The AM Program onABC Radio this week discussed how "Medical Deans lament [the] lack of internships" in Australia.
Surely the availability internships should have been a consideration when the deans and senior folk within the Universities were considering starting up the medical schools or setting student numbers in th the first place.
...and surely when the numbers of graduating doctors could have been anticipated (not that hard considering that people can count how many medical students there are in the medical schools years ahead of them graduating) we could have had years of developing models to provide junior jobs instead of going "oops we forgot that they needed internships to get qualified" when they are just about to graduate.
There is now a very short time fram in which to try and build the capacity of the health system to supervise junior doctors. It is all well and good to say - lets put them in private hospitals and general practice. The reality is that interns do require a significant amount of supervision and unless there is funding available for the time of senior doctors to do the supervising, adequate medical indemnity provisions to cover the junior doctors in non traditional settings, adequate scope of pathology and clinical exposure to ensure an adequate training experience, and appropriate administrative support for the private sector to take on junior doctors, this is not going to be a satisfactory solution.
Thursday, August 26, 2010
Monday, August 16, 2010
not enough jobs for junior docs
Unsurprisingly, the media is reporting on a shortage of junior doctor jobs for the 3000 or so medical students about to graduate from Australian medical schools.
Lets go back in time to the '90s... all the rhetoric in the early '90s was about the oversupply of doctors. The Medicare budget was blowing out, and the clever bean counter types looking at the supply and demand equation were convinced that this was due to too many doctors spruiking for business. There were 10 medical schools in Australia and there was a rumour that there were plans to decomission one of them bringing the number back to 9; the government of the time put caps on vocational training places (particularly in general practice). This, of course, was a bit of a surprise to the doctors out in the commuity who were having diffculty recruiting other doctors to work with them and hadn't had a holiday for years because of lack of cover.
It didn't take long for the real truth to emerge in the numbers. Far from an over supply of doctors, there was actually a shortage. This was brought to a head by the limitations in training places. All over the country, communities were reporting difficulties accessing medical care (general practice and specialist). Demographers started to pay attention to the aging medical worrkforce.
Lets fast forward a little - a decision was made to open up medical school training places. This would supposedly produce all the doctors we need to fix the shortage... The universities were more than happy to put their hands up to run medical training; after all medical schools are prestigious things for universities to have. More and more universities started announcing medical schools, and the number of medical graduates has more than doubled.
Somebody forgot to consider that, for doctors to be able to work in unsupervised in the community where they are needed, a they need a period of vocational training in supervised jobs. So here we are in the ludicrous position of simultaneously having ongoing medical shortages in the community and a shortage of supervised junior medical jobs.
The sad thing is that this was not unexpected. For several years there have been senior doctors expressing concerns about the rapid expansion of medical schools in Australia and the capacity of the system to take on junior doctors.
What's the best way forward?
The government is keen on expanding training outside of the major public hospitals. As a concept this is laudable - the test will be putting it into operation and ensuring that the quality of supervision and the adequate safety measures are not compromised. Will smaller private hospitals (the bigger ones already take junior docs) and nursing homes have sufficient numbers of medical staf around to ensure adequate supervision? Will the breadth of clinical presentations and scope of practice provide enough valuable experience for junior docs? Will there be enough support for training within the infrastructure of these organisation?
Time will tell.
It is a difficult time to be a new graduate. My thoughts and sympathies are with all my junior colleagues out there about to take on the big adventure of meidcal practice.
Lets go back in time to the '90s... all the rhetoric in the early '90s was about the oversupply of doctors. The Medicare budget was blowing out, and the clever bean counter types looking at the supply and demand equation were convinced that this was due to too many doctors spruiking for business. There were 10 medical schools in Australia and there was a rumour that there were plans to decomission one of them bringing the number back to 9; the government of the time put caps on vocational training places (particularly in general practice). This, of course, was a bit of a surprise to the doctors out in the commuity who were having diffculty recruiting other doctors to work with them and hadn't had a holiday for years because of lack of cover.
It didn't take long for the real truth to emerge in the numbers. Far from an over supply of doctors, there was actually a shortage. This was brought to a head by the limitations in training places. All over the country, communities were reporting difficulties accessing medical care (general practice and specialist). Demographers started to pay attention to the aging medical worrkforce.
Lets fast forward a little - a decision was made to open up medical school training places. This would supposedly produce all the doctors we need to fix the shortage... The universities were more than happy to put their hands up to run medical training; after all medical schools are prestigious things for universities to have. More and more universities started announcing medical schools, and the number of medical graduates has more than doubled.
Somebody forgot to consider that, for doctors to be able to work in unsupervised in the community where they are needed, a they need a period of vocational training in supervised jobs. So here we are in the ludicrous position of simultaneously having ongoing medical shortages in the community and a shortage of supervised junior medical jobs.
The sad thing is that this was not unexpected. For several years there have been senior doctors expressing concerns about the rapid expansion of medical schools in Australia and the capacity of the system to take on junior doctors.
What's the best way forward?
The government is keen on expanding training outside of the major public hospitals. As a concept this is laudable - the test will be putting it into operation and ensuring that the quality of supervision and the adequate safety measures are not compromised. Will smaller private hospitals (the bigger ones already take junior docs) and nursing homes have sufficient numbers of medical staf around to ensure adequate supervision? Will the breadth of clinical presentations and scope of practice provide enough valuable experience for junior docs? Will there be enough support for training within the infrastructure of these organisation?
Time will tell.
It is a difficult time to be a new graduate. My thoughts and sympathies are with all my junior colleagues out there about to take on the big adventure of meidcal practice.
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