Public hospitals are required to fulfil a number of roles. First and foremost they are an environment for the provision of health care. The demands placed on them in this area cannot be overstated. They must also be an attractive workplace - able to draw and retain skilled staff - and be able to keep up with advances in medical knowledge and technology. In addition, public hospitals need to be run in an efficient and cost effective manner and be responsive to government and community concerns. They also have a responsibility to perform critical teaching and research functions. These important, and sometimes seemingly contradictory, responsibilities must all be met.
The acuity and complexity of illness treated in metropolitan public hospitals has increased markedly. Patients with less complex conditions are being increasingly treated in other settings including private hospitals, private rooms and community settings.
While this is a key issue driving an expansion of specialist training settings, such expansion must be mindful of the consequences that an uncontrolled move of the specialist trainee workforce could have on the service capacity of metropolitan public hospitals.
The specialist trainee workforce was described in consultations as the 'backbone of service delivery'.18 While acknowledging the training benefits, most public hospitals administrators consulted considered that an expansion of training settings would result in a substantial decrease in major public hospital capacity - broadly pro rated with the loss of employee time in the hospital - unless the vacancies were able to be backfilled.
New South Wales stakeholders highlighted that the proportionate loss of service time may increase as specialist trainees progress through their training program, become more proficient, and spend an increasing proportion of their time in service delivery.19
Representatives of the Victorian Department of Human Services indicated that the delivery of public medical services is 'critically dependent' on specialist trainees in most areas of medicine and surgery, with the possible exception of dermatology.20
Furthermore all specialist trainees are integral to the training of doctors in the early postgraduate years, and advanced specialist trainees provide educational support to early trainees in their particular specialty. This training has a number of elements - clinical 'on the job' training, lectures, teaching procedures and examination preparation - and must be maintained and supported in the public system. They also provide significant training to medical students and other health professionals.
18 Applied Economics Pty Ltd, Assessing the Effects of the Proposed Medical Specialist Training Arrangements on Service Delivery in Public Hospitals (2006) p. 20.
19 Ibid
20 Applied Economics Pty Ltd, Assessing the Effects of the Proposed Medical Specialist Training Arrangements on Service Delivery in Public Hospitals (2006) p.32.