The extraordinary clash of views between Treasurer Joe Hockey and the AMA president Brian Owler about the funding for a new medical school in Perth is just the latest example of the dangers of political meddling in doctors' professional affairs. To understand why such a politically savvy head of a major professional body would be moved to describe what you might think would be welcome news in such scathing terms requires explanation, so I’ll have a go.
It takes a long time to grow a doctor from a seedling. It used to be just 6 years as an undergraduate plus one as an intern before you went into some type of minimally supervised practice. With more graduate entry medical schools now, and virtually compulsory postgraduate training periods, that time is more than decade for most working doctors now. That’s 10 prime years of your life where medicine takes centre stage ahead of family, exercise, hobbies and relaxation. After that you will typically practice for 40 years as long as your mental and physical health holds out, but you will tend to stick to a particular field of expertise. To pull that off, a complicated system of training and mentoring is needed to ensure that attrition is low, given the expense and effort lavished by society and the profession on every trainee and student.
When I was a young tearaway, the Keating Government was seeking to cut medical student numbers supposedly as a way of reducing long-term Medicare costs. It was a dumb idea, both logically and professionally. Kind of like trying to reduce car insurance premiums by putting off apprentice mechanics. The AMA and AMSA (the national medical student body) pointed out that it would create a generation gap in around 20 years' time and this has turned out to be completely what has happened. An alarming percentage of GPs and specialists are within 10 years of retirement and their replacements are simply not there. The other issue exacerbating the problem is the fact that medicine has for decades graduated roughly equal numbers of men and women, but this was only really becoming apparent back then that this meant we needed MORE graduates to replace the silverback population of mostly male baby boomer doctors. Generational change has also meant that Gen Y doctors of both sexes are working more sensible hours, not the punishing, unsafe shifts of old. This contributes again to the severe shortage of locally trained doctors that the Abbott Government says it is responding to.
It may be not yet be obvious why a new medical school is a bad idea, but hang in there. Universities are largely Federally funded. Hospitals are funded by the States. Both are necessary to increase the number of locally trained doctors. Graduates of medical schools need somewhere to work while their training is continued. They can’t just be shoved out to replace overseas trained doctors in rural general practice or suburban bulkbilling clinics. The Abbott Government is desperately trying to deny that it is planning to make a massive funding cut to the States for their hospitals. They want the graduates, but they aren’t planning on helping the States train them properly. Owler and the AMA understand the depth of the cynicism and political opportunism at work here. No wonder they’re angry. So am I.
The Government is therefore offering to fund a medical school which it knows full well will help create a generation or more of medical school graduates who are seriously looking at being unable to work once they finish university. Curtin Uni has been lobbying hard for a medical school for years and it happens to suit the current political climate to offer it to them. It’s not going to do anything at all to improve the long-term medical workforce situation unless the intern and other training positions are also created, and the money to pay for those positions is about to disappear to the point that the AMA (and hospital CEOs) are unable to say how they can even expect to maintain current levels of service, let along employ more junior doctors and the people who will have to supervise them.
So on behalf of the next couple of generations of locally trained doctors I implore the Health Minister and her boss to stop using medical training as pork barrelling. Some of us have seen all this before, and we are all still seeing the fallout from the ill-advised short-termism of your long-departed predecessors. Grow up, take the profession seriously and you might be remembered as a competent politician with the public interest truly at heart. Don’t dismiss these concerns as lightly as your colleague Mr Hockey has. If you thought the backlash from the co-payment was a bad look, wait until the first WA graduates turn up driving taxis or flipping burgers to make ends meet.
Authors: The Conversation