Australia has too many sick people and not enough doctors. And it’s crunch time if we want to fix it.
We hear about the challenges facing our health system all the time - waiting lists for surgery, overcrowded wards, long queues to see a GP.
Most of these problems can be traced back to a simple equation - there are too many sick people and not enough doctors. Demand is greater than supply, and the imbalance is getting worse.
That’s why we need to turn every single one of our medical graduates into a practising doctor.
The current shortages in our medical workforce resulted from a decision by the Federal Government in the 1990s to slash the number of medical school places.
This has created a structural deficiency in the medical workforce - which is made worse by the global competition for skilled talent.
Overcoming the doctor shortage will take time, but the process has begun. The number of medical students going through the six medical schools in NSW has increased dramatically over the past few years.
Medical school graduates, however, must complete a postgraduate intern year before being fully registered as a doctor.
After their intern year, they must typically work and train for another year or two in a hospital, and then train as GPs or specialists for up to another 10 years.
In other words, increasing the number of medical school graduates is not an answer in itself.
The demand pressure on our hospitals, and the intense workload on senior doctors, mean there is simply not enough time and resources to provide hospital training places for all the medical graduates coming through the system.
Inevitably, given these pressures, training activities are seen as secondary to “service delivery” priorities within our hospitals.
That means the junior doctors who are successful in finding places in hospitals are not getting the level of training they need.
We’ve come to crunch time in dealing with the junior doctor bottleneck in our hospital system.
A total of 577 medical students graduated in NSW in 2009 - this is projected to almost double to 1,096 in 2014. We have to bite the bullet, and we have to find better ways to ensure junior doctors can complete their training urgently.
Broadening training opportunities beyond the hospital ward is a useful idea. Similarly, the possibility of conducting some training activities in overseas hospitals may be worth exploring.
The bottom line, however, is that we need more doctors working here in Australia.
The AMA NSW has developed a five-point plan to tackle the training crisis in NSW hospitals. We have delivered our proposals to the major parties for their consideration ahead of the March state election.
Our first recommendation is to include the education and training of medical staff as a Key Performance Indicator for Local Health Networks - as also recommended by the Garling Report. This would include minimum targets for ‘pager-free’ training as a proportion of doctor’s ordinary rostered hours.
Secondly, governments at State and Federal level should endorse the outcomes of the National Medical Training Summit hosted by the AMA in Canberra in September.
This includes a commitment to guaranteeing internship positions to all local and international full-fee paying students.
Thirdly, Medical Education Units should be established within each Local Health Network. These units would be responsible for the development, co-ordination, delivery and evaluation of all education and training activities for prevocational doctors.
Fourthly, 30 per cent of all ordinary rostered time for hospitals doctors (second year doctors and above) should be protected as “clinical support time” for teaching, supervision, administration and professional development.
Interns (i.e. the first year out of medical school) should have 20 per cent of rostered time protected for training activities.
Protected education time is enforced in hospital systems around the world, and is the only way to ensure that the daily pressures of service delivery do not undermine training and skills development.
Finally, an independent auditor should be commissioned to conduct annual audits on each Local Health Network’s education and training performance.
Together, these measures will clear the way for the next generation of Australian doctors to complete their training and enter the workforce, and lay the foundation for a stronger health system.
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