Catastrophise (verb): to make a situation seem worse than it actually is
One day last week, while Australia’s media was preoccupied with Labor leadership tensions, gender cards and disgraced menus, the 16th report of the Medical Training Review Panel was quietly tabled in Parliament (to view, click here – http://www.health.gov.au/internet/publications/publishing.nsf/Content/work-pubs-mtrp-16-toc).
There are those who may agree with the aforementioned media bias, but for medical workforce buffs – and those whose careers hang on the whim of health bureaucrats – it signifies the release of crucial information regarding the current workforce environment.
The panel aspires to provide a comprehensive picture of medical education and training and, for the most part, it succeeds.
The report, presenting data from 2012, delivers a vision of a medical training sector rapidly approaching capacity.
With the much referred-to ‘intern tsunami’ almost at its peak, focus is shifting further down the training pipeline to prevocational and vocational training.
Vocational training has undergone a massive expansion, with two and half times the number of vocational trainees in training now as there were in 2000. Correspondingly, the number of new college fellows has also doubled, and this will accelerate further given the volume of vocational trainees currently in training.
Similar trends are apparent in prevocational training. The number of interns has increased by 8.3 per cent since 2011, and is up 92.7 per cent from 2004. The number of post-graduate Year Two trainees has risen by 23 per cent in the past two years, although it is in this area – and in the later prevocational years – that the data becomes increasingly inaccurate and prone to methodological error.
The number of medical students reached 16,868 in 2012, more than double the number in 2000, and graduate numbers are up two fold from 1999.
The trends differ between domestic and international graduating students. The number of domestic graduates increased by 99.6 per cent between 1999 and 2011, while the number of international graduates has more than trebled over the same period, rising by 217.4 per cent, with a corresponding increase in the proportion of total graduates who are from overseas, to a peak of 19.5 per cent in 2009.
Of more relevance, the report documented the growth in medical graduates. Their number jumped by 8.5 per cent between 2010 and 2011, and by 11.9 per cent between 2011 and last year. Further strong growth is predicted this year and next, before tapering off to a more modest pace of annual growth thereafter.
Translating this into something meaningful for today’s graduates is problematic, as only one side of the workforce equation is demonstrated.
The report predicts that 3556 medical students will graduate and be eligible for an internship this year.
Preliminary indications are that there will be a shortfall of between 200 and 300 places, with only 3201 internships to be delivered by the states and territories in 2014. With the 2006 COAG agreement that all graduates occupying Commonwealth Supported Places (CSP) remaining in place, the exact shortfall will depend upon the number of international student graduates seeking an internship in Australia rather than continuing their careers offshore.
As yet there is no indication of the magnitude of the shortfall in other prevocational or vocational training positions, although there are preliminary suggestions that vocational training programs are experiencing unprecedented application numbers this year.
So is this a catastrophe? Has the AMA and AMSA catastrophised the intern crisis or training crisis?
Critics would argue yes, and point out that last year only 22 of the federally supported intern posts were taken up, ignoring more plausible explanations including the lateness of the offers, the return of service obligation and the novel settings in which they were offered.
Instead, should it be argued that the states and territories are guilty of catastrophication?
Discussions surrounding the numbers of graduating medical students – and the likely quantum of intern posts – are shrouded in secrecy.
It is disappointing that State and Territory health departments remain so busy guarding the budgetary bottom line that they remain blind to the opportunities that this glut of junior doctors brings – blind to the opportunity to provide an Australian trained medical workforce for their communities; blind to the opportunity to stop the ‘brain drain’ from low income nations.
Rather, State and Territory health departments catastrophise.
How terrible it is that, now we are educating the numbers of doctors that the community requires, this dilemma is universally portrayed as a catastrophe rather than the fantastic opportunity it truly represents.
Follow Will on Twitter (@amacdt) or Facebook (http://www.facebook.com/amacdt)