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Never-ending intern and training crisis looms again

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Hundreds of medical graduates and junior doctors face missing out on vital training places in the next two years without urgent investment by Federal, State and Territory governments, the AMA has warned.

As aspiring doctors and specialists scramble to secure internships, prevocational and vocational positions, the Association has urged governments to honour existing training funding commitments and lift their investment in specialist education if the country is to avoid a looming shortage of doctors.

Medical graduates in South Australia are facing uncertainty following indications the State Government is preparing to renege on its commitment to fund internships for all SA medical graduates.

The AMA has warned that, on current projections, 22 SA medical graduates will miss out on an internship in the State in 2017, rising to 39 in the following year.

Further along the training pipeline, the AMA has told a Health Department review of the Specialist Training Program (STP) that the number of places provided under the scheme will increasingly fall short of what the nation needs.

AMA President Professor Brian Owler said modelling by the former Health Workforce Australia indicated the nation was facing a shortfall of 569 first-year advanced specialist training places by 2018, increasing to 689 places in 2024 and 1011 places in 2030.

He warned this would have knock-on effects throughout the medical training pipeline, and there are concerns it could leave the nation short of the specialists it needs to meet future demand.

HWA predicted general practitioners, psychiatrists and anaesthetists, in particular, could be in short supply by 2030, and the problem will be especially acute in rural and regional areas.

Professor Owler said the Government should boost the size of its well-regarded STP program from 900 to 1400 places by 2018, and to 1900 places by 2030.

“We should now be trying to improve the distribution of the medical workforce and encouraging future medical graduates to train in the specialties where they will be needed to meet future community need for healthcare services,” he said.

Until now, much of the growth in training opportunities has been at the undergraduate level. In the past decade there has been a 150 per cent jump rapid expansion in the number of medical school places, and currently there are 3736 students enrolled nationwide.

But the AMA and the Australian Medical Students’ Association have warned that much of this investment will be wasted without a commensurate increase in intern, pre-vocational and specialist training places.

Modelling undertaken for the Australia’s Future Health Workforce identified an emerging mismatch between trainees and the number of vocational training places, with a shortfall of around 1000 places by 2030.

Professor Owler said this was particularly concerning because the pressure on intern places nationwide meant there was no guarantee that SA graduates unable to secure a place locally would be offered an internship interstate.

In its submission to the STP review, the AMA urged that the program be used to help address current and developing workforce shortages in particular specialties and regions.

It said the program could make an important contribution to relieving shortages in the specialist workforce in rural areas by increasing the priority given to providing training positions in rural and regional areas.

Already, 41 per cent of STP training positions are in rural Australia, but the AMA has argued this should be increased, in part by shifting away from the current emphasis on one-year placements to a structure that instead supports clear and co-ordinated pathways for trainees interested in pursuing rural careers.

It said STP funding could support the establishment of regional training networks – vertically integrated networks of health services and regional prevocational and specialist training hubs – which the AMA has proposed as a way of remedying chronic rural workforce issues by enhancing generalist and specialist training opportunities and supporting prevocational and vocational trainees to live and work in regional and rural areas.

“Medical training does not stop at the gates of the medical school,” Professor Owler said. “We have seen a massive investment in extra medical school places, which must not be allowed to go to waste.

“It is important that all governments look beyond the intern year. With medical workforce planning data showing shortfalls in specialist training places, we need investment across the medical training pipeline,” he said.

Adrian Rollins