Australia has a shortage of doctors. There has been a shortage in the bush for years, and now it is hard for many patients even in metro areas to find a GP to take them on. We cope by importing doctors from other counties. In fact, Australia has been the highest per capita importer in the world of foreign-trained doctors.
Politicians have tried for many years to help. First increasing the output of doctors, but then realising that under “fee for service”, more doctors means more costs for Medicare. So medical student numbers were cut back
More recently, about a decade ago, the federal government began a massive increase in the number of medical students. The first phase of this increase has now graduated.
The average member of the public has only a hazy view of medical training. On graduation from a medical school, these doctors cannot practise independently but require graduated and supervised training. In round terms, one can double the length of training, so to produce a fully fledged GP or specialist will be of the order of 12 years (sometimes longer) after leaving school.
For the first year after graduating, these doctors have to work as interns. As interns they contribute to patient care. But they need close supervision, but the supervision gradually becomes less as they become more senior. So the service provision at more junior levels is less, but increases with increasing level of seniority.
But — and a big but — there were initially too few jobs for the graduating interns. Each state has then increased the number of intern positions (by 120 last year and this year in Queensland, for example). Next year, there is a need for a similar bulge in the numbers of slightly more senior doctors and this continues up the training scale.
The increase in interns will flow on — like global warming — giving rise to increased numbers at each stage after graduation. Eventually, they will become advanced trainees, then finally fully fledged general practitioners or specialists. The process has begun, and will yield more GPs or specialists in 4-6 years from now.
Training positions require salary and infrastructure. The states have to find money. But junior doctors do not treat as many patients as fully trained doctors. So the states spend more now, and hope for a dividend in 4-6 years from now with increased GPs and specialists.
What will happen next? How about bedding down the increase of medical graduates? Well, um, no …
Two universities have applied for a new medical school — Charles Sturt University in NSW and Curtin University in WA.
There are strong lobbyists for each. A popular one is “rural” focus. They forget that each of the older Australian medical schools has a rural clinical school where students spend a full year studying in rural areas.
Who is lobbying for Curtin University? Some well-connected people. Jim McGinty is chair of Health Workforce Australia, and former Minister of Health in the previous ALP government Health Workforce Australia has a budget of several billion to pay for undergraduate training in the health professions.
In addition to McGinty on the board of the proposed Curtin Medical School, there is the director of the Institute of Health at Curtin, Dr Neale Fong. He was previously “Australia’s highest paid public servant” as Director-General of Health in WA but resigned following inappropriate contact with Brian Burke. Lobbyists with grunt?
Australia needs more doctors. And a university with a medical school has more prestige. But there are arguments against: the cost (if more doctors are needed, then it is cheaper to expand numbers at current medical schools than to open new ones) and the lack of medical teachers (medical deans fear there are already too few medical teachers — more medical schools will spread this more thinly). Plus the current increase in medical graduates has not yet impacted upon the GP/specialist workforce — is it better to wait and see?
There’s no funding yet. But the lobbyists are quietly confident the Commonwealth will eventually agree to two more medical schools. What odds, anyone?
I am very sceptical of anonymous contributions.
Has Crikey assured itself that this contributor doesn’t have a conflict of interest, for example, by being a ‘medical academic’ at or associated with the University of Western Australia and thus a competitor of a second medical school in WA?
I understand that students recruited from and trained in regional areas are more likely to practice in regional areas than those who do most of their training in a city, even with a year away at a rural clinical school. I don’t see how that would support Curtin’s bid, but it would support Charles Sturt’s bid.
Macquarie University is developing postgraduate medical education at a private hospital it is developing on its campus and I expect La Trobe University will seek a medical school, probably at its health centre on its Bendigo campus.
Certainly not as titanic a conflict as interest as Jim McGinty, it’s a simply staggeringly inappropriate arrangement.
@ nodoz
I agree that McGinty seems seriously conflicted.
Does Australia really need more doctors, let alone more medical students? Life as a country doctor sounds hellish and no-one wants to practice there, so I’m willing to concede there’s a shortage in rural areas. But our free-cheap medical system means too many people want to see a doctor too often for no real reason. As a doctor’s wife with an obvious interest in keeping his salary as high as possible, I think I’m allowed to say that there are enough doctors, but too many worried well.
Kez, seems to have it right, maybe a qualified nurse, could treat the colds flu etc and dole out the painkillers, for the minor aches and pains and band aids, for the scratches and cuts, leaving the serious stuff to the doctor.
This system works well in my tiny town in the NT, our doctor visits once a week, and covers a wide area.