2.1 Introduction
The issue of expanding settings for medical specialist training has been discussed for many years. For example, the Australian Health Ministers Advisory Council (AHMAC) established a working party on specialist training outside teaching hospitals in 2001. As a result of this group, the discussion paper 'Medical specialist education and training: responding to the impact of changes in Australia’s health care system' was prepared by Phelan Consulting to explore the potential use of settings other than public teaching hospitals.The Phelan Report included an assessment of changes to health care delivery that limit traditional approaches to medical specialist training, strategies for resolving these issues, and a consideration of the consequential costs and funding.
These issues were subsequently taken up by the Medical Specialist Training Taskforce, which reported to AHMAC in October 2004 on a model for implementing training in other settings. This model defined the settings to be involved in training and assessed the barriers to implementation.
The Phelan Report and subsequent processes had observed that training in a diverse range of settings had already been occurring on an ad hoc basis with the support of local, enthusiastic health care settings and supervisors. However the success and continuation of these arrangements was often subject to funding uncertainties. Many of the working groups and stakeholders who have been involved in the conceptual development of training in other settings have also cited funding issues as the main barrier to expansion.
The Medical Specialist Training Steering Committee was established by AHMAC to complete an assessment of particular issues before implementation of training in a diverse range of settings. These issues, including the costs of any such expansion, were assigned to three reference groups.
This report has been prepared by Reference Group 1 to fulfil the Medical Specialist Training Steering Committee's terms of reference which require 'the development of a risk assessment detailing the benefits and costs associated with the revised training model'. This assessment was undertaken for ten representative specialties - agreed to by the Medical Specialist Training Steering Committee – with differing service delivery and training features.
2.2 The costs of training
Historically, specialist training has been integrated with the delivery of services in public hospitals. The increasing pressure on public hospitals to meet budgetary constraints has prompted an assessment of training arrangements and the value of trainees’ services compared with the cost of providing training. Previous work in this field has focused on the differentiation between training costs and service provision costs.In determining the costs, and subsequently the required quantum of funding needed to expand the range of training settings, it was agreed by Reference Group 1 that costing the minutiae of training would not be a meaningful basis for this assessment. This has been attempted in previous reports without results that would help to develop specific implementation outcomes.
2.3 The role of Reference Group 1
In early 2006, on behalf of Reference Group 1, the Australian Government engaged PricewaterhouseCoopers (PwC) to estimate the costs of expanding training settings on a broad scale. This task was a high level analysis to identify and measure the types of costs of providing training in a broad range of settings - as opposed to extrapolating variable low level costs that are confounded by benefits and gains in productivity.Reference Group 1 guided and directed the methodology used by PwC, in line with their terms of reference (see Appendix 1).
Reference Group 1's advice was conveyed to PwC through regular reference group meetings. At each of these meetings, PwC described their progress and provided the group with preliminary outcomes. The schedule of meetings held by Reference Group 1 is listed in Appendix 2.
Through its expert representation, Reference Group 1 was well placed to provide feedback on the range of issues related to training costs in different settings and specialties. The membership and representations of the group are listed in Appendix 3.