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Summit emphasises need for national medical workforce strategy

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By AMA VICE PRESIDENT DR CHRIS ZAPPALA

The Medical Workforce and Training Summit convened by the AMA in March, the first since 2010, is notable. The Summit drove home the importance of ending the expansion of medical schools, finding strategies to address workforce maldistribution and ending the poor coordination between the Commonwealth and State governments when it comes to workforce planning and training. If we are to preserve the public-private balance in medicine with a focus on quality, then we need to help Government solve this problem. It’s vital that the Summit’s call for a national medical workforce strategy overseen by the nation’s health ministers will be heeded.

Australia is now becoming saturated with doctors, as emphasised by recent workforce data.  AIHW projects that there will be an oversupply of at least 5,000 doctors in 2020 (I suspect this is under-estimated). The prospect of organising vocational training for all these graduates is daunting and as we are currently finding, not really feasible. Some Colleges are training record numbers of trainees with, it appears, no real sense of what all of these specialists are going to do. 

Everyone must make a living somehow, so this is when we see fringe medical practices emerge and the enervating effects of bulkbilling become prominent. The obstetricians provide a worsening example of this problem. Ultimately high quality, ‘fee-for-service’ medicine is in jeopardy and we set the stage for an indentured medical workforce trapped in managed care practices without independent decision-making, public practice (which will always be underfunded) or doing something else.

A 2015 OECD study showed that Australia has the highest medical graduate rate per capita with 3.4 per 1000, compared to New Zealand and the United Kingdom (2.8 per 1000) and the United States and Canada (2.6 per 1000), with Australian medical graduate numbers more than doubling in the past decade. We will graduate just under 4,000 new doctors in 2018 and this number will increase as Curtin and Macquarie Universities come online with increased Commonwealth places over the next couple of years. Unemployment looms……

It is estimated there will be 118,803 doctors registered in Australia in 2019. This compares to 79,653 employed in medicine in 2012. Health Workforce Australia estimated our doctor to patient ratio has increased to 3.6/1,000 which is well above the OECD average of 3.2/1,000 and well above the UK (2.8/1,000) and USA (2.5/1,000). 

The universities like the thought of their graduates getting jobs but this is unashamedly not their primary concern. They are not concerned at the prospect of their graduates obtaining vocational training. They are not concerned about the profession’s ability to mentor and train the extra junior doctors as residents. All the university wants to do is fill seats. They’re not worried about doctors or the profession – this is our concern. I accept this is how universities operate – they are a business selling education. Therefore, we definitely should not let them (or Government) dictate workforce outcomes for the profession.

The high graduating workforce numbers adds to the pressure on the growing cohort of vulnerable doctors in training. They should be assured of transparent and fair selection and examination processes with open knowledge of workforce trends. The AMA has a clear need to strengthen relationships with the Colleges and move us collectively in this direction.

Post-graduate training opportunities have grown by 2.5 times in the last 15 years or so, but there remain real challenges in resourcing vocational training opportunities for registrars such that this will remain a bottleneck that will only become more problematic as graduating numbers increase. In this environment it is clearly imperative that medical student and vocational training numbers should reflect credible workforce data and not be driven by political/institutional desires or parochial interests. 

It is important to acknowledge the strides being made to meet the health needs of our rural communities with the design of the National Rural Generalist Pathway now underway; nevertheless, as a physician who practises in both metropolitan and regional Queensland, I am keenly aware of the shortages of specialists and sub-specialists in the regions and outer-metropolitan areas. It’s perhaps forgotten sometimes that regional centres servicing large geographical areas also need specialists and sub-specialists. Innovative solutions that will not cost much are part of the solution e.g. combined public-private jobs that capture the principles of easy entry-gracious exit as espoused by the AMA, with industrial recognition of the difficulties faced by regional/rural doctors.

As well as moderating the size of the workforce which requires urgent attention, an important area of work for the MWC will therefore be advocating for the colleges and jurisdictions to increase specialty training positions in areas of unmet community need, based on the advice of the National Medical Training Advisory Network.

 

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