Employment arrangements vary across jurisdictions. In New South Wales and Victoria, it is the major public hospitals that employ trainees and the trainees can be seconded under various arrangements to other institutions. For example in NSW, different employment arrangements apply between Area Health Services, so that as trainees rotate between the areas, new employment arrangements can be necessary. In Queensland, Health Districts are generally the employers of trainees. In Tasmania, the state health authority operates a centralised payroll system and allocates trainee costs to specific cost centre budgets where services are provided.
There can be a lack of clarity about the employer's contractual responsibilities to provide training services and the state's responsibility for funding training. Some stakeholders also noted that the public hospital structure of employment vests a significant amount of control with teaching hospitals in the allocation of trainee rotations.
Further, various issues arise with employment rotations, including the administration costs, lack of clarity about professional indemnity insurance, interstate differences in award systems and providing appropriate financial remuneration to private hospitals. Most problems arise when registrars are rotated to training terms that cross sectoral (public / private) or jurisdictional (e.g. Victoria to Tasmania) boundaries. In both these cases, trainees can move between quite different industrial environments and so maintaining 'appropriate' and consistent entitlements and reimbursement for their services can be difficult. Examples of successfully diversified training programs exist, but the often idiosyncratic and informal means by which this has been achieved to date is unlikely to translate well to larger scale implementation.
At this stage in the development process, the proposed training arrangements remain a concept rather than a operational model. To make the concept useful, it needs to be developed into an operational model. However, the concept to be implemented is so diverse with respect to medical specialties and jurisdictions that it is neither possible nor desirable to produce one all encompassing training model.
Rather, a system needs to be established that can support the training requirements and arrangements for each medical specialty in the various jurisdictions. To implement such arrangements, local opportunities and constraints need to be recognised. In some cases, some reform of employment contracts and obligations may be appropriate, but it is not expected that there will be one all encompassing employment model.
It is with these issues in mind that the Reference Group has developed options and principles for the governance and administration of an expansion of specialist training settings.