By Professor Bruce Robinson. First published in the Sydney Morning Herald.
In my office recently I saw a patient with a large pituitary tumour. It was causing multiple symptoms, including partial blindness. The patient didn't require surgery; his condition can be managed with medication and he will be cared for entirely as an outpatient.
Consequently, although young doctors in training interns, residents and specialists-in-training could have learnt much from this person and his condition, it is unlikely they will cross paths with him.
This is not an isolated case. During my 30 years of practice, hospitals have become places where only acutely sickpeople and those requiring elective surgery are admitted. This represents a small fraction of the work of clinicians in 2011, much of which deals with chronic illness.
Clinical training programs for young doctors, though, have changed little in the pastthree decades. While opportunities have increased for students and young doctors to undertake some of their training in general practices, they rarely spend time in specialist rooms. Nor in private hospitals or health centres, such as Aboriginal Medical Services. Nor do they benefit from the brilliant training opportunities available internationally, particularly in Asia and the Pacific.
Postgraduate medical training in Australia generally consists of a one year internship and one or two years of residency. Graduates cannot be registered to practise without completing an internship. To become a specialist generally requires between five and seven years' further training either in a hospital or in general practice, depending on the specialty.
The theme that has underpinned most of the clinical training of young Australian doctors is “only public hospitals and only in Australia”. The result: not only are we unnecessarily placing additional pressures on the already struggling public hospital system, but trainee medical staff are missing many important lessons in patient care. This is to our detriment.
The Herald recently reported on the predicament of international medical students in the invidious position of being able to complete their medical degrees but unable to secure internships. Training certainly does not stop after internship; further training is required for all young doctors to become proficient, and there are inadequate places to accommodate future requirements.
So far the state has fortunately been able to provide intern positions for all who require them. All graduates from last year were offered places and in NSW we understand there will be sufficient positions for those who complete their studies this year.
But if it ever comes to the point where medical graduates are denied the opportunity to work as doctors because governments have not provided sufficient training places, it would be both a disaster for the individuals and a poor reflection on the state and federal governments who fund and manage health workforce training.
We have a critical shortage of medical practitioners.Australia spends millions advertising internationally for doctors. Denying work opportunities to smart, well trained and motivated medical graduates from our own universities when we need doctors defies reasonable sense.
Governments and their agencies responsible for ensuring adequate numbers of health professionals need to improve their performance.
A shortage of internship places looms and new positions must be provided. Unless the number of specialist training positions increases significantly, a similar shortage is inevitable. But it is not simply a question of numbers.
Broadening the training opportunities for young clinicians will, ultimately, improve the quality of our medical workforce. We know the solutions.
Instead of relying on big city hospitals, we could have more specialty training positions in country hospitals. We could have more young doctors learning in specialist rooms, andwe could place these doctors overseas where they would be exposed to different ways of preventing and managing illness and allocating resources.
All these non traditional settings that is, non-Australian public hospitals offer rich opportunities for gaining one ingredient that contributes to becoming a good doctor: experience.
Professor Bruce Robinson is dean of the Sydney Medical School at the University of Sydney.
