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Sweeping Budget changes dramatically alter training landscape

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In recent weeks, much has been said of the 2014 Federal Budget and its impact on patients and doctors.

Between a $7 co-payment for each GP, radiology and pathology service, Medicare rebate cuts and few protections for the vulnerable, only a hostile Senate currently stands in the way of the Coalition Government’s vision for a wholesale change to a user-pays health system.

This move to shift more costs on to patients comes at a time that health systems around the world, most notably the United States, have embraced the need for equitable access to health care for all, particularly those who cannot afford it.

After the dust has settled, however, it’s clear that the Budget has also made a number of changes to the landscape of medical training. Health Workforce Australia, created by the nation’s Health Ministers in 2009 to formulate a National Training Plan for Australia’s medical workforce, will be dissolved, with its functions transferred to the Commonwealth Department of Health.

While the Government is promising that a commitment has been made to continue essential projects, including the National Medical Training Advisory Network, the challenge during the coming months will be to ensure that workforce planning expertise is retained and no momentum lost during the move from Adelaide to Canberra.

General Practice Education and Training is also being absorbed by the Department of Health, a significant shake-up for GP training, along with a proposal for future competitive tender processes for general practice training providers.

The Confederation of Postgraduate Medical Education Councils was also singled out for a complete cut in its federal funding; nobody has been identified to pick up the CPMEC’s good work in the prevocational space.

The only good news from the Budget was the creation of an additional 300 GP training places – funded, however, by cutting the valuable Prevocational General Practice Placements Program (PGPPP), which had provided up to 975 rotations for junior doctors to gain experience in general practice.

Notably, in South Australia, PGPPP had been providing required Emergency Medicine core rotations for 23 internship places, which will be cut unless additional public hospital ED rotations can be urgently found.

The consequences for later stages of training are even more significant, as the loss of these rotations threaten hundreds of prevocational posts around the country.

These decisions reek of shortsighted cost shifting, as the Federal Government looks to vacate the prevocational space.

 At the same time the Federal Government expects its State and Territory counterparts to fill shortfalls in training funding it has created, it has abandoned the National Health Partnership Agreements, resulting in a reduction in growth funding for the states.

Unfortunately, the education Budget papers contained perhaps the most dangerous paradigm shift for medical education.

With an average 20 per cent cut to federal funding for each university place, lower indexation arrangements and the deregulation of student fees, universities are likely to soon be charging students hundreds of thousands of dollars for a limited number of medical places.

The effect will be a higher education system in which a medical degree will soon be completely out of reach for those not fortunate enough to have chosen rich parents.

While scholarship programs are welcome, international experience demonstrates that the prospect of high postgraduate debts deters students from poor backgrounds and can drive graduates away from less-well-remunerated specialties, such as general practice.

All in all, it’s clear that the AMA Council of Doctors-in-Training has much to work on in the coming weeks and months.