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Risky to rely on foreigners to plug health gaps

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Global competition for skilled health workers is intensifying, increasing the urgency of efforts to upgrade the nation’s beleaguered medical training system.

The AMA has warned that the country will struggle to meet future health needs unless the Commonwealth, State and Territory governments cooperate in developing a long-term plan that ensures there are sufficient medical students and graduates with access to quality training opportunities to provide necessary care.

In a sobering assessment of the state of the nation’s medical training pipeline, the Association said that Government investment had failed to keep pace with growth in demand, leading to mismatches and bottlenecks that were squeezing opportunities for junior doctors and deepening the nation’s reliance on an increasingly competitive international market for medical workers to plug workforce gaps.

AMA Vice President Professor Geoffrey Dobb said rapid growth in medical student numbers (from 7746 in 2000 to 16,868 last year) had not been accompanied by an appropriate increase in prevocational and vocational training places, potentially denying many the ability to pursue their training and wasting the large public investment made in their education.

“There is growing pressure on the medical training pipeline, and Health Workforce Australia is projecting that, by 2016, Australia will be facing a shortage of specialist training places unless urgent action is taken,” Professor Dobb said. “It takes time to train a high-quality medical workforce – planning for the future must start now.”

In its Position Statement on Medical Workforce and Training 2013, the AMA said the big expansion in medical schools, which are expected to produce 3830 graduates a year by 2017, provided a “tremendous opportunity” to address concerns about future shortages of medical practitioners and their maldistribution, and to reduce the nation’s reliance on International Medical Graduates to fill workforce gaps.

But Professor Dobb warned that, to take advantage of this chance, the Commonwealth, State and Territory governments had to jointly develop a national training plan to ensure sufficient practitioners to meet future need.

The AMA said the plan needed to be supported by accurate data and robust projections, be driven by community need, have adequate funding, be underpinned by the principle of self-sufficiency and be linked to global medical workforce trends.

As a start, the Association said it was essential that there be sufficient prevocational and vocational training places for all locally-trained domestic and international medical students.

To help address medical workforce shortages in rural areas, the Position Statement said the plan should be guided by evidence of what worked, including improved financial incentives, increased training opportunities in rural areas, and voluntary return-of-service obligations. It warned that bonded places did not deliver a sustained increase, and tended to stigmatise rural medicine.

The AMA suggested there be improvements in the structure of training programs, including better integration between prevocational and vocational training. This could entail revised entry requirements and prerequisites for vocational positions.

But it warned that efficiency improvements alone could not deliver the increase in places needed, and the Commonwealth needed to ensure it provided adequate funding.

“[There is an] urgent need for further investment in primary medical education as a result of significant underfunding by the Commonwealth government,” the AMA said. “This has led to the uncoupling of international medical student enrolments from community need and an increasing divergence between medical graduate numbers and the number of available prevocational and vocational training posts.”

The Association said there should be no increase in full-fee paying places to try and address the looming shortfalls.

Instead, Professor Dobb said, the Commonwealth, State and Territory governments needed to reach agreement on:

·        the number of medical school, intern, prevocational and specialist medical training places needed, based on Health Workforce Australia (HWA) analysis;

·        the financial contribution each government would make;

·        robust benchmarks to measure progress toward providing sufficient training places; and

·        the development, in consultation with the profession, of performance benchmarks to ensure quality standards were maintained.

In its Position Statement, the AMA has also backed Health Workforce Australia, amid concerns the agency may be abolished as part of the Abbott Government’s cost-cutting drive.

The AMA said HWA was making a valuable contribution to improved medical workforce planning and training, and needed to continue its work.

The Association warned that Australian governments needed to get the training planning right if the nation was to ensure its medical workforce was adequate to meet future need.

“There is currently a worldwide shortage of health professionals,” the AMA said. “Chronic deficiencies in skilled labour can seriously impact the strength and sustainability of health systems. There is a strong imperative for Australia to develop a self-sufficient health workforce”.

The Position Statement on Medical Workforce and Training 2013 can be viewed at:


Adrian Rollins