Reference Group 1, with the assistance of the PwC consultants, explored the costs and benefits of expanding specialist training outside traditional settings - that is, metropolitan public teaching hospitals. The group has been aware of the overlap in terms of reference with both Reference Groups 2 and 3. In particular, Reference Group 3 explored the educational imperative from a theoretical and practical level, mostly through surveys to colleges. Reference Group 1 does not believe that its conclusions are at odds with those of Reference Group 3.
Similarly, Reference Group 1 understands that Reference Group 2 is considering expansion of training in the public hospital workforce and this has figured largely in the discussions with health departments that have been undertaken by Reference Group 1. The guiding principle that an expansion will not impact negatively on the public hospital workforce was the core foundation of the modelling that was undertaken by the Reference Group 1 consultants. The robust and transparent governance arrangements that might be suggested by Reference Group 2 will be important to ensure that the benefits of any expansion are realised and the costs adequately controlled.
The discussions with representatives of the colleges have, not surprisingly, confirmed a general educational imperative to expand training outside traditional settings. The imperative is reportedly less strong overall than might have been anticipated. In general, colleges have applied between 10% and 20% of training to be spent outside traditional public teaching hospital settings to optimally satisfy curricular requirements. With the change in health care service delivery over the past few decades, these surprising results may reflect that colleges have already adapted their training programs in response. However in many situations the changes that have been described have been small scaled, informal and ad hoc.
In describing the issues to be resolved before the implementation of expanded training settings, there has been commonality across the colleges. Funding has been reported as the primary obstacle - followed by issues of accreditation, supervision, indemnity, and transfer of trainee entitlements. Similar issues have been reported by trainees who do not wish to see the expansion of training settings being used as a way of addressing workforce shortages.
In discussions with health departments, there were a range of views about the benefits of such expansion and the ability of the current state public systems to meet curricular requirements and employ and train additional numbers of vocational trainees in the near future. Most jurisdictions felt that the expansion of training would be beneficial.
Discussions with a number of private hospitals and industry groups about expansion received a favourable response.
A major benefit of expanded training settings is the provision of increased capacity to train more medical students who will soon be entering pre-vocational and then vocational training. This includes potential to provide increased levels of service provision, particularly in current parts of the public system that are underserved - outer metropolitan and regional areas - and, eventually, improve the supply of specialists ahead of an ageing workforce.
Reference Group 1 notes that - given the large increase in the number of junior doctors entering vocational training within the next ten years - a significant expansion of trainees in the public sector will be required. Reference Group 1 recommends that, in the current climate of expanding medical education, it is practical and a good opportunity to also expand the settings providing medical specialist training. The costs of more doctors in the overall training system will be significant, however the cost of expanded training settings will only be a marginal addition. The use of new training settings will ensure that the investment in our junior doctors is maximised by providing training in high quality settings, where public hospitals have reached their capacity.
Reference Group 1 believes that the costs and benefits of expanding training have now been assessed to a level that allows informed decisions about how, when and where such expansion can occur.