3. Background

3.1 Consultants & project scope

Applied Economics Pty Ltd were contracted by the Australian Government Department of Health and Ageing to support the work of Reference Group 2. Specifically, they were engaged to assess the impact of the proposed expansion of specialist training settings on the service delivery capacity of metropolitan public teaching hospitals, and to consider related administration and employment issues. The study assessed these issues for the following ten sample specialities: anaesthesia, dermatology, gastroenterology, general surgery, obstetrics and gynaecology, orthopaedic surgery, paediatrics, pathology, psychiatry and rehabilitation medicine.

In addition, Applied Economics undertook to project estimates of the supply of medical specialist trainees from 2005 to 2015 to further inform this analysis.

The proposed expansion of specialist training settings examined by Reference Group 2 and Applied Economics is based on the concepts conceived by the Medical Specialist Training Taskforce. The Taskforce recommended to AHMAC that settings for specialist training should be diversified to better match the service delivery requirements of the community. These settings include public settings (including regional, rural and ambulatory settings), the private sector (hospitals and practices), community settings and non-clinical environments (for example, simulated learning centres).

The Applied Economics' report focused on the impact of expanding specialist training settings on the service delivery capacity of public hospitals, barriers to implementation, and potential administrative and employment arrangements. Members of the Applied Economics consultancy team met with a wide array of stakeholders including representatives of health authorities in all jurisdictions, major metropolitan and regional public hospitals, private hospitals, medical specialist colleges, specialists and trainees.

After obtaining feedback at interviews, the write-ups of the consultation meetings were provided back to parties for comment and verification. It should be noted that these consultations were undertaken prior to the deliberations and decision by COAG in July 2006, supporting the establishment of rotational specialist training arrangements.

3.2 Methodology

The study was based on an interpretation of how diversified training settings might work for the sample specialties. For the purposes of consultation with stakeholders, Applied Economics assumed that on average about 10-15% of the total training time of a 5-6 year training period would move from current settings to other settings. About two-thirds of these movements would be to private hospitals and practices, with the balance to regional public hospitals, community-based and non-clinical settings.

This assumed average was not intended to represent any authoritative or 'optimum' shift in training settings, particularly given that the estimates of training times by setting vary greatly among the different specialties.

In providing information on the current and preferred proportion of specialist training time by setting to Reference Group 3 (and the consultants supporting Reference Group 1), the specialist medical colleges highlighted that they are predicated on current patterns of service delivery which may change over coming years. They also emphasised that the estimates provided were generalisations regarding national training arrangements which are in reality subject to significant sub-speciality and jurisdictional variation.

The information collected by Reference Group 3 illustrates that there is significant variation among specialties - some requiring virtually no change while others indicated that a substantial shift in training to other settings is required.² Moreover, any changes would be implemented gradually over a number of years. Accordingly, although this distribution was used as a conceptual tool to assist in obtaining feedback, consulted parties were informed that the concept was merely illustrative.

2 Reference Group 3 Report to the Medical Specialist Training Steering Committee, 2006.