Aniello Iannuzzi: The cost of academic inflation

REMEMBER when you could buy a Paddle Pop for 20 cents? My mum tells me she could buy one for 5 cents. Now you pay at least $1.20 — that’s money inflation.

Remember when a medical degree gave you enough qualifications to open a practice? Not only that, but to also enough income to buy a house, a car and send your kids to private schools?

To do that now you need to be a procedural specialist. Or own a chain of medical centres.

Or perhaps you remember when a medical degree allowed you to simply choose what specialty you wanted to do, and then do it?

Now you need to have a Masters, a PhD, publications, and to have waited for half your life just to get an accredited training spot. And if you want to do dermatology or ear-nose-and-throat surgery, just be prepared to wait three-quarters of your life and have a university medal too!

Remember when finishing specialty training meant you’d get a job at the hospital where you trained?

Now you need to have an overseas fellowship year, a PhD, have published widely and have impressed everyone from the cleaner to the health minister.

And remember when you just needed a good high school pass to enter medical school?

Now most entrants need prior degrees, Hollywood-quality acting skills for interviews and Mensa memberships to pass the IQ puzzles that make up the screening exams. To cover their bases, many candidates have done extensive community service, higher degrees and plenty of work experience. Before long, a PhD may be required to enter medical school.

Is this really what we want for our profession?

These four points demonstrate academic inflation — degrees and diplomas just lack the punch they used to have. To make matters worse, many specialty training schemes have blown out and can now take up to 6 years to complete.

In the past when I spoke to registrars and young Fellows, most felt they had mastered the general aspects of their specialty by the third or fourth year of training, with the final 2‒3 training years spent acquiring subspecialty skills and other CV-liners to assist in finding a job.

This sentiment is verified by GP training and GP special skills training. Both the GP colleges produce competent generalists in 3 years. GPs can then extend their training to become competent in general obstetrics, anaesthetics or emergency medicine after a 12-month special skills post.

Many country towns and regional centres boast GP generalists who perform as well as specialists. Older readers may remember GPs with appointments at city hospitals pulling out babies, appendices and tonsils.

Given the dearth of specialists in many areas, insufficient training posts for graduates and lack of specialist posts in larger centres for new Fellows, it may be time to assess whether academic inflation needs to be reined in.

Not all new specialists need to be in teaching hospitals. It may reasonable to want some of the specialists in the teaching hospitals to have PhDs and to know every footnote in Harrison’s, but is it necessary for all to be like that?

Reducing specialist training to 3–4 years would allow colleges to reintroduce the membership award, which would allow members to practise in suburban and regional centres. Many registrars would be grateful to finally alight from years of school, university and postgraduate study to start earning an honest living.

This would free up training posts for others, fill vacancies in the outer suburbs and the bush and reduce reliance on patient transfers to big hospitals.

Medicare could be modified for the changes and it would reinvigorate hospitals and medical services in areas that have languished for years.

Registrars who aspire to higher levels of specialisation could press on for another 1–2 years, achieve a full Fellowship and compete for the teaching hospital posts.

Back to the future!

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

Posted 27 February 2012

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