern and tertiary education a federal responsibility.

Could it be that the bureaucrats are clinging onto fragments of the blame game?

However, there are other players: our universities! Increasing medical student numbers has meant the kudos of a new medical school for some, while others have enjoyed increased revenue flowing into the faculty coffers.

But what has been done about the looming internship gap? Very little, it would seem, beyond committees and reports.

We are now confronting a tsunami of medical graduates, but with no tangible national action to boost the capacity of our hospital system to absorb them.

There are rumours that the first to bear the brunt of the lack of intern positions are international medical graduates, followed by domestic fee-paying students.

We may well see a repeat of what happened with the Modernising Medical Careers training program for junior doctors in the United Kingdom, when medical students and doctors marched in the streets in protest.

Someone is responsible for the mess we find ourselves in, and heads should roll within the ranks of our prevaricating and blundering bureaucrats.

Dr Martin Van Der Weyden is the Editor of the MJA.

This article is reproduced from the MJA with permission.

Med J Aust 2010; 193: 313.

Posted 20 September 2010

9 thoughts on “Dr Martin Van Der Weyden: Orphan interns and blundering bureaucrats

  1. Barry McGrath says:

    The issues raised by Martin Van Der Weyden reflect the lack of vertical integration of medical education and training in Australia.

    There is no national authoritative body that has this role and it is high time we had such a body with the right set of teeth.

    The nearest broadly representative oversight body we have is the Medical Training Review Panel which has struggled for years with inaccurate data on training positions and this body was in limbo for a long period whilst its role was reviewed.

    The Confederation of Postgraduate Medical Education Councils (CPMEC) has defined a national prevocational curriculum, set up a process for national accreditation of intern training positions with established guidelines, and is in constant dialogue with its state and territory counterparts in relation to training of interns.

    However it is the State and Territory Health Departments that define the training positions and hold the budget.

  2. daman says:

    In QLD, the waiting time in private to see an immunologist is 6 months, in public up to or more than one year.

    There is one training position in the state.

    There is another approved and partially funded, but no actual commitment to providing supply.

    It is cost reduction by lack of access. This is not mismanagement, it is deliberate.

  3. Paul Gatenby says:

    This is another example of the complete lack of a whole of system approach to medical training and man-power. The proposed reforms of the NHHRC as put into practice by the Commonwealth and effectively maintaining the status quo will ensure the continuation of this crazy system. The jurisdictions have to find the money to pay for more intern positions to train interns, most of whom will go into GP or specialist private practice, ie not remain employees of the jurisdictional health service. Even though such individuals will contribute positively in future to the sum total of our health services they are of limited interest to the jurisdictional health departments and consequently not a priority.

  4. Steve Hambleton says:

    The above is exactly why the AMA has called key stakeholders together for the AMA Training Crisis Summit being held in Canberra on 29 September 2010. We must work towards a whole system approach.
    Steve Hambleton

  5. Anonymous says:

    Its nice to see this article pointed out the role that greedy university medical faculities have played in the creation of this mess. When the medical school student association at my university put the question to the dean of why he was continuing to increasing student numbers despite the pending shortage of internship places [I understand] his response was “other graduates don’t expect employment when they [graduate, so then] why should medical students?” This money grabbing attitude is unethical and immoral and the reason we’re in this mess right now.

  6. Roch says:

    “There is no national authoritative body that has this role and it is high time we had such a body with the right set of teeth.”

    Well the precise problem with MTAS in the UK was that a single national body was responsible for everything, and it screwed everything up. Central planning never worked in the past and it won’t work in the future. Perhaps the people jockeying to get into medicine now need to look around and assess whether they might be more likely to get a job if they study something else. I’m a specialist in private practice and I don’t believe I have a divine right to always be employed…

  7. Roy says:

    ‘Blundering bureaurocrats’, ‘heads should roll’ – Can we please have some sensible and measured discourse about these problems. Let’s consider the (most likely not unreasonable) motivations of all the players, the barriers to finding solutions, and start to understand where compromises may need to be made in order to find jobs for these junior doctors. We can all spew cliches and demand to punish scapegoats. But at best this is symptom management and at worse placebo. It is nowhere near a cure.

  8. buzz says:

    If they don’t find jobs as doctors, perhaps they could get jobs as beauracrats … there seems to be no limit to the number of clipboard holders that the government can employ!

  9. Tony Michaelson says:

    Has the time come to revise the post graduate training program for general practice?
    When full time intern positions are in short supply, graduates could start an apprenticeship in general practice and work part time in a hospital.

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