Information in this section is taken from Medical Specialist Training Taskforce, Systematic Framework for Medical Specialist Training, November 2004, Appendix B.
In 2001, the Australian Health Ministers' Advisory Council (AHMAC) established a working party to research issues relevant to medical specialist training outside teaching hospitals.
The working party commissioned Professor Peter Phelan to write a discussion paper on 'Medical specialist education and training: responding to the impact of changes in Australia’s health care system'. The Phelan report was released for public comment in February 2002.
Some of Professor Phelan's main findings were that:2
- Comprehensive clinical experience cannot be provided for most specialist trainees in a single hospital, including large teaching hospitals.
- There is limited experience in ambulatory or longitudinal care of patients in many hospitals.
- A variety of conditions are now managed predominantly in the private sector and are not accessible to specialist trainees working only in the public sector.
- The concentration of public psychiatry on managing people with serious mental illness has resulted in psychiatric trainees gaining little or no experience in managing patients with more frequently diagnosed mental health issues.
- Block periods of time in community based health services have become an important part of training in geriatrics, psychiatry, paediatrics and child health.
- Some experience in the private sector will be necessary for almost all trainees in ophthalmology, dermatology, radiology and pathology.
The Phelan report formed the basis for consultations and a public submission process conducted by the working party in 2002. Fifty-three written submissions were received from specialist colleges, organisations and individual practitioners. The working party then conducted three targeted stakeholder forums to discuss issues and options for the future.
Consultations with the states and territories showed that some states already provide medical indemnity cover for specialist trainees in private settings, under specially negotiated agreements between state and private hospitals. The provision of continuous employment conditions for specialist trainees varies from state to state and largely depends on the broader financial arrangements in place.
Consultation with the Committee of Presidents of Medical Colleges revealed that a range of specialist colleges were already providing training in non-teaching hospital environments – such as private practices, private hospitals and community settings. Private hospital involvement in specialist training was consistently raised as an issue in the context of specialist training outside teaching hospitals. There were approximately 18 accredited training positions (across a range of specialties) in private hospital settings, and many private hospitals were interested in playing a greater role in training specialists - but felt that there were too many barriers.
During the consultation process there was:
- Broad agreement on the need for change, and for change to be implemented in a collaborative and incremental manner.
- A strong commitment to excellence in specialist training, and agreement on the need to maintain the current high quality medical education and training.
- the need to identify costs and attribute stakeholder responsibilities
- concerns about the potential impact on service provision in public hospitals
- medical indemnity and employment conditions for specialist trainees working outside the public hospital system
- access to appropriately trained trainers
- resources for accreditation of non-teaching hospital sites.
2 Peter Phelan Consulting, Medical Specialist Education and Training: Responding to the impact of changes in Australia's health care system. A Discussion Paper (Prepared for the AHMAC Working Party to Research Issues Relevant to Specialist Medical Training Outside Teaching Hospitals), February 2002, p 13.
3 Medical Specialist Training Taskforce, Systematic Framework, Appendix B, p 35.