Why the ACCC is wrong on medical colleges being anti-competitive

By Sunalie Silva

31 Jul 2019

Claims that medical colleges are trying to limit competition by being ‘slow to expand’ training programs are misleading and distract from the real problem of  lack of funding, doctors in training say.

An article in The Australian recently portrayed the Colleges’ role in setting training place numbers as anti-competitive behaviour, quoting the former ACCC chair Graeme Samuel as saying “You don’t need to ­restrict the number of training places to maintain quality standards.”

It claimed that an ACCC enforcement officer had told a recent meeting of the National Medical Workforce Strategy committee that restrictions on training numbers  should only be authorised if an “overwhelming public interest’ could be demonstrated.

But speaking to the limbic Dr Tessa Kennedy, Chair of the AMA Council of Doctors in Training said the article did not reflect the reality of a complicated system that sees the increasing number of medical graduates chasing a handful of funded training positions.

Dr Kennedy said the medical colleges’ role in setting trainee numbers was limited and the real bottleneck is in the number of public hospital positions available at the completion of training.

Medical colleges have to balance state and territory funded public hospital resources and the capacity for doctors to take on supervising roles, she added.

“The Colleges’ primary responsibility as delegated by the AMC (Australian Medical Council) is to ensure that training is conducted to the highest standard. Some people might say they’re using that as an excuse to be a cartel – to only have x number of positions so there’s no competition down the end of the road; it’s not as simple as that,” she said.

But Dr Kennedy agreed that the specialist training pipeline system is in need of a shake up to address the tensions created as communities experience longer wait times and higher gap fees, while trainees are ‘desperate and lining up’ to get into specialist training programs but are being turned away.

“We have to have a very serious discussion about how we meet our service needs without just filling them with an endless supply of registrars, which is only possible given the significant increase in medical graduates, many of who will have no hope of getting a consultant post.”

According to Dr Kennedy, nearly every specialist field already has more medical graduates in training than there are jobs available. In addition, trainees are increasingly undertaking training in sub-sub specialties, leading to a maldistribution of doctors not just geographically but by specialty.

It’s a trend that Dr Kennedy suspects has grown out of an intent to be ‘job ready’ for metropolitan posts – but she cautions that it’s leading to more trainees becoming less useful in the areas where doctors are needed most.

“With increasing competition, particularly in metropolitan centres, people are trying to differentiate themselves. Lots of trainees are doing a PhD in a very narrow field of a sub-sub specialty when they haven’t done their general training because the expectation is, that unless you carve out that niche for yourself, there isn’t going to be a job for you.”

It’s an area the National Medical Workforce Strategy (NMWS) has flagged for reform, with a push to have more rural generalists and more training positions in private hospitals.

However the most recent government review of the Specialist Training Program (STP), concluded in 2017 with recommendations to maintain the same number of funded training positions, with some redistribution between specialities to reflect changing supply and demand.

In a statement to the limbic the Federal Department of Health said the Medical Workforce Reform Advisory Committee (MWRAC) had ‘invited’ the ACCC to a meeting to help develop a scoping framework for the NMWS, which is expected to be completed in 2020.

“In preparing the Strategy, members have been considering how to improve supply and demand modelling, and how to ensure training settings provide doctors with the skills required to meet Australia’s future medical care needs. In this context, the MWRAC invited the ACCC to discuss its legislation and policies with a view to informing the strategy,“ a department statement said.

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