Jane McCredie: Going private with training

MORE than 3000 students around the country have just started taking their first steps on the long road to a medical career, with all the excitement and trepidation that entails.

There’s no doubt we need them, but will our struggling health system be able to give these young people the education they need to become good doctors?

Workforce shortages and the health demands of an ageing population have led successive governments to preside over a huge rise in the intake at university medical schools in recent years, and it’s set to continue.

Medical Deans Australia and New Zealand predict 3876 new doctors will graduate in 2014, up more than 75% on the 2008 figure.

Good news — perhaps. Increasing the medical workforce isn’t just about opening new medical schools and admitting more students to existing ones, as the deans and others have pointed out.

The system’s capacity to provide essential clinical training has simply not kept pace with the flood of students and junior doctors.

Some overseas students are already finding they can’t get an internship after spending hundreds of thousands of dollars to obtain their degrees. The AMA warns local students may be next.

We’re still waiting for a real solution to this training crisis, despite the efforts of a series of government bodies and associated reports and funding packages.

The latest organisation addressing workforce shortages — Health Workforce Australia — is working on a national training plan to be presented to the federal government later this year. It will be interesting to see what strategies they come up with.

With the traditional teaching hospitals straining at the seams, there have already been moves to broaden the options for clinical training. For example, the federal government announced a funding package late last year that was partly aimed at expanding undergraduate and prevocational training in private settings.

Such a system is not without its challenges — standardisation of training, and support and remuneration for supervisors, to name a few — but the general practice experience in vocational training has shown these are not insurmountable.

In fact, some specialists believe training junior doctors in a variety of clinical settings could actually better prepare them for the real world.

The acute and acute-on-chronic presentations that dominate in a major public hospital are an essential part of a medical education, but they may not bear all that much resemblance to the actual case load faced by a newly qualified specialist in private practice.

Young doctors need to learn how to manage the ongoing rumblings of chronic illness as much as the eruptions of an emergency.

And, given that public hospitals often struggle to provide sufficient outpatient services, a supervised stint in private practice might be the best way to achieve that.

Jane McCredie is a Sydney-based science and medicine writer, and author of Making girls and boys: inside the science of sex, published by UNSW Press.

Posted 28 February 2011