Australia

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Australias Medical Education and Training
Trends and Issues

• Col White
• Chris Mitchell
• Health Workforce Queensland

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• 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.

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• 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/responsibiliti
  es 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.

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• 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.

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• 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 AMCTRD Aust Trained
  NZ grads)
• That in 2007, PGY1 numbers consisted of the
  previous years domestic graduates plus an
  additional 441 (including AMCTRD 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)

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• Assumptions
• That PGY1 numbers will include the previous
  years domestic graduates plus an additional 450
  AMCTRD 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.

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Projected PYG1 and PGY2 numbers by year
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• 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.

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• Summary (contd)
• 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.

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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.