Doctors in the waiting room

The president of the College of Psychiatrists, Julian Freidin, openly admitted this fact in the December 2005 issue of the Medical Journal of Australia. “Over the five years that psychiatrists work as registrars, they spend only a short time training. They are working to keep the state system from falling apart.” he said.

The same could be said of any other medical specialty.

Colleges have come under fire from health bureaucracies and the Australian Competition and Consumer Commission for over-regulating the number of juniors in specialty training. While the Australian Medical Workforce Advisory Committee makes suggestions regarding medical workforce composition, the colleges ultimately decide the number of training positions available.

The government has a vested interest in producing far more junior trainees in order to cope with the demand for services. The catch comes later. While the government wants colleges to allow more doctors to enter into training programs, it refuses to increase the number of advanced training positions.

Put more simply, the government wants to create a bottleneck at the point of becoming a specialist.

The Royal Australasian College of Surgeons argues that 100 junior surgeons are already waiting to progress through their training but cannot do so because of too few advanced positions.

This is the holy grail for the state health ministers. They imagine a system run by junior doctors who cost far less to employ than specialists, but who arguably do the same work.

Meanwhile there is a growing demoralisation on the part of training doctors. A survey this year by the NSW Australian Medical Association found that the level of morale among training doctors was the lowest ever recorded. The survey was done by anonymous questionnaire and wasn’t statistically relevant, but it was still an indicator of growing dissatisfaction.

While the mantra of market forces and deregulation are called upon in almost every other sector, training doctors must cope with a growing resistance for them to ever access market forces. They are the last socialists in the market economy, only forcibly so.

If the trend continues, future medical graduates will begin their careers only to realise they have been duped into a job working as cheap labour to prop up a disintegrating public health infrastructure. Meanwhile, they will be told that it is in their best interests, because they need to be “trained”.