Doctors in training: a.k.a. cheap labour

The tragic suicides of two young doctors in Victoria have cast a shadow over the long hours that doctors work. This is particularly the case for those still undergoing training, who must satisfy their superiors and hospital administrators.

But the emphasis on working hours alone misses deeper aspects of the profession and the nature of medical training, in particular its length, that require greater scrutiny.

Health remains arguably the greatest non-security challenge that Western governments face. The prospect of managing ageing populations, the cost of whizzbang medical technologies and a demanding public are awesome tasks.

Furthermore, last year's Productivity Commission report into the health workforce and its recommendations for greater task substitution have placed doctors in a defensive posture. The leaders of the profession are particularly concerned with maintaining the status quo, worried that any chinks in the armour may progress to the dismantling of their status.

This is unfortunate, because medical training is one of last bastions of the Old World left in our economy and requires a genuine shake-up.

Almost every other sector in the past 10 years has faced enormous pressures, resulting from the phenomenal pace of communications development, to perform their tasks faster, cheaper and better simultaneously. Failure to do so quickly resulted in extinction.

Medical training is not one such sector. It has been completely immune to the wider forces shaping the world, still relying on systems, through colleges and apprentice-style training that have effectively been unchanged for decades. While there is certainly much to recommend it, the democratising forces flattening all other sectors have barely surfaced in the training of doctors, It is the East Germany of our society, waiting for its wall to fall.

It is only in the past year that doctors in training even have had a say in the colleges that govern them, something that occurred only after strong recommendations from the Australian Medical Council, the body that accredits each individual college.

The length of training that graduates now face borders on the farcical.

If we assume that someone entering university never takes any time off, something highly unlikely for this generation, he or she is unable to practice independently for, on average, about 13 years. In that time, their friends in other industries have often progressed to senior positions, established themselves financially or experimented with multiple careers.

While the work of any kind of doctor, especially those practising complex procedures, requires enormous technical expertise, there are few tasks in today's world that require a decade and half to practice independently. Fighter pilots are ready in a fraction of that time. Barristers complete an exam and are deemed ready to start.

It is only in medicine when all the new knowledge that constantly emerges is effectively just placed on top of all the other training that was already expected. This is despite the fact that the ultimate tasks of modern specialists are exceedingly narrow.

Each new facet of knowledge is just placed on top of the pyramid of training, so that the pyramid gets higher and higher and is administered by grey, old men sitting in the colleges who are not subject to genuine scrutiny or competition.

In my own experience, the main gripe from colleagues in training is the sheer length of time it takes to come out the other side. They feel that training is a euphemism for serving as cheap labour in under-funded public hospitals.

While they try to establish lives outside their work and deal with all the pressures of modern life, the mountain to climb in their work seems to be insurmountable. And this realisation hits people who have been at the top of almost everything they have done, especially when it comes to academic achievement.

There is a creeping sense in the middle stages of medical training that things should have turned out much better. There is no job in which expectations are so distant from the reality.

The problem is only likely to worsen, considering the numbers of medical students around the country is set to almost triple in the next decade, with only Queensland training more students than Victoria.

Some of the country's best and brightest young people are being short-changed by a system that does not value them and places undue demands on their lives, unsupported by evidence.

Unfortunately, the arrangement suits many people in authority, both within the profession and in government.