Teaching students a costly venture

DOCTORS involved in medical education have warned that it will become increasingly difficult to convince general practices to teach medical students, following a new study that shows they usually end up in the red.

The authors of the study, reported in the latest MJA, called for a review of subsidies paid to teach undergraduate medical students to ensure that, “at the very least, a cost-neutral financial outcome is achieved”.(1)

The issue has become more urgent with demand for teaching practices to increase substantially over the next 5 years.

The authors said with an estimated 3000 medical students, 900 interns and more than 600 registrars requiring placement in general practice each year by 2012, training positions would fall well short of requirements unless more teaching sites were recruited or larger numbers of trainees were placed at each site.

Their 2007 survey of GPs in South Australia found it can cost private general practices up to $1746 a week to teach fourth year medical students.

Those who teach junior doctors and GP registrars may have their costs offset by subsidies and income generated by the trainees, but not to any significant degree.

“These results have implications for the recruitment and retention of general practices as teaching environments, particularly for medical student teaching,” the authors said.

Professor Dimity Pond, president of the Australian Association for Academic Primary Care, said the study supported the views of the association that it cost a lot of money to train medical students, and that $100 per session in Practice Incentive Program (PIP) payments was not enough to recompense GPs for their time.

PIP paid each supervisor for only one student at a time regardless of how many students were present for a session.

“I believe that this … will make placements next year much more difficult,” she said.

Professor Pond said the cost of the training should be recognised by universities and by potential funders such as the Department of Health and Ageing and state departments of health.

She also called for equitable arrangements to adequately fund GP supervisors.

“They are not cogs in a machine, they are private practitioners giving up valuable time and effort to train students, none of [whom] may ever come back and help them personally.”

For the study, the Adelaide to Outback GP Training Program surveyed general practices in 102 urban, outer metropolitan, rural and remote areas.

The net financial outcome each week for practices for teaching was minus $1385 for fourth year medical students, minus $1285 for fifth years, minus $630 for sixth years, plus $484 for postgraduate year one junior doctors, plus $224 for years two and three, plus $206 for basic term registrars, plus $173 for advanced registrars and plus $158 for subsequent term registrars.

“One possible option for this level of teaching is to introduce a graduated subsidy rate, reflecting the varied costs of teaching within the stages of medical student training, as occurs at the prevocational and vocational training levels,” the authors said.

Professor Simon Willcock, chair of General Practice Education and Training (GPET), said the study was a further indication of the need to look at block systems of funding for supervisors.

“It is crazy to have differential incentives to teach,” he said.

“All it will mean is that it may be harder to get student placements in general practice.

“There is funding for undergraduates, prevocational doctors, registrars and infrastructure but it is all in separate pools, and there is no cohesive linkage, and that creates the opportunity for perverse incentives to do one rather than the other.”

He said GPET had increased teaching allowances and practice subsidies for supervisors in the Australian General Practice Training and Prevocational General Practice Placements programs by up to 20% from 1 July.

1. MJA 2010; 193: 608-613.

Posted 15 November 2010