4.3 Specialist trainee supply project

Reference Group 2 examined the future supply of the specialist trainee workforce. The methodology used was based on a mixture of historical data, modelling the change to intake of medical school students as a result of policy announcements, and a small number of assumptions about the attrition of the workforce during various stages within the continuum of education and training.

Medical school students

In 2004, significant increases to the number of university medical school places were announced. An additional 605 medical school places were announced between April and July 2006, to be introduced between 2007 and 2011.²¹

The majority of doctors who practise in the Australian health care system have graduated from Australian medical schools. The increases to medical school intakes are anticipated to have significant effects on the future number of specialist trainees, and the subsequent medical workforce.

There are a number of recent changes to medical education and medical student numbers that have not been included in the modelling due to their complexity and the uncertain nature of their impact.

These include the:

• increase to the cap on fee paying medical school students (from 10% to 25%)]
• uptake of new fee paying medical school student caps by universities
• uptake of new fee paying medical school student caps by potential students
• intake of international medical students
• introduction of postgraduate medical courses
• differing length of postgraduate medical courses compared with undergraduate courses.

The potential impact of new medical school places on the intake and graduation of students has been based upon historical published data from the Committee of Deans of Australian Medical Schools (CDAMS), covering the period 2000-2005. Data for domestic students for 2006 was obtained directly from CDAMS, and the number of international students in 2005 was added to this sum.

An average period of five years has been incorporated in the modelling to allow for progression through the undergraduate medical course – as course lengths vary between four and six years. The standard attrition rate of 3.5% used by the Australian Government was applied between entry to medical school and graduation.

The ramifications of increases to the allowed proportion of full fee-paying students have been deemed too uncertain to be included in these analyses, so the projections are conservative estimates.

Using these methods, the approximate medical school intake will increase from 1,660 in 2000 to an estimated 2,866 by 2011 (an increase of 73%). At the same time the number of graduates will increase from 1,195 in 2000 to 2,766 in 2015 (an increase of 131%).

The numbers entering medical school to take up Commonwealth supported places and the number of graduates are shown in Figure 1.

Figure 1: Medical school intake and graduates

Source: CDAMS 2006 & analysis by DoHA

Pre-vocational and vocational (specialist) training

After completing university (and hospital) based medical school courses, junior doctors must complete a hospital based pre-registration year - also called the intern year or postgraduate year 1(PGY1). This is completed under the supervision of the relevant state postgraduate medical education council in order to obtain unrestricted registration with medical boards. The doctor can then undertake a second year of pre-vocational training (PGY2) before starting vocational (specialty) training under the supervision of a specialist college in PGY3. However doctors are increasingly starting specialty training in PGY2, although some do not start until PGY4 or later.

Data limitations

Accurate and comprehensive historical data is not available and a number of factors have been identified which increase the complexity of the projections.

To produce authoritative projections, several of the following major data limitations would need to be addressed.

• The number of successful candidates from the Australian Medical Council assessment of overseas-trained doctors and their career progression. For example, the numbers progressing into postgraduate training, specialty training or leaving the medical profession are unknown.
• The attrition rate between pre-vocational to vocational (specialty) training.²²
• The attrition rate during specialist training. This is currently unknown, but is estimated as being quite low. The information is currently not available from all specialist colleges.

First year specialist trainee supply and demand

In the absence of data on specific attrition and rates of training completion, it may be assumed that the numbers of new specialist trainees will also increase by approximately 605, when increased numbers of medical students progress through the undergraduate and pre-vocational training system. This is shown in Figure 2.

Figure 2: Increase to specialist trainees

Source: CDAMS 2006, MTRP 2005 & analysis by DoHA

It is difficult to estimate the demand for specialist trainees, even in the first year of training. While some colleges can provide figures for the number of training places available, this cannot be done for every college and only the number of actual trainees can be provided. Data from the 2005 MTRP report indicates that around 1,900 first year vocational training places (excluding general practice places) are likely to be available in 2006. Therefore not all places are filled by Australian graduates.

As mentioned above, the relative demand for and uptake of vocational training places between the specialties (including general practice) is difficult to model or predict. The recent AMWAC report into the GP workforce suggested that there should be close to a doubling of GP training places to meet the workforce demands. Given the critical role of general practitioners in addressing primary health care needs, it is likely that the number of GP training places will increase over the next few years. Possible increases in vocational training places in other specialties are difficult to predict.

Given that the average medical course lasts for five years, with an average of two years of pre-vocational training before entering vocational training, it will not be until 2011 at least that the number of Australian graduates capable of entering vocational training will exceed the current number of first year vocational training positions. This does not take into consideration any possible increases in the number of positions that might be made available by jurisdictions in the interim.

In the absence of any other data, we have modelled increases in specialist trainees to align with the current distribution of the trainee workforce across specialties, including general practice.

Implications

The results are broad estimates, representing the approximate number of potential specialist trainees and training positions that can be expected in future years. Although the results are indicative rather than definitive, they support the need for expansion of training into settings outside public teaching hospitals, even on a conservative basis.

Reference Group 2 confirmed that there was support amongst stakeholders for expanding training settings and acknowledgment of the education and training benefits. They also confirmed the very important role that specialist trainees have in the public hospital workforce. Movement of trainees to other settings would be likely to have a detrimental impact on major public hospital service delivery capacity, unless the positions can be adequately backfilled.
Expansion needs to be measured and gradual. It should be designed to supplement, not replace, public hospitals as the key setting for specialist training.

21 Council of Australian Governments Communiqué 14 July 2006.
22 A number of bodies, including the postgraduate medical education councils and specialist medical colleges, are involved in monitoring trainees as they progress through the continuum of medical education. They collect data only for discrete periods of training. As the data sets are neither continuous nor comprehensive, it is currently not possible to effectively track trainee progress through the various levels of medical training.