Medical Training Review Panel: fourteenth report

Executive Summary

Page last updated: 11 March 2011

The Medical Training Review Panel (MTRP) was formed under legislation in 1996 to report to the Commonwealth Minister of Health on the activities of the MTRP and provide data on medical training opportunities in Australia. Over the years the panel has aimed, through its annual report, to provide a comprehensive picture of medical education and training, supplementing this with other data on the medical workforce supply.

The fourteenth annual report of the MTRP provides information on university, prevocational and vocational medical training positions, applicants, trainees, examinations and college fellows. Information is also included on medical practitioners who have trained overseas seeking to and currently working in Australia.

The report was compiled by the Australian Government Department of Health and Ageing, with oversight by MTRP. Data was provided by the Medical Deans Australia and New Zealand Inc (MDANZ), medical colleges, General Practice Education and Training Limited (GPET), state and territory health departments and the Australian Medical Council. Selected administrative data from the Australian Government Department of Health and Ageing and the Australian Government Department of Immigration and Citizenship have also been included.

To aid readability, tables in the body of the report present time series information pertaining to the latest five years of data and, where data is available from previous years, these have been included in Appendix D. For the purposes of the Executive Summary, the latest available data has been summarised and trends in the data have been examined across all years for which national data is available, where possible back to the first year in which the MTRP reported, 1997.

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University Medical Training

Initial medical education is provided by university medical schools in Australia as six-year and five-year undergraduate courses or as four-year graduate courses. There are 18 universities with accredited medical schools and 15 of these had produced graduates as at the end of 2009. The first graduates emerged from Bond University in 2009. The University of Wollongong and University of Western Sydney (UWS) commenced teaching in 2007 and their first medical students will graduate in 2010 and 2011 respectively. Medical students first commenced at Deakin University and the Sydney campus of Notre Dame University in 2008, with the first medical students graduating in 2011.

In 2010, there were 15,397 medical students studying in Australian universities, an increase of 876 or 6% on the previous year, 2009.

Of these, 12,946 or 84.1% were domestic students, an increase of 849 or 7% from 2009.

One hundred and sixty one of all medical students identified as an Aboriginal and/or Torres Strait Islander.

In 2010, more than three quarters of students (76.7% or 11,810) were in Commonwealth-supported places.

Over the last decade, the total number of commencing medical students has more than doubled, increasing by 109% from 2000 to 2010. This increase was primarily due to changes in the numbers of domestic students, which increased by 116% compared with an increase of 76.9% for international students.

The increase is mirrored in the number of medical graduates each year. In 2009 there were 2,380 medical graduates, a rise of three quarters (76.7%) over the last decade (Figure 1). However, the picture is somewhat different for domestic and international medical graduates. Since 1999, when the number of international medical graduates was first published, this number has more than trebled from 144 to 465 in 2009 (a rise of 222.9%), whereas the number of domestic students increased each year, rising one and a half times (52.5%) over the same period.

Figure 1: Domestic and international medical graduates, 1997–2009

Figure 1: Domestic and international medical graduates, 1997–2009D

Source: Medical Deans Australia and New Zealand Inc

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It is anticipated that the number of medical graduates will continue to increase in the coming years (Figure 2). From 2008 to 2009, the actual number of graduates increased by 11.3% from 2,139 to 2,380. It is anticipated that it will increase to 2,776 graduates in 2010, a 16.1% increase and the greatest annual growth in graduate numbers since reporting began.

By 2015 it is projected that the number of graduates will increase to 3,794, an increase of 59.4% from 2009 and over two and a half times (171%) the number graduating in 1999.

While it is anticipated that medical graduate numbers will increase substantially each year over the next few years, little growth is projected in 2014 and 2015 (1.7% and 0.2% respectively), primarily as these years are outside the period in which current initiatives impact.

Figure 2: Projections of domestic and international medical graduates, 2010–2015

Figure 2: Projections of domestic and international medical graduates, 2010–2015D

Source: Medical Deans Australia and New Zealand Inc

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Prevocational Medical Training

Satisfactory completion of the first postgraduate year (PGY1) is required before junior doctors can receive full medical registration. After PGY1, and prior to starting vocational training, most doctors spend one or more years working in the public system to gain more clinical experience.

In 2010, there were 2,394 trainees commencing PGY1. This was an increase of 151 (6.7%) on the previous year (2009).

Two thirds (67.0% or 1,604) of all PGY1 trainees commenced training in the state or territory in which they undertook their medical degree. Another 323 (13.5%) Australian trainees commenced their PGY1 training in another state or territory. A further 386 PGY1 positions were filled by temporary residents of Australia.

PGY1 commencements have increased substantially each year, with the exception of 2007, showing an overall increase of 56.4% or 863 trainees from 2004 (when data was first collated for the MTRP) to 2010.

Figure 3: Prevocational year 1 commencements, 2004–2010

Figure 3: Prevocational year 1 commencements, 2004–2010D

Source: State and territory government health departments

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In 2010, 2,313 doctors were reported by states and territories as commencing in PGY2 supervised medical training positions across Australia. This is likely to be an underestimate of the true numbers of doctors undertaking their second year of prevocational training, as an unknown number may be recruited directly by health services.

Of the 2,313 reported trainees, three-fifths (1,423 or 61.5%) were in positions within their own state or territory. Another 361 Australian trained doctors were in positions within another state or territory and 194 positions were filled by temporary Australian residents.

Although the number of PGY2 commencements appears to have increased substantially in recent years, it is difficult to ascertain the true extent of the increase due both to differences in the ways prevocational trainees are actually contracted and methodological issues, primarily related to differences in the data captured through the various state and territory reporting systems.

While a number of specialist medical colleges may accept entrants to vocational training programs directly following completion of PGY1, most require applicants to have completed the PGY2 year of general prevocational training.

Not all junior doctors go on to specialise. A number continue to work in hospital settings in nonvocational career roles, typically as career medical officers.

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Vocational Medical Training

Most junior doctors will seek entry into specialist training or vocational training, which leads to fellowship of one of the recognised medical colleges. Each college has its own training program and structure.

There were 14,679 vocational medical trainees in 2010. This is over double the number (an increase of 128.6% from 6,422 vocational trainees) in 1997, when the MTRP first reported this information.

Before 2004 the number of vocational trainees fluctuated, even decreasing in 2001 before rising again each year (Figure 4). Since then there have been significant increases each year, with the overall number of vocational trainees doubling over the seven year period from 2003 to 2010. During this period the rate of growth has varied considerably ranging from a high of 20.7% in 2007 to a low the following year of just 3.7%.

Figure 4: Vocational medical trainees, 1997–2010

Figure 4: Vocational medical trainees, 1997–2010D

Source: Medical colleges

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The education and training requirements of each medical specialty depend on the type of clinical medical practice, but commonly include basic and advanced training. Where required, a trainee can only apply for and compete for a position on an advanced specialist training program after successfully completing a basic training program.

Between 1997 and 2008, several of the colleges introduced additional basic training requirements prior to permitting the commencement of advanced training. This led to an increased number of basic trainee positions in recent years relative to advanced positions, as seen in Figure 4. In 2010, there were 5,057 basic trainees, comprising just over one third (34.5%) of all vocational trainees compared with the one-tenth (11.8% or 757 trainees) they comprised in 1997. There were 9,432 advanced trainees in 2010, two thirds more (66.5% or 3,767 trainees) than in 1997.

Almost one third (33.2%) of all vocational trainee positions was in the physician specialties (adult medicine, occupational and environmental medicine, paediatrics, public health medicine, rehabilitation medicine, addiction medicine and sexual health medicine) with 23% in adult medicine (Figure 5). The next largest proportions of vocational trainee positions were in general practice (18%) and emergency medicine (12%).

Figure 5: Vocational trainee positions by medical specialty, 2010

Figure 5: Vocational trainee positions by medical specialty, 2010 D

Source: Medical colleges

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When medical practitioners finish their vocational training and have met all other requirements of the relevant college, they are eligible to apply for fellowship of the college.

There were 2,395 new college fellows in 2009. This is a slight increase (6.1%) from 2008, when there were 2,257 fellows, and over double the number of new fellows in 2000 (1,126), when these data were first collected (Figure 6).

Figure 6: New fellows by sex, 2003-2009

Figure 6: New fellows by sex, 2003-2009D

Source: Medical colleges

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Overall new fellows were proportionally split across specialties as shown in Figure 7, with 42% in general practice. The proportions have remained roughly the same across the specialties over recent years.

Figure 7: New fellows by medical specialty, 2010

Figure 7: New fellows by medical specialty, 2010D

Source: Medical colleges

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The significance of the increased training activity and consequently the number of new fellows can be put into perspective by looking at it in relation to the total number of college fellows. There were just over 45,000 fellows of medical colleges in the recognised medical specialities,bnot all of whom would be actively practising in their specialty. New college fellows therefore constituted 5.3% of the total fellows in 2009. Exits from the medical workforce have been estimated at around 5%, which would mean that this constitutes a net growth in the number of specialists overall.

The relative proportion of new fellows to fellows within a given specialty reflects the growth in the specialty area and, in turn, gives an indication of changes in the number practising. Growth has been far greater for some specialties, with new fellows constituting the largest proportions of all fellows in intensive care (11.4%) and emergency medicine (7.4%) in 2009. These were followed by radiation oncology, general practice (RACGP fellows), anaesthesia and adult medicine in which new fellows constituted 7.1%, 6.3%, 6.2% and 5.9% of all fellows respectively.

Female Trainees

In 2009 females comprised just over half (53.6%) of the students commencing medical studies (52.9% of domestic and 42.5% of international graduates) and a similar proportion of medical graduates (54.1% of domestic and 51.6% of international gradates).

This proportion has varied little over the last three years in which data is available with females representing 56.7% and 55.6% of all medical graduates in 2008 and 2007 respectively.

The proportion of females going on to specialise is slightly lower, comprising 48.1% and 47.6% of all vocational trainees in 2009 and 2010 respectively. The proportion that became new fellows is, however, considerably lower, remaining relatively stable at around two-fifths of total new fellows each year from 2000 (39.0% or 935 in 2009).

In 2009, 14,324 or 31.8% of all fellows were female.

There is considerable variation in sex ratios across the various specialties, with only one of 11 (9.1%) of the 2009 new fellows in occupational and environmental medicine being female, through to the converse with 10 out of the 11 new fellows in dermatology being female. In terms of the larger specialities, the proportion of females ranged from 19.5% in surgery through to 62.5% in obstetrics and gynaecology. However, in most of the larger specialties females comprised around two-fifths of 2009 new fellows - paediatrics (47.4%), pathology (46.9%), general practice (43.3%), psychiatry (42.4%) and adult medicine (35.8%).

Considerable variation in the sex ratio is also seen from year-to-year within specialties, particularly those with smaller numbers.

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International Supply of Medical Practitioners

Overseas trained medical practitioners form a large part of the medical workforce in Australia, particularly in rural and remote areas.

In 2009-10 there were 3,190 medical practitioners granted visas in the three main visa subclasses (422, 442 and 457). This is three quarters of those granted in 2008-09, when 4,080 visas were granted in these subclasses.

Almost one third (31.7%) of these visas were granted to applicants from the United Kingdom and Republic of Ireland in 2009–10. Although the number of visas granted to Indian applicants has decreased, India remains a key supplier of medical practitioners to this country with 13.1% or 420 of all visas being granted to medical practitioners from India (compared with 790 or 19.4% in 2008–09). A number of other Asian countries (Malaysia, Sri Lankan, Pakistan and Singapore) are also major suppliers of medical practitioners, as are Canada, South Africa and Iran.

In 2006, COAG agreed to the introduction of a nationally consistent assessment process for international medical graduates and overseas trained specialists. This process now consists of three main assessment streams: the Competent Authority Pathway, the Standard Pathway and specialist pathways. The Australian Medical Council (AMC) is responsible for processing applications by international medical graduates and overseas trained specialists.

In 2009, the AMC assessed 1,626 applications through the Competent Authority Pathway, with 853 applicants being granted AMC Certificates allowing them to then apply for general registration.

Under the Standard Pathway 2,460 applicants passed the Multiple Choice Questionnaire examination and 748 applicants passed the AMC clinical examination.

There was a total of 1,661 specialist applications processed by the AMC in 2009. Medical colleges conduct the assessments of comparability to Australian standards for the specialties and found 453 substantially comparable and a further 363 partially comparable (that is requiring up to two years upskilling to reach comparability).

Of these applicants a total of 332 overseas trained specialists were approved to practise, with one half of these coming from India (93 or 28%) and the United Kingdom and Ireland (84 or 25.3%) (Figure 8).

Figure 8: Country of training of overseas trained specialists with approved applications, 2009

Figure 8: Country of training of overseas trained specialists with approved applications, 2009 D

Source: Australian Medical Council administrative data, 2009

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Medical practitioners who have trained overseas can apply for exemption under Section 19AB of the Health Insurance Act 1973 (the Act), which limits their practice for a defined period to areas of workforce shortage, as defined by the Australian Government. These ‘Districts of Workforce Shortage’ are determined on the basis of the area having less access to Medicare than the national average.

At June 2010, there were 6,576 overseas trained doctors with Section 19AB exemptions restricting their practice to Districts of Workforce Shortage in order to access Medicare benefits for the services they provide.

Some jurisdictions, particularly Queensland and, to a lesser extent, Western Australia and the Northern Territory are more reliant on overseas trained doctors to provide services, with higher proportions working in regional and remote areas. Overall, however, half of all overseas trained general practitioners and 70% of overseas trained specialists worked in major cities.