Our future’s future
The future of the medical profession and the AMA will be in the hands of our new graduates and doctors-in-training. For most of this group it is an exciting time of year, with the start of the intern year, the first year of vocational training or a new rotation within vocational training as a further stepping stone to specialist recognition.
For some, however, the start of the year means an unwanted further year of pre-vocational training or ‘service’ jobs while polishing up the curriculum vitae to be as attractive as possible to those on the selection panels for vocational training positions in the middle of 2014.
Medicine has always been competitive, from medical school entry, through selection into vocational training – especially in the more ‘desirable’ specialties – to appointment as a general practitioner or hospital specialist in the location of choice. Now, new pressures are entering the competitive mix and are the frequent talk of the tea room, doctors’ common room or while relaxing with friends at the end of the day.
The first and most obvious of these pressures is the increase in the number of Australian medical graduates, up from 2139 in 2008 to 2964 in 2011, with further increases since then. In 2012, 3686 medical students started their course.
The AMA has worked hard in lobbying all governments to ensure that Australian medical graduates have access to the intern positions they need to meet the requirements for full registration. Despite some hiccups along the way, the indications are that intern positions are currently just about matching the number of medical graduates who need one. Hopefully that will continue.
The focus of our advocacy must now move to PGY2, PGY3 and vocational training positions. While the increase in medical graduates has been called a tsunami, the reality is that it is more like a permanent increase in the sea level.
In the recent past, many of the PGY2, PGY3, ‘service’ registrar and vocational training posts have been occupied by overseas trained doctors to meet the gap between workplace requirements and the output of Australian graduates.
Now, that gap is rapidly disappearing, or has disappeared completely, and the increase in Australian graduates is not the only factor at work. There has also been a freeze on additional appointments as hospitals struggle to meet their budgets, and a reduction in the number of positions available as a result of ‘reform’ or adjustments to match ‘affordable staffing’ within the constraints of Activity Based Funding.
A lack of specialist posts available for those who complete their training is also having an impact, as these doctors remain in positions that could otherwise be occupied by vocational trainees. This is particularly the case for those specialties that are largely or wholly practiced in a hospital environment, as our public hospitals, especially, are squeezed.
Medical workforce planning isn’t easy. There are strong arguments that Australia has never got it right. This is despite having a number of bodies with responsibility or oversight for such planning. These include the Health Workplace Principle Committee (made up of jurisdictional representatives), the Medical Training Review Panel, which provides an annual report for the Commonwealth Parliament (though it hasn’t met for some time now), and Health Workforce Australia.
The Health Workforce 2025 report was a first attempt to draw on current medical workforce information and then, applying a range of assumptions, make future projections about supply and demand. These projections are due to be updated in early 2014, and the outcome will be received with interest.
In the meantime, the main opportunity for coordinating the medical training pipeline lies with the National Medical Training Advisory Network (NMTAN). All doctors, but especially doctors-in-training, need to be very aware of the NMTAN as it starts its work.
Principles that will guide NMTAN include:
– training of the medical workforce should be matched to the community’s requirements for health services;
– matching supply and demand for medical training should recognise the changing dynamics of the health care system over time; and
– the medical training system should recognise the balance between today’s service delivery demands and providing the supportive environment to meet the training needs of the doctors Australia will need in the future.
The main output from NMTAN is to be a series of five-year rolling medical training plans to inform Government and the health and education sectors. These plans will be provided to health and education Ministers annually to inform decisions on medical student intakes, internship positions and specialty training places. More information is available on the HWA website (https://www.hwa.gov.au/).
NMTAN will be guided by an Executive Committee which will include a representative from the AMA Council of Doctors in Training, together with representatives of governments, universities, Medical Colleges, employers and others. Theirs will be a heavy responsibility for the professional lives and careers of our future medical workforce. It will surprise no one that the AMA will be monitoring their work very closely.
In this changing environment, there are benefits that can be available through AMA membership – and never has AMA membership been more important. These benefits include fraternal support, career guidance and access to advice or mentorship if needed. The AMA can also assist with the human resource related and contract issues that inevitably arise.
The future for doctors in training will be different from today but it should be a better future than today’s, not worse, and that has been the AMA’s long-term goal.