5.2 Summary of methodology

This section aims to assess the extent to which training should be provided in a expanded range of settings - defined as the 'educational imperative' - and apply costs to this expansion based upon the additional number of specialist trainees that would be required to maintain the public hospital workforce and the use the additional settings. These analyses were conducted for ten sample specialties, chosen for their diverse service delivery and training features.

The ten specialties are:

• anaesthesia
• dermatology
• gastroenterology
• general paediatrics
• general surgery
• obstetrics and gynaecology
• orthopaedic surgery
• pathology
• psychiatry
• rehabilitation medicine

The same methodology was used for each specialty, although the resulting changes to specialist trainee numbers and the costs varied between specialties, jurisdictions and settings. It should be noted that these results are broad approximations, given the variable nature of the medical workforce and the factors that influence its supply and demand. They are also based on stakeholder perceptions of the current workforce and training situation.

Estimating workforce numbers and distribution

Estimates of current numbers of specialist trainees, in total and year by year, were obtained from the Medical Training Review Panel (MTRP) and the relevant specialist colleges. These were then considered in light of the current workforce supply on the basis of advice from the relevant college and the most recent AMWAC report for that specialty, where available.

An assessment was made - based largely on advice from the relevant college - of the importance of expanding training into settings outside the major public hospitals to meet the educational imperative for that specialty. This included obtaining quantitative information about the current and optimal distribution of specialist trainees between major public teaching hospitals and other settings. In most cases the optimal distribution did not vary markedly from the current distribution, but added between 10% and 20% of training time to expanded settings.

Modelling was performed to determine numbers of specialist trainees required in the public system if expanded settings were implemented. In this modelling the number of trainees in public hospitals for each specialty was maintained, because of their importance to the overall public hospital workforce. Allowances were made for varying the distribution of specialist trainees between early and later years of training – since some specialties distinguish between stages of the training program - reflecting a difference in training requirements and the level of acquired knowledge and skills. The optimal distribution of training in different settings was then converted to actual specialist trainee numbers in each setting and in total.

Use of scenarios to reflect the most appropriate situation

The consultants developed different scenarios to assess the change in vocational training numbers needed to maintain the public hospital workforce. These scenarios reflect that the number of trainees in each year of a speciality training program will vary.

The first scenario maintains the public teaching hospital workforce by averaging the number of specialist trainees in public teaching hospitals across all training years without distinguishing between early and later stages in the training program (for example, basic and advanced training).

The second scenario sets the number of specialist trainees in each year to the highest of either the early or later stage of training, where the two parts exist.

The number of specialist trainees required to meet the educational imperative for training in other settings is then calculated for both scenarios. This results in a range of between 616 and 660 extra training positions that would be required to expand training into alternative settings and still maintain the public teaching hospital workforce. This is approximately a 20% increase in the number of specialist trainees.

Table 1: Projected increase in number of specialist trainees required to expand training settings

Reviewed speciality	Current number of specialist trainees	Current number of specialist trainees1	Increase in specialist trainee numbers
			Scenario 1	Scenario 2
Gastoenterology	76	72	14	14
General paediatrics	182	210	131	131
General surgery	297	360	42	42
Orthapaedic surgery	170	180	26	26
Obstetrics and gynaecology	350	360	55	77
Pathology	294	300	85	85
Anaesthetics	795	795	127	140
Psychiatry	782	780	108	111
Dermatology	65	72	8	13
Rehabilitation medicine	130	128	20	20
Total selected specialities	3,141	3,257	616	660

Source: PricewaterhouseCoopers 2006

Calculations for gastroenterology, general paediatrics and the surgical subspecialties are for advanced training only. Additional trainees may be required to flow from the basic paediatric, adult medicine and surgical training programs to support the increases in these advanced programs.