Australia needs more doctors — but does it need more medical schools?
The committee says, when the first Aboriginal person graduated from medicine 30 years ago, that was a hundred years behind New Zealand and Canada. A new agreement signed as part of NAIDOC Week aims to close the gap in that area with a commitment to increase and support Indigenous doctors. Professor Kate Leslie is chairwoman of The Committee of Presidents of Medical Colleges, or CPMC, and a senior anaesthetist at the Royal Melbourne Hospital. She says the Australian Indigenous Doctors Association and the CPMC will work together to try to increase the number of Aboriginal and Torres Strait Islander medical specialists. The Collaboration Agreement, signed this week, will contribute to closing the gap by looking at ways to train more Indigenous medical specialists. The agreement is also a move to improve the ways medical specialists and Indigenous people work together. Professor Leslie says the deal is an important step forward. “Well, this is a landmark agreement between the Australian Indigenous Doctors Association and the Committee of Presidents of Medical Colleges, which represents the specialist medical colleges of Australia. And our aim is threefold. (First,) to close the current gap in health outcomes and life expectancy between Indigenous and non-Indigenous Australians. We also want to increase the understanding of all Australian doctors about cultural issues in relation to Aboriginal and Torres Strait Islander people. And, thirdly, and probably most importantly, we want to increase the number of Indigenous doctors who do specialist medical education after they finish medical school.” Professor Leslie says about 175 Indigenous doctors work in Australia, mainly as general practitioners, or GPs. She says, while there is a great need in all communities for GPs, there is only a small group of Indigenous doctors in other medical specialities. That includes obstetrics, gynaecology, psychiatry and surgery. Professor Leslie says there is a need for doctors in all specialties. “Our position is that an increase in the Indigenous specialist medical workforce is important regardless of the types of specialties or the particular needs of any community.
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Politicians have tried for many years to help. First increasing the output of doctors, but then realising that under fee for service, more doctors means more costs for Medicare. So medical student numbers were cut back More recently, about a decade ago, the federal government began a massive increase in the number of medical students.The first phase of this increase has nowgraduated. The average member of the public has only a hazy view of medical training.On graduation from a medical school, these doctors cannot practise independently but require graduated and supervised training.In round terms, one can double the length of training, so to producea fully fledged GP or specialist will be of the order of 12 years (sometimes longer) after leaving school. For the first year after graduating, these doctors have to work as interns. As interns they contribute to patient care.But they need close supervision, but the supervisiongradually becomes less as they become more senior.So the service provision at more junior levels is less, but increases with increasing level of seniority. But and a big but there wereinitially too few jobs for the graduating interns.Each state has then increasedthe number of intern positions (by 120 last year and this year in Queensland, for example).Next year, there is a need for a similar bulge in the numbers of slightly more senior doctors and this continues up the training scale. The increase in interns will flow on like global warming giving rise to increased numbers at each stage after graduation. Eventually, they will become advanced trainees, then finally fully fledged general practitioners or specialists.The process has begun, and will yield more GPs or specialists in 4-6 years from now. Training positions require salary and infrastructure.The states have to find money.But junior doctors do not treat as many patients as fully trained doctors. So the states spend more now, and hope for a dividend in 4-6 years from now with increased GPs and specialists. What will happen next?How about bedding down the increase of medical graduates?Well, um, no Two universities have applied fora new medical school Charles Sturt University in NSW and Curtin University in WA. There are strong lobbyists for each. A popular one is rural focus.They forget that each of the older Australian medical schools has a rural clinical school where students spend a full year studying in rural areas. Who is lobbying forCurtin University?Some well-connected people. Jim McGinty is chair of Health Workforce Australia, and former Minister of Health in the previous ALP governmentHealth Workforce Australiahas a budget of several billion to pay for undergraduate training in the health professions. In addition to McGinty on the board of the proposed Curtin Medical School, there isthe director of the Institute of Health at Curtin, Dr Neale Fong.He was previouslyAustralias highest paid public servantas Director-General of Health in WA but resigned followinginappropriate contact with Brian Burke.Lobbyists with grunt? Australia needs more doctors. And a university with a medical school has more prestige. But there are arguments against: the cost (if more doctors are needed, then it is cheaper to expand numbers at current medical schools than to open new ones) and the lack of medical teachers (medical deans fear there are already too few medical teachers more medical schools will spread this more thinly).