Doctors in the waiting room

When we think of health, especially at this time of the year, we tend to think of our own bulging bellies and alcohol-soaked grey matter. Meanwhile, it is also the time when our health system suffers strain from a lack of staff and enormous demand from elderly, homeless, and just plain lonely, people.

This is the message of the latest public hospital advocacy team, the Hospital Reform Group. The group announced its concerns in December in Sydney and tabled a solution, which naturally is just more money.

But for those of you who find yourself in overcrowded waiting rooms, spare a thought for the training doctors manning their stations. Their wait is of an entirely different magnitude and an increasingly unjust one.

The recent draft report by the Productivity Commission into Australia’s health workforce acknowledged there was indeed a widespread shortage of doctors and its causes were rooted in government policy.

The federal health department believes that doctors create their own demand, and so strain the health budget. It supported measures in the 1990s to ration the supply of doctors and service provision. Medical student places, specialist training places and Medicare provider numbers were all restricted.

However, the government and its advisers in the Australian Medical Workforce Advisory Committee got their numbers badly wrong. They underestimated the demand for medical services and overestimated the number of hours doctors were prepared to work, with more doctors retiring early or working part-time.

This shortage is now acknowledged by all the relevant stakeholders.

But the solution is a mischievous one where there is a growing collusion between governments and the “learned colleges” to trap new arrivals in the public sector. The training of specialists is a complex task and regulated by governments and the aforementioned specialty colleges.

After completing their undergraduate years of university training, doctors must go through many more years of training until they can work independently and bill the government. While they complete their training, they are forced to work for a comparably low salary in the public hospital system.

One of the main issues is the conflict between “training” and “service provision”. Medicine is the ultimate form of on-the-job training. Training doctors learn their trade while providing an essential service to the community.

While the importance of having well-trained specialists is not in question, this balance is becoming skewed towards service. Training programs are not merit-based, but dependent entirely on time served. This time served is becoming longer and for spurious reasons. The time taken to produce an independent specialist from the day they enter university is approaching 15 years.

In the modern age, some people have had three careers before many doctors have even begun one.