Extrapolation to all specialties
Extrapolation of these results to all specialties is problematic because it is difficult to determine whether the ten sample specialties are truly representative. Also, significant increases to specialist trainee numbers (and therefore costs) are impossible to achieve without an increase in numbers underpinning the training system - that is, in medical schools. This section should therefore be read in conjunction with the next section on the projected growth in medical graduates.The ten specialties studied in detail for this project account for about half of the total number of specialist trainees (excluding general practice) at the present time. If it is assumed that the average educational imperative for expanded training settings for the ten sample specialties (between 10% and 20%, using 15% as a midpoint) is representative for all other specialties, between 1,232 and 1,320 additional specialist trainees would be required to meet the educational requirement across all specialties.
Effect of projected growth in medical graduates
The total number of specialist trainees is expected to approximately double over the next decade, based on the recent and planned expansion in the number of medical students. However it is not known how these specialist trainees will be distributed, both geographically and in terms of specialty discipline.If the results of the current study were to be extrapolated to this increased number of specialist trainees, this would result in increases of between 2,100 and 2,400 specialist trainees in expanded settings by 2015. These figures do not include those undertaking general practice training.
There are many factors that may affect the validity of these assumptions, including future models of service delivery and the career decisions made by students entering university and graduating from medical schools.
The cost of increasing the number of training positions within the public hospital system to accommodate new specialist trainees will be significant, regardless of whether any expansion of training settings occurs - the number of training positions, and thus funding, would need to be nearly doubled.
If an expansion of training settings is implemented on the relatively small scale indicated by the ten sample specialties, the pressure exerted on the public system by the doubling of medical specialist trainees would be mitigated. At the same time, only marginal extra costs would be incurred by providing training in these expanded settings.
In addition to the marginal infrastructure costs estimated in this analysis, a once-off injection of capital funds may be necessary to increase training infrastructure where appropriate facilities do not currently exist. This may particularly be necessary as the requirement for training nearly doubles. An estimation of the quantum is beyond the scope of this study.