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Specialist unemployment: time to be worried?

Consultants working for free to maintain their recency of practice. New Fellows accepting positions with reduced conditions to get their foot in the door. Others prompted to work part time or as locums. Young Fellows choosing to do more sub-specialty training because they cannot find work in their chosen field.

Apocryphal stories maybe, but there is genuine concern in the profession that some specialists are experiencing underemployment or even unemployment.

“Exit block” from training – where recently graduated Fellows stay in training positions that would otherwise be filled by specialist trainees because the consultant jobs aren’t there − is a knock-on effect from this scenario.

We should be worried about shrinking employment opportunities for new Fellows and exit block for specialist trainees.

Among other things, it would mean that some specialists are struggling to get the workload they need to keep their skills fresh. Nor would trainees be getting access to the positions that provide the clinical cases they require to complete their specialist training. It would ultimately mean that Australia is squandering its considerable investment in the medical workforce over the past decade.

So are we really seeing the early signs of an oversupply of specialists, or is the issue a poorly distributed workforce?

Unfortunately, there is no hard data, but anecdotal reports of underemployment and unemployment in some specialties are emerging.

A specialty that might be affected is anaesthesia, where there is increasing concern that an oversupply of anaesthetists is looming. There is a range of possible reasons for this situation, including the large numbers of anaesthesia trainees employed by public hospitals; fewer opportunities for consultants in the public system; fewer private sector opportunities in major metropolitan areas; difficulties in getting credentialing at private hospitals; and senior specialists delaying their retirement.

I met with the Australian and New Zealand College of Anaesthetists and the Australian Society of Anaesthetists in January to discuss the state of the anaesthesia workforce.

Surveys of new Fellows run by both organisations showed that some had experienced unemployment and underemployment after gaining Fellowship, and were concerned about future career prospects.

I understand that the situation in anaesthesia could be emerging in some other specialties as well.

The outcome of the meeting was a joint submission to the National Medical Training Advisory Network (NMTAN) asking it to include the anaesthetist workforce in its modelling program as a matter of urgency. Pleasingly, it has told us that this is indeed a priority for the network.

The AMA is being proactive in getting an understanding of the scale of specialist unemployment across the specialties. The Medical Workforce Committee is taking the lead, working closely with our doctors in training.

We need to get this right and find out whether an oversupply of specialists is building, or whether the problem is one of distribution.

Both scenarios would have obvious, and very different, implications for developing and coordinating the future medical workforce.

Separate to the joint submission on the anaesthetist workforce, the AMA has asked NMTAN to undertake the data collection needed to determine what’s happening across all specialties, and identify the measures needed to ensure that, subject to community demand for medical services, there will be sufficient jobs for doctors when they finish their training.

I’m hopeful that NMTAN is taking the issue seriously.

In the meantime, we are liaising with the Colleges on how their new Fellows are faring.

While we don’t want to generate unnecessary angst among trainees on their job prospects, it is important that they have a clear idea of future workforce scenarios when they make their career choices.