- On January 30, 2017
- Jan/Feb2017, NSW Doctor
Getting it right
AMA (NSW) Councillor Sergio Diez Alvarez argues more investment is needed in medical training positions in hospitals, particularly in rural and regional areas, to address the poor geographic distribution of doctors.
There has been a lot of talk recently about the state of the medical workforce and an imbalance between GPs and specialists, in particular.
The root cause of this is actually further back in the medical training pipeline.
Our current system is struggling to keep up with the massive influx of incoming university medical graduates.
Medical training is never really over for any doctor. All doctors must undergo continuing professional development throughout their careers, to keep up with the latest treatments.
However, for interns fresh out of university, they still have a long way to climb before they are fully trained.
Depending on the specialty they choose, this can take over a decade. Even for the specialties with the shortest post-university training for full qualification, this education lasts several years.
The recent tsunami of medical graduates resulted from a complete U-turn on efforts made to limit doctor numbers during the 1990s.
Limitations on university degrees were put in place in a short-sighted attempt to limit Medicare spending.
This left us with a doctor shortage, which forced Australia to poach doctors from overseas in order to meet the medical requirements of our population.
Today, this shortage has left the training pipeline with too few senior doctors to adequately cope with the training of the next generation.
This problem is exacerbated in areas outside of major cities. Even though junior doctors are rotated through a variety of hospitals in their training networks, both metropolitan and rural/regional, most training is based in capital cities. This is compounded by the fact that rural hospitals can struggle to attract senior staff.
Before more training positions can be based in rural and regional areas, more needs to be done to encourage senior doctors to work in these areas.
If we can get more viable training positions based in country areas, this will help overcome the problem of poor geographic distribution of doctors.
And I have to specify here that I am talking about training positions in hospitals, not new university courses based in the country. Additional universities teaching medicine courses would just exacerbate our current problems.
Doctors set up practices where they have connections to other doctors, hospitals, GPs, and specialists. If more doctors can be trained in rural and regional areas and have good experiences there, it will be easier to persuade them to stay and work once they are fully trained.
It hasn’t helped that with each passing year, the number of university graduates entering our hospitals as interns has been getting larger.
That said, we need all of these doctors to complete their training and become the GPs and specialists our nation requires.
It has been the case that an unlucky few, typically overseas medical graduates, have been turned away from gaining an intern position.
That is only the first hurdle, however.These young doctors need to choose a specialty training program. The huge numbers of doctors-in-training we’re seeing is causing massive competition for the available training spots.
It’s only natural that a training system under such stress would ultimately lead to a less than ideal distribution of doctors on grounds of both geography and specialties.
When the system is preoccupied with ensuring there are training positions available for everyone, because we do need all of these doctors, of course it will be less focussed on directing them to where they are needed.
Specialties can be dictated for our current doctors-in-training by an individual medical college’s ability to provide training.
The bigger colleges often have greater capacity to provide training.
But if, for example, it is possible to train a legion of surgeons when what we really need is more dermatologists, this is not necessarily helpful.
It’s vital that we train all these doctors to their full qualifications but it is equally important that we get it right.
The problem is greater than just distribution of GPs and specialists and city doctors vs rural-based ones.
And it’s deeper than just the personal choice of individual doctors.
But, if we are serious about fixing these problems – and a good number of others besides – we need to provide greater investment in medical training.