Australians have access to a world-class health care system that is the envy of many other countries. According to the Australian Institute of Health and Welfare, life expectancy in Australia is amongst the highest of all OECD countries[1].
One of the keys to the success of the Australian health care system is that patients have access to a highly skilled and motivated medical workforce working in general practice, community and hospital settings. Australian doctors are held in the highest regard throughout the world.
Medical workforce training in Australia follows rigorous, independently set standards that require students and junior doctors to work in accredited, supervised training positions which enables them to get the experience they need to provide high quality care to the community.
Data from the former National Health Workforce Taskforce (NHWT) suggests that there is now a shortage of approximately 6300 medical practitioners across the country[2]. This shortage has developed over the course of the last 15 years, largely as a result of policy decisions and inadequate workforce planning.
Since 2004, the Commonwealth has responded to medical workforce shortages by taking several steps to significantly increase the number of medical school places across the country. It increased the numbers of Commonwealth Supported Places at existing medical schools, provided funding to open eight new medical schools and temporarily lifted caps on domestic full fee paying places.
The Australian health system is highly reliant on the contribution made by international medical graduates (IMGs). At any one time there are around 6100 IMGs working in Australia on temporary resident visas. Many work in rural Australia and other areas of workforce need, as well as in the public hospital system. Additional investment in prevocational and vocational training positions will help ease this reliance and ensure better access to locally trained medical practitioners.
In 2002, as part of its efforts to address medical workforce shortages, the Commonwealth Government announced a specific policy measure to allow international full fee paying medical students to stay in Australia after graduation in order to complete an intern year and achieve full registration as a medical practitioner.
This policy has helped to encourage a significant increase in the number of international students studying medicine in Australia and the NHWT report referred to above suggests that in order to meet our future medical workforce needs, Australia should make every attempt to retain these students once they graduate.
By 2014, the number of domestic graduates from medical schools will grow to 3108pa – which compares to 1287pa in 2004[3]. Taking into account international full fee paying students, the total number of graduates from Australian medical schools in 2014 will be 3786. This presents Australia with a real opportunity to not only reduce overall medical workforce shortages, but to also address more specific workforce issues such as the lack of access to medical care in rural and remote areas.
Increasing the number of medical school places is only the first stage in the process of training more doctors to meet health delivery requirements. Graduates go on to complete one to two years of generalist (prevocational) training and then three to eight years of specialty training in one of a range of specialties, including general practice. Increasing the number of medical school places will be ineffective in addressing medical workforce shortages unless there is a coordinated increase in:
– clinical training places for medical students;
– intern and prevocational training places; and
– vocational (specialist) training places.
Some steps have already been taken towards meeting these challenges. In 2008 the Council of Australian Governments (COAG) announced a $1.64 billion package to support undergraduate clinical training for the health workforce. More recently, the Commonwealth committed $640m to support a significant expansion in prevocational and vocational GP training positions as well as additional specialist training positions in the private sector. There has also been a commitment to increase training positions in Emergency Medicine.
However, the above investments will not be enough to ensure that Australia’s future medical graduates can progress through prevocational and vocational training and realise their full potential as medical practitioners. To illustrate the challenge ahead, in 2009 there were 2243 intern places in Australia, which falls well short of the more than 3700 positions that will potentially be needed for domestic and international graduates in 2014. If current rates of expansion continue there will only be 3200 positions in 2014
Through the COAG processes, State and Territory governments have committed to guarantee an intern place for all domestic Commonwealth funded medical graduates. They have also set a goal to provide all Australian medical graduates, including full fee paying graduates, with an intern place to allow them to complete their training.
Reliable data on the remaining prevocational training years is not currently available, although we understand that Health Workforce Australia (HWA) is working to improve data collection in this area. In addition, no formal process is currently in place to assess how the provision of places will be matched to the additional number of medical graduates progressing through prevocational training towards vocational training.
First-year vocational training positions have been growing at a rate of around 8.2% pa since 1999. This historical rate of growth falls short of the expected growth in graduate numbers. Vocational training programs are generally three to eight years in duration and this means that not only will we require around an additional 1200 first year vocational training places by 2015, we will also need to support the ongoing provision of new training posts over several years to allow these trainees to complete their training.
This statement reflects the consensus view of our respective organisations on the key steps that need to be taken in order to ensure that the community does not face a situation where it has supported the training of more medical students only to see them fail to get the training and clinical experience needed to provide high quality care to the community in the long term.
Source: Australian Medical Association EMB