The requirements of the specialist training programs - including the training settings and the associated organisational and location arrangements - are important factors in the choice of career path by young doctors.
Over the next decade, the number of medical school graduates entering the medical workforce will approximately double. The extent to which this increase effectively addresses current and emerging medical workforce issues will be determined by whether enough of the new graduates choose to enter the specialties with the greatest number of vacancies - including general practice - and practise in the regional areas which are chronically undersupplied.
This section outlines the trainee related workforce issues that were highlighted during the Reference Group 1 consultations, briefly discusses the influence of workforce factors on career choice identified in the AMWAC careers study, and summarises the positives and negatives of increased diversification of training settings from the perspective of trainees.
The impact of increased diversification of training on the availability of trainees as part of the public hospital workforce is not discussed in this chapter. This is an important issue but is considered in depth in the report of Reference Group 2.
Most stakeholders referred to trainees becoming more conscious of their working conditions and, in some ways, more demanding in terms of hours worked and workplace flexibility.
The main reasons cited for these trends were:
- increased female participation in the workforce
- a greater emphasis on work/life balance by younger generations of doctors
- the AMA safe hours campaign
- older graduates from the graduate medical schools being more likely to be married and have a family.
There were particular issues expressed about the current psychiatry training environment that is considered to adversely affect the intake of trainees to this specialty. The shortage of trainees has forced the public teaching hospitals to focus their scarce resources on the high acuity public mental health facilities which may be very stressful. Psychiatric trainees do not experience the broader, less stressful and often more professionally rewarding general consultative aspects of the specialty and, as a result, psychiatric traineeships are not as highly sought after as the other specialties reviewed.
The detailed studies of trainees' choice of specialty training program carried out by AMWAC suggest that the factors that matter most are:
- overall career implications
- the impact on location, working conditions and family
- the level and certainty of funding
- overall employment conditions
- medical indemnity coverage.
A policy initiative to expand the range of settings and diversify training will need to clearly address these issues and proactively communicate details of new arrangements to prospective trainees to avoid creating uncertainty and a deterrent to prospective specialist trainees.
At the present time the colleges, major teaching hospitals and jurisdictions largely cooperate to make sure that the transition between the trainee's base hospital and other training settings is as seamless as possible. The major stakeholders clearly appreciate that maintaining this fundamental approach will be vitally important in determining the success of further diversification of specialist training.
Finally, it is worth noting that the substantial increase in the number of medical graduates that will occur from about 2010 onwards has the potential to place a major strain on training programs and traditional relationships in specialty training. The factors identified in this project, and by AMWAC in relation to training programs and career choice, will need to be taken into account in developing strategies for an expansion in specialist training.