The commonwealth’s plan to create more GPs involves giving graduates fewer options.
When enticing people with carrots seems too hard – maybe because carrots are too expensive, or in short supply – apply the squeeze.
Part of the federal Department of Health’s strategy to increase the proportion of graduates going into general practice is to make sure they have fewer other options, the department’s secretary has told Senate estimates.
The problem is real. Australia graduates more doctors every year, and in 2019 the number of doctors in clinical practice topped 100,000 for the first time.
It’s not slowing down, either – just today, the elite Group of Eight universities, responsible for training more than half of Australia’s doctors, released a report calling for an additional 1,000 places per year for domestic medical students.
The additional students, it argues, will fill the workforce gaps.
But growth in the overall number of doctors has not led to proportional growth in the number of GPs. Consultancy firm Deloitte predicts a shortfall of about 10,000 GPs by 2030.
By the same year, there is expected to be an oversupply of doctors overall, including about 1300 excess emergency medicine specialist trainees.
The AMA has dismissed the Group of Eight’s claim that more student places will fix the rural doctor shortage.
“Unfortunately, Australia is not doing enough to encourage these record medical graduate numbers to work in the locations and specialties where they are most needed, and this is where most policy effort should be focused,” AMA president Dr Khorshid said.
“The Group of Eight report gives this very little attention and its upfront call for 1,000 extra medical school places is lazy policy that ignores the need for proper medical workforce planning to inform how these shortages should be addressed.”
The Australian Medical Students Association also smashed the proposal.
“There is a significant risk that increasing medical student numbers, without a proportional increase of internship places and specialty training positions, will detrimentally exacerbate the bottlenecks we have in training doctors in this country,” said AMSA president Jasmine Davis.
“It would be profoundly irresponsible for a government to fund such a large number of new medical school places without adequate data, robust modelling, and consultation of stakeholders.”
Enter the National Medical Workforce Strategy, which the DoH slipped out about a month ago.
The document outlines five priorities for action – priority number three is reforming training pathways, followed by four, building the generalist capability of the medical workforce.
It recommends the development of a national needs-based demand model that will “inform decisions about the number and distribution of training places”, which can be used to develop policy interventions “to promote specialties in undersupply”.
Department of Health Secretary Dr Brendan Murphy put it clearly in Senate estimates last month.
“Frankly, if the other colleges are not training as many people, more will choose to go into general practice,” Dr Murphy said.
Emergency medicine, anaesthesia, intensive care and cardiothoracic surgery are all specialties with a growing oversupply.
“The colleges, and the states and territories have all bought into this strategy to reduce the number of training positions for those specialties that we don’t need [more of],” Dr Murphy said.
“For example, we’ve already got an agreement with the College for Emergency Medicine to do that.
“We’re working with the heart surgeons society in order to reduce the number of trainees in cardiac surgery; we just don’t need them.”
Neither the Australian College of Emergency Medicine and the Australian & New Zealand Society of Cardiac & Thoracic Surgeons – the two training bodies specifically named by Dr Murphy – responded to requests for comment.
The next step, Dr Murphy said, was marrying those changes with the increased opportunities the department hopes to provide in general practice.
The Medical Republic asked the RACGP what it thought of this strategy, especially given the recent discussion about general practice being seen as inferior to other specialties. The college, understandably, would prefer a more carrot-focused approach.
“In our submission to the National Medical Workforce Strategy, we recommend solutions that support general practice and incentivise careers in general practice are prioritized; general practice must be the career of choice for graduates,” RACGP President Adjunct Professor Karen Price said.
“This includes plans to raise the profile and prestige of general practice, increase trainee numbers, modernise and improve the MBS, and support the rollout of the rural generalist program.”
When asked whether the strategy outlined by Dr Murphy – essentially limiting the options for medical graduates to funnel people into general practice – adequately supported the RACGP’s plan to “raise the profile and prestige” of the specialty, the college declined to elaborate further.
Instead, it reiterated that more needs to be done to make general practice an attractive choice for graduates, and that investment in general practice is key to making that happen.