Australia’s Medical Education and Training – Trends and Issues

1. Australia’s Medical Education and Training – Trends and Issues Col White Chris Mitchell Health Workforce Queensland

2. Context • Predicted medical workforce shortages have led the Australian government to significantly increase the number of medical schools and medical students with domestic medical graduates to rise from 1582 in 2007 to 2920 in 2012. • This rapid expansion is likely to have significant consequences in terms of funding, supervision, training capacity and infrastructure. • This 85% growth in medical students will have flow-on effects throughout the whole medical education and training system. • By 2013 an extra 5173 Australian graduates will flow into our medical system over and above previous average intakes of around 1300 per annum (e.g. 1335 for 2007). • Based on previous trends, over this same period, there is the potential for an additional 2400 AMC and temporary resident Australian trained doctors to flow into the system.

4. Following from this increasing number of medical students and graduates, there will be: • An increased need for clinical training placements during university education. • Increased need for Supervisors in the hospital system and general practice. • Increased supervision expectations/responsibilities for senior hospital doctors, general practitioners and registrars • A need to expand clinical training capacity at PGY1 and PGY2 levels and increase vocational training capacity across all specialities. • Increased accommodation and infrastructure requirements for medical education and training. • As the capacity of the public hospital system to cater for increased student and intern numbers is challenged, it is likely that community clinics, private hospitals and general practices will be increasing used to provide clinical training. This will have significant financial and infrastructure implications.

5. Vocational Training • There was an estimated 10,100 basic and advanced vocational trainees in 2007. • Of these, 6,833 were advanced vocational training placements while there were an estimated 3,267 in basic trainee programs. • There were 1,957 first year advanced vocational training placements in 2008. • As the number of graduates entering the medical system between 2007 and 2012 will increase by 85%, it is reasonable to expect that the number of vocational training places required will increase by a similar amount by 2014. • Based on a number of knowns and assumptions, the following projections indicate the minimum number of advanced training places that need to be created from 2009 to 2013.

6. Knowns: • Domestic medical graduate output 2002 to 2012 • Domestic medical growth 2007 to 2012 (N1338) or 84.6% • PGY1 numbers 2005 to 2007 • PGY2 numbers 2005 to 2007 • That in 2006, PGY1 numbers consisted of the previous years domestic graduates plus an additional 451 (including AMC+TRD Aust Trained + NZ grads) • That in 2007, PGY1 numbers consisted of the previous years domestic graduates plus an additional 441 (including AMC+TRD Aust Trained + NZ grads) • GPET Registrar intake 2000 to 2008 • The number of first year advanced training positions available from 1997 to 2006 • In 2007, the number of first year advanced training positions was 58% of the total PGY1 and PGY2 cohort (1957/3362)

7. Assumptions: • That PGY1 numbers will include the previous years domestic graduates plus an additional 450 AMC+TRD Aust Trained + NZ grads to 2010, then reduce to 350 from 2011. • That 90% of PGY1 intake will continue to PGY2. • That the number of first year advanced training positions available for 2007 and 2008 is similar to that of 2006, approximately 1957. • That there is unlikely to be an increase in first year advanced training positions prior to 2010. • That the desirable number of first year advanced training positions will remain at 58% of the total PGY1 and PGY2 cohort for each year.

8. Projected PYG1 and PGY2 numbers by year

10. Summary • The data shown previously includes first year advanced training positions only. It does not include basic trainees or advanced trainees in subsequent years. • It is likely that number of basic and advanced trainee positions across the system will be increased, but probably not prior to 2010. • We believe that the number of funded trainee places is likely to be too few, too late. • The rapid growth in medical graduate numbers will place significant pressures and costs on current medical training systems and processes. • State Health Departments and hospitals will struggle to accommodate, finance, and train the increasing number of doctors entering PGY1 and PGY2.

11. Summary (cont’d) • Delays in establishing and funding adequate numbers of training positions will create a ‘blocking effect’ whereby graduates from subsequent years will experience difficulties in obtaining a training position due to graduates from previous years also competing. • Without adequate planning, consultation and resourcing, it is possible that Australia could face a similar situation to that to that recently experienced in the U.K. where insufficient training places were available for graduating doctors.

12. References: Medical Deans Australia and New Zealand. (2008). National Clinical Training Review: Report to the Medical Training Review Panel Clinical Training Sub-Committee. Sydney: MDANZ. Medical Training Review Panel. (2006). Tenth Report. Canberra. Medical Training Review Panel. (2008). Eleventh Report. Canberra: Commonwealth of Australia. General Practice Education and Training. (2008). 2008 AGPT Selection Final Outcomes Report. Canberra: GPET.