LAST week the ominous situation facing medical graduates in South Australia was exposed
with an estimated 22 domestic graduates projected to miss out on internships in 2017, and up to 39 to miss out in 2018.
Unfortunately, this training gap only represents the tip of the iceberg, with a national workforce report
predicting that more than 1000 junior doctors will miss out on an advanced training place by 2030.
The recent approval of a new medical school
in Western Australia shows that the tsunami of medical graduates is unlikely to abate, so is it time to rethink medical education?
This year, an estimated 3736 Australian medical students are expected to graduate
, an increase of almost 280% from the 1347 who graduated in 2001. Despite this massive increase in graduates, there has been a comparatively small increase in the number of training places available to junior doctors. This leaves many graduates facing a grim training outlook.
The latest Royal Australasian College of Surgeons Activities Report
indicates that in 2014 more than 800 applicants to surgical education and training (SET) were unsuccessful. There are reports of similar results for training places in other specialities, including general practice.
Few, if any, training programs across the medical landscape have been under subscribed, with the net result being an unprecedented training backlog with little relief in sight.
When this mass of prevocational junior doctors is added to the still growing tidal wave of graduates year on year, the stark reality is self-evident — not all of us can be clinicians.
Unfortunately, there is no easy solution.
Junior doctors could move offshore, but increasing regulatory barriers mean that the days when young doctors could simply move to the UK or the US and expect to work are gone, let alone come home and have qualifications recognised.
Medical training in Australia could be completely overhauled to more closely resemble US-style training. This would mean service registrar positions, the utility of which has long been questioned
, would be abolished and training streamlined.
However, reform would take years and would likely face tenacious opposition.
Another option is to reduce student numbers, but for various reasons this has proven untenable. One reason may be the high cost of establishing and managing medical schools, so reducing numbers is unlikely and potentially short-sighted.
Nonetheless, with an oversaturated market, should these new schools have a moral imperative to ensure that their graduates are employable?
Australian medical education is, by tradition, clinically focused. Variation from this invariably includes teaching, research and, more recently, public health.
The shortening of contemporary medical courses as postgraduate degrees has resulted in an even greater prioritisation of clinical skills, possibly to the detriment of skill diversity. Graduate medics may benefit from exposure to varied subject matter in their undergraduate degrees, but these too are becoming increasingly prescribed and narrow in focus.
The result? Junior doctors often graduate with few transferable skills, making the ramifications on their career prospects even more dire.
The trend towards focused clinical education in Australia
actually goes against what is happening in other countries, particularly in the US and UK. In those countries, programs combining degrees such as a Master of Business Administration, Master of Public Health, Juris Doctor or Doctor of Philosophy degree with medicine are booming in popularity and some Australian institutions have been quick to follow this trend
However, for debt-laden graduates, further studies cannot be the sole answer. Industry placements, non-clinical electives, innovation training and mentorship and coaching programs should all be considered as ways to better equip medical students for modern career challenges.
Producing competent clinicians should always be the main priority of any medical school, but the time has come to ensure that medical schools also prepare graduates for careers outside of practice.
After all, for those trapped in the midst of the graduate tsunami, one thing is crystal clear — we cannot all be clinicians.
Dr Tim Lindsay is an Australian junior doctor and PhD student in the department of surgery, University of Cambridge, UK, supported by the Cambridge Commonwealth Trust. Dr Harris Eyre a psychiatry registrar and is undertaking a PhD through the University of Adelaide.