Issue 7 / 28 February 2011

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

6 thoughts on “Jane McCredie: Going private with training

  1. Anonymous says:

    Drs. Lindsay and Hockings, good on you! We need more doctors with your generouus and compassionate attitudes.
    GreenPastures and woolly, I think most trainess would rather not be taught by you anyway with the kind of attitudes you have.

  2. GreenPastures says:

    I find Wooly’s remarks spot on. I spent many years teaching and training in the public sector. It is often thankless and takes a lot of hours if done properly. However it was considered almost part of the Hippocratic Oath to deliver one’s knowledge to the next generation. Of course we were taught by our elders too. However, at some point there is a refuge in the private sector where one practises one’s medical crafts uninterrupted and without having to deliver different goods at the same time. It is a pleasure to be without trainees in the private and I would not like to have them foisted on me! Now, did I say that?!!

  3. Greg Hockings says:

    This article raises a very important point. Private hospitals do have the capacity to undertake considerable undergraduate and postgraduate medical training. This is already happening at some locations, such as Greenslopes Private Hospital, Brisbane, where there is a UQ clinical school as well as interns, residents and registrars, including advanced trainees.
    I have found that active involvement in such training, as a VMO in private practice, does require substantial time committments in relation to administration, organisation, preparation, timetabling and accreditation. At present my time is given on an honorary basis, and some of the administrative work is also carried by my practice staff.
    Therefore there is a real need for an appropriate funding model that can be introduced on a national basis if medical training is to be expanded within the prvate sector.

  4. David A Lindsay says:

    Teaching medicine and surgery (and several “subspecialties”) to Bond University medical students at Pindara Private Hospital (Gold Coast). This is the second year of teaching. Volunteer physicians, surgeons (and others) not currently a problem, and patients happy to be involved. The private hospital sector appears to be “useable”, and is currently underused for undergraduate teaching. It would be possible to teach postgraduates, but only with well structured training programmes, and funding (federal &/or state governments (?other sources). Hopefully, the private sector, other than the already used general practices, are on the agenda of Health Workforce Australia – are they?

  5. Adrian R. Clifford says:

    I have long maintained that on the job training is the way to go for many professional fields of endeavour. It works for plumbers, builders, electricians and other blue collar specialists, why can’t it work for doctors?

  6. woolly says:

    3 large issues are obvious here.
    Medical defence. Who will be responsible for covering these young doctors in training when they are in a private setting ? It’s unfair to expect the private practitioners to carry all the burden.
    Financial. Private practice doctors are running a business, with lots of running costs, and they are busy busy busy, therefore would need substantial compensation for the time spent training juniors. Private practices are not a charity. I can’t imagine the Govt. offering financial compensation acceptable to most specialists considering the Medicare rebates and gap issues that already exist.
    Patient expectations. Patients pay substantial private health insurance premiums in order to receive expeditious treatment by a specialist of their choice, and often also have to pay out of pocket gap expenses. Understandably they are therefore unlikely to agree to have their surgery performed by just a trainee!

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