The Work of Workforce

5 Sep 2016

A previous Health Minister once said that they’d be happy once they had doctors driving taxis; a throwaway comment around a preference for massive workforce oversupply of medical graduates. Such a comment not only shows a colossal misunderstanding of the medical workforce, but a huge overestimation in a doctor’s capacity to drive a taxi.

Doctors are special, and definitely not for the reasons you might think. We’re an unnatural workforce. By the time we become consultants, hundreds of thousands of mostly public dollars have been spent on each of us for our training. The community should expect a return on investment of sorts. We also work across both the public and private sector in equal parts, with differing business models working towards the same health care needs. And let’s not forget the age old debate of service and training. Doctors provide a health care service, but also have their training needs to consider. You can’t have a workforce with an a la carte selection of specialties and rotations with no regard for community need, but likewise the idea of having a doctor in training do 26 weeks of nights in a row is a self-defeating, suicidal plan for a sustainable workforce (and 26 weeks of nights is a true story, by the way).

You’ve heard the arguments and the history. We were short doctors in the 70s, so we increased student numbers. Then we were in a surplus in the 80s so we cut intakes in the 90s. Then we had a shortage, so we increased numbers and medical schools drastically in the 2000s and here we are. It’s really no surprise that we’re here. Medical school takes 4-6 years, prevocational training takes 2+ years, vocational training takes 3-8 years. It’s madness to use the supply input of medical students as your major effector on doctor outputs in such a prolonged training program. We’re a weird profession when you look at what has to be done post-graduation, and hats off to AMSA for maintaining the rage all these years when successive governments still didn’t get the message.

One of the more common questions I get is “will I have a consultant job at the end of all of this?”. It’s a hard one to answer and the depressingly vague answer is “it depends”. Firstly, you need to have the data. We have a system in which most jurisdictions can’t even tell you how many PGY2+ doctors are working in their State. We’ve already lost the battle on prevocational doctors if we don’t even know how many we have or where they are; fairly basic analytics. Without oversight, this space becomes an endlessly expanding pit of doctors, with worsening prospects of meaningful training experiences and jobs. The AMA has long been calling for a National Training Survey to give us data such as this, and we’re finally starting to see traction on this issue with the Australian Health Ministers’ Advisory Council. We’ve also called for ongoing funding for the Confederation of Postgraduate Medical Councils, a victim of the previous government’s financial razors. Without these basic steps, you’ve lost the battle before it’s begun.

The vocational space is starting to look clearer. The National Medical Training Advisory Network was formed from the ashes of Health Workforce Australia, and it currently has the task of mapping out training pipelines and advice for specialty training in Australia. In December 2015, NMTAN committed to the mapping of six specialties by the end of 2016 (O&G, radiology, emergency medicine, ophthalmology, intensive care & dermatology). As well as these, the anaesthetics workforce report was released in August of this year. These aren’t throwaway exercises, by the way. They involve the training colleges quite intimately; it’s the department and doctors working together on this issue. The AMA has been a strongly involved with NMTAN and we look forward to the release of these reports. At the very least, we’ll start to get a much clearer picture of where we stand, so we know where to step. It’s a painful wait for those at the pointy end of their training, but like all major projects the fruits are starting to appear in exponentially increasing numbers. I look forward to sharing them with you as they are released.

Health ministers have come and gone. I’ve lost count of the number of acronyms I’ve seen in health workforce. It seems each budget contains a new initiative that has gone by the successive one. Only one thing has remained constant throughout all of this.

The AMA

The AMA has been the only voice at the table to constantly be there. To constantly call for sensible workforce reform. To lobby not just for more resources for the right programs, but to cut the ones that don’t work. And we’ve got good reason to be this persistent. We’ve got skin in the game. If you’ve ever needed a good reason to justify your membership, let it be the AMA’s unyielding presence and successes on the battlefield that is medical workforce.

Until next time,

Z

Dr John Zorbas

Chair, AMA Council of Doctors in Training