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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38 comments

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    • HarlequinBeetle says:

      05:33am | 25/01/11

      Pondering: demand greater than supply.  Surely this has come from the medical profession - more tests, returning for results, ongoing treatment.  My thoughts?  Yes, there is an insufficency of doctors - particularly in lower socioeconomic areas - having spoken to my Dr who with partners owns a large clinic in Melbournes western suburbs.  We have been ‘taught’ to go to the GP for many things which in a day or two will improve…oh I have sniffles…!!!  Ditto, we now have so many medical tests which necessitate a Drs appointment to authorize, a Drs appointment for results and so often a Drs appointment for ongoing treatment.  Time for commonsense to prevail. We have insufficient Drs because we have been taught by the medical profession that we need to visit.  Perhaps the time has come - as the walros said - to reassess when we need a Doctor ..and when a nurse practitioner would do…or maybe, just wait a day or two…and nature may heal without intervention.

    • kj_storm says:

      01:52pm | 25/01/11

      Add also the need to have a sick certificate for everything. I mean if I stay off work sick usually the receptionist at the doctors can tell I’m sick as I use almost a full box of tissues while waiting…

    • Steve says:

      06:27am | 25/01/11

      They have done the exact same thing in the UK too - i.e. substiantially upped the number of medical school places and deliberately created a bottleneck once junior medics get to senior house officer level. It has been done to reduce NHS salaries for medical staff over time - similar to what occurs across continental Europe where salaries for doctors are much lower. It’s a case of simple economics - supply and demand. The more doctors you have, the less you have to pay them.

      While governments can increase the number of medical school places, it’s the specialist medical colleges who have the final say on the number of places available for junior doctors to train as specialists. It has always been in the best interest of these senior doctors (ie established and wealthy consultants) and the various specialist colleges to restrict the number of registrar positions available. More trained specialists means lower fees and salaries over the longer term. Specialist Australian doctors are already amongst the best paid in the developed world - and they want it to stay that way.

      The answer is, of course, for junior doctors and medical students to be more realistic about their career options. You cannot and should not be guaranteed opportunites to train as highly-paid specialists if you’re not competant enough to do so. The reality is, there simply isn’t the money or the desire amongst the medical colleges to train more $500K+ a year specialists. You cannot rush the training of a surgeon or physician, either. The only solution for the colleges is to continue to limit the number of training opportunities available. Those who miss out (and there will be an increasing number), will just have to settle for what they can get - just like in every other profession. Welcome to the real world.

    • TChong says:

      06:28am | 25/01/11

      Sensible ideas mostly, but 30% of rostered hours away from “front line” for education , administration etc sounds excessive. How would the deficit be covered ? - by employing more MOs? ( Locums) ? or expanding the size of teams to include more interns?- the financial cost would be very high, plus patients might object. - many people put a lot of faith in being seen by their-“my’ doctor
      Its a pity for “Health” that both sides of politics allowed the Practioners run a closed shop- very few training positions in hospitals, for so long. Way back when, too many senior Doctors fought very successfully to keep new grad
      ( in specialities) numbers low, ensuring very high financial returns for the incumbants.
      The publics perception that all Doctors are like Terrence Elliot at Wandin Valley - noble, all wise, ultristic ( and many are) , allowed a blind eye to be turned to a self serving system of few specialists now being able to charge absurd amounts of money for their services.

    • In the know says:

      07:20am | 25/01/11

      All governments have seen this coming for a LONG time. All governments have decided to do nothing about it because the doctors unions are too powerful. It’s like the waterfront used to be. There’s no good adding more med students if the senior doctors keep running a cartel operation to keep training limited to keep their own rates up. It’s time for some Patrick’s style medical union busting

    • Flexo says:

      07:38am | 25/01/11

      Let us put things in pespective. We have a shortage of doctors. We have a shortage of doctors who work in rural areas. We have a shortage of training places for interns, residents and registrars. There will be a great deal of unemployed or untrained doctors in the next few years (not 10 years from now, not 6 years from now but within 3 years!). Many of these doctors were trained in Australian universities and have had their fees subsidised by the Australian taxpayers. Many millions of dollars in tax subsidy. The government will have to fund many new training spots. The government has limited amount of money (in fact there is no single governmeent on the face of this Earth with an endless supply of tax dollars). Medicare is a finite commodity. Yet Miss Roxon knew about this way back in 2008 and was going to ‘fix’ this problem. Yet we have unemployed medical grads this year. Yet the kind Minister is spending tax payer and Medicare dollars on Nurse Practitioners and midwife medical indeminity. Why not make sure every single Australian medical graduate has a secure training spot from intern to the time they finish ther GP/speciality training and fund rural benefits for them before wasting hard earned tax payer dollars on semi trained nurse pracs who add another unnecessery layer to health care and on midwives who should pay for their own insurance cover. By the way the insurance indeminity cover given to midwives isn’t extended to GPs who do O&G (and they have far more experience, and ALL ROUND training) if that is not prejudice and worthy of a class action against the kind Federal Minister for Health, I don’t know what is.

    • TChong says:

      08:40am | 25/01/11

      Flexo :Roxon having three years to fix the problemis only a quater of the time the Howard, with Abbott as health minister did nothing at all about the problem, long forseen.
      BTW the shortage of rural doctors is because the doctors dont want to work in the bush - some of the locum pay and conditions offered would make most professional blush with embarrasment to see such financial and infrastruture services offered, yet the conditions are still insufficent from the MOs point of view.
      “Greed is good"may be attributed to the Gordon Gecko character, but it could have been penned by the AMA.

    • Flexo says:

      09:00am | 25/01/11

      TChong, stop blaming the Howard government. The ALP have been in since 2007, it is now 2011, get with the program and solve the problem. If you want to blame previous Governments why not blame Hawke or Keating. It doesn’t help your cause by blaming instead of solving.

      If doctors want to be paid more to work in the bush why not? They are on call for more weeks in the year, they have to do more and be more skilled (where do they learn their skills? Hours in the hospital sacificing their time to be paid peanuts in the pulic system), and they have to bring up a family (with a wife or husband that might not be thrilled by the rural lifestyle). We don’t seem to complain that bankers or politicians make lots of money and get huge retirement benefits for making our lives more difficult. Why not complain aout the locksmith or mechanic that charges an arm and a leg for minor repairs. Double standards. And nurses and nurse pracs costing the system with their wages and their constant strikes and demands.

      Enough is enough, Roxon needs to go, she has more than enough time to fix this problem, her performance at any private enterprise would not have been tolerated for 3 seconds yet alone 4+ years.

      No more excuses, fix the problem within the next few weeks or leave. And seeing as we have a QLD flood disaster requiring lots of $$$$, I wish we had a surplus to draw on but you guys know what ALP politics is like - spend, spend, spend, waste, waste, waste, tax, tax, tax, don’t save, don’t save, don’t save and screw all Australians as per usual.

    • TChong says:

      10:18am | 25/01/11

      Flexo - whats your rave about? You obviosly are a conservative ( no probs as far as I’m concerned,)  but you appear to be bagging mechanics , bankers, locksmiths etc - sure , I agree, but doesnt LNP policy believe in user pays? Only doctors should charge what they can, but outrage from you, if others do?
      Nurses “constant"strikes? constant ? a bit of hyperbole.
      Nurses and nurse pracs demands ? All professions do , medical practioners included. Whats your problem ?
      Its not a case of doctors wanting to be paid more for working in the bush, its the fact that the incentives needed are financially hurting to the area health services.
      Roxon since 2007, Howard and Abbott from ‘96 till 2007, but thats irrevalent?, as the problem needs to be fixed in the next few weeks ?
      Hmmmm.
      Why didnt Abbott propose any solution, at all, other than taking over 1 Tassie hospital, in a marginal seat. ?
      You know the answer Flexo. It aint pretty from a political POV, is it?

    • The Cannulator says:

      12:10pm | 25/01/11

      Whilst Midwives should be paying their own way, Nurse Practitioners are a damn site more useful than some socially inept braniac 24 year old lacking any life experience on the way to becoming a socially inept exorbitantly rich 40 year consultant without any life experience. That’s where the money goes.

      GP’s aren’t doing too bad—they can afford insurance.

    • Against the Man says:

      06:32am | 26/01/11

      TChong you miss the point (as usual). Maybe English lessons? If others can charge what they want, why can’t doctors? Free market isn’t it. I’ve no problem with other professionals being ‘crooks’ and charging more if you don’t single out doctors, In other simple words, don’t complain about rich doctors (who earn their money improving or saving your life) if you’re not going to complain about bankers, locksmiths, nurses etc.

      I have a feeling Roxon, TChong and the cannulator are medical school rejects that are a lil’ bit jealous. HaHa maybe in your next life.

      ps: Please don’t see a doctor when you are sick, stick with the nurse pracs as you don’t seem to respect or deserve the quality of care they provide.

    • Ryan says:

      08:19am | 25/01/11

      Why would any young person today study for 5+ years to leave university with a MASSIVE HECS debt that will take years to repay only to be treated with the utmost disdain by the Labor government and branded “the rich” and hence un-Australian and must PAY even if you are still trying to pay off a HECS debt and catch up to your peers for all those lost years of earning potential while studying. Is it any wonder our young ones aren’t interested in being treated like filth for achieving and contributing back to society.

    • Razor says:

      12:15pm | 25/01/11

      Dear Ryan,

      Either you have a poor understanding of what a HECS debt is and how it is repaid or you are trying to continue the furphy that HECS debts stop people studying.

      The HECS debt is a non-recourse loan and the cheapest money you will ever borrow.

      When you apply for a mortgage or anyother sort of loan it is not included as a liability.

      If you never reach the income threshhold you never repay it.

      If yo leave the country and never retrun you never repay it.

      If you die you never repay it.

      The debt increases at the rate of inflation.

      Both my wife and I have paid of two HECS debt through the PAYG system and the long term potential benefit of the Degrees we earned more than make up for the years of lower income while studying.

    • Ryan says:

      08:09pm | 25/01/11

      @Razor: that wasn’t my point, my point was the fact that (assuming you got a degree other than some useless arts degree) you having a deree now makes you “the rich” and hence an “enemy of the state” by most of Labors policies. I think you will also find that 99% of tradies who do more cash in hand jobs than you can shake a stick at earn more than you do by far, pay little if any tax and take home vastly more money than you regardless of your degree.. but they are not “the rich” they are “the battlers”.

    • Eigengrau says:

      08:12pm | 27/01/11

      Hear hear - when potential medical students start seeing the erosion of job security and wages, why would a bright, enthusiastic school leaver do medicine? You can do a combined law degree in 5 years, or a commerce degree in 3 - forget about the years of postgraduate training while working long crushing hours for a relatively low wage. Junior doctors are forced to work long hours as well as do rural rotations with no thought to their social or family commitments. At least in law and finance you are well paid for the long hours. For what can happen to a devalued profession, just look to teaching which in years past once attracted some of the best school leavers, but now struggles to have ATAR cutoffs above 60.

    • Loxy says:

      09:34am | 25/01/11

      I think a review of wages would help, it astounds me how little doctors in the public system get paid - especially given all the years of training they do and the long hours they work.

    • K. says:

      02:36pm | 25/01/11

      are you for real????? they get paid enough already, they do a good job, they earn good money - why do they deserve more money? If they each made slightly less money then maybe we’d have the funds to hire more of them!

    • Jimbo says:

      06:05pm | 25/01/11

      Read the post again K, Loxy was talking about doctors in the public system, who, especially the more junior doctors, don’t get paid well considering the ridiculous hours many work, the years of training it takes to become a doctor, and the life and death nature of their jobs. Most of those earning ‘good money’ will be working at least part of the time in the private system.

    • l-tin says:

      09:53am | 26/01/11

      Jim… i disagree with you too because i also believe that those in the public sector do get paid enough…

    • Barry Business Class says:

      10:03am | 25/01/11

      The only reason I’ve been to a doctor in the past 5 years is for medical certificates for sick leave. All were common ailments that I knew would be over in a couple of days and it only wasted my time (and money) and theirs. It’s a real shame that our employers don’t trust us to take sick leave without a certificate. Some people ruin it for everybody else.

    • Helena Handcart says:

      10:04am | 25/01/11

      This is special - the AMA to the rescue, solving a problem they helped create.  There must be a term for this - it’s something politicians do all al the time.

    • Democrat says:

      10:59am | 25/01/11

      Let’s remember the Howard years when the number of training places in universities for medicine was cut by a third.  Considering the amount of time it takes to train a doctor that may well explain the shortage now.  That is whey we are pleading with people with medical training to migrate to this country rather than ensuring we have trained our own.

    • n_dude says:

      11:51am | 25/01/11

      Interesting that the AMA have raised this. Yet it is they (or the specialist colleges which sit under them) which decide how many specialists they allow. Traditionally specialists have tried to protect their own turf which means they make it more difficult for new doctors to qualify (using the excuse “need to meet high standards”). They are happy to work the long hours as they are amply rewarded for it.

      Interns, residents and registrars are amongst the lowest paid professionals. However once they qualify as a specialist their salary more than triples. This is the system the AMA has been complicit in setting up. There is also entrenched discrimination against overseas trained doctors. They use the excuse that they are worried about bogus qualifications (fair enough - but that is up to the stringent background checks performed by the registering bodies), but then make it extraordinarily difficult for them to become qualified - forcing a fully qualified specialist to go through basic MBBS training, internship, residency, registrarship and then pass multiple specialist exams is plain stupid and adds to the doctor shortage.

      If there is a shortage. Then address it locally, but be willing to lok overseas to fill the backlog and treat each doctor on a case by case basis.

    • Razor says:

      12:18pm | 25/01/11

      Kathryn,

      Having personally talked to the Chairman of Health Workforce Australia about the issues you have raised i would recommned you give him a call.  Might alleviate some of your fears.

    • The Cannulator says:

      12:24pm | 25/01/11

      What system is so inefficient that it takes 16 years to be considered an ‘expert’?
      Everyone from Registrar down is a trainee—Perhaps the socially inept brainiacs graduating were given a boot camp in reality, they would become specialists in a shorter space of time.
      Even the American model of specialising early- does every doctor need to be a jack of all trades before specialising?

      Perhaps removing the elitism of achieving status in the colleges of the specialties and instead of focusing on achieving a qualification.
      Perhaps too the medical profession and governments had the cohones to tell the public to harden up and solve your own self-induced ailments instead of expecting the health system to do it for you then the poor, poor doctors would get their widdle twaining time.

      @ n_due; You think that Junior docotrs are paid bad—sparea thought for Registered nurses and Paramedics-working hard enough and educated high enough and can’t even get recognition and wage parity as professionals- time for the Residents and Registrars to suck it up.

    • TChong says:

      03:46pm | 25/01/11

      The cannulator -  damnn straight !!!!!!!!!!!!!!!!

    • Hemp for Health says:

      02:04pm | 25/01/11

      I shouldn’thave to make a full appointment just to get a script I’ve gotten 50 times already. There should a be a standing order facility at chemists with date limitations so that a person can auto-fill a prescription as long as it’s not within a time limit since the last one. I mean seriously I can go to the chemist and Buy Panadeine Extra which is basicallythe same as Panadeine Forte, but I have to get a script for that. And then the stupid thing is, you take more ‘Extras’ to match the codeine in the Fortes but are worse off because of the extra paracetemol. It HAS to be a scam.

    • Razor says:

      03:07pm | 25/01/11

      That’s why they have repeats.

      A Doctor should regularly review your condition and reuired medicines.

    • Against the Man says:

      02:17pm | 25/01/11

      Well, I’ve been talking about this for months in my posts. Finally we have an article that highlights my concerns with having Gillard/Roxon in charge. This is an accident that has already happened.

      Firstly it is too late for Roxon to do anything. Failure is done and done.

      Next I think blaming the last government is the right way to go - Rudd failed and lied to us with his ‘the buck stops with me’ crap. The buck stops at his foot infection which required a doctor’s help. Boo Hoo Mr Rudd!

      This is how you should have fixed the problem Miz Roxon!
      1) Cut all medical school intake by 30%! When you can afford to find and develop training positions than you increase the number of places.

      2) Channel the money you save from the 30% reduction in tax payer funded medical places and unnecessary crap like nurse pracs and midwives insurance (thanks Flexco someone with vision) into funding more training spots.

      3) Set up a working party to address where further training places can be developed such as private hospitals, GP clinics, New Zealand etc

      4) Import highly qualified specialist of world class standards to train the new grads. Both the Australian citizens and the new med grads will benefit from their knowledge/skills.

      It is too late folks, Gillard /Roxon have done another number on you guys.

    • Shane From Melbourne says:

      02:39pm | 25/01/11

      People need to suck it and not go on sick call. I knew a medical officer (not a real doctor) who used to give a proctol exam whatever the ailment. Certainly discouraged me from going on sick call for a couple of years…..

    • The Cannulator says:

      03:11pm | 25/01/11

      How about channelling some money into teaching doctors how to recognise manage common emergencies like Shortness of Breath in all of it’s guises, Cardiac Chest Pain, Sepsis, Acute abdomens and so on instead of writing scrawled notes with “Thankyou for seeing…..” instead of filling our hospitals with failed community medicine cases from underequipped and uneducated practices.

      High Class doctors have been imported: Thomas Kossman was and then bludgeoned out of the pubhlic system by witch hunters.

      Everyone makes sacrifices and choices for their chosen career most us in the health system deal with it. Lay off the nurses- we work hard enough for far less performing many tasks you should be doing yourselves but the culture of handball to the handmaidens still exists.

      Pick on your won colleagues drving around in CL500s while their patients live in squallor.

    • john tracey says:

      05:24pm | 25/01/11

      I will graduate from Medical Science as soon as I can pass the subjects and not before.

    • V says:

      05:27pm | 25/01/11

      Compare income growth, to the growth of health-care expenditures year on year and you will see that something has to give. It’s basic math. Yet we all believe in the free lunch (or doctor visit).

    • MudCrab says:

      08:32pm | 25/01/11

      Cool - Dr Horrible smile

    • J. says:

      03:49pm | 26/01/11

      Well make more places in uni for med students!! Keeping the number of uni places into medicine low doesn’t really help with increasing the number of doctors, does it? In QLD this year there were 200 more OP1s awarded out than any of the previous years, showing that students are getting smarter. Not only that, students performed exceedingly well in the UMAT exam this year, forcing unis to pull their cut offs even higher, and destroying the hopes of hundreds of bright future doctors. Universities need to address the need of the community and review their systems- Australia needs doctors, our universities need to make way for them.

    • Bam Bam says:

      04:13pm | 26/01/11

      Dr Austin says “we have to bite the bullet”.  How antiquated. These days, we have anaethesia. Biting the bullet is no longer necessary. I’m going to a different doctor.

    • Michael Fasher says:

      06:03pm | 27/01/11

      There’s a lot of good diagnostic thinking going on out there - let’s have more

 

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