Vertical Integration: HWA Report; Rural Generalist Pathway; Engagement with Specialist Colleges
Richard Murray (ACRRM) introduced the topic.
Health Workforce Australia (HWA) Report – methodology used, was to take healthcare delivery for doctors, midwives, nurses in 2009 and apply in 2025 (incl. projected population growth, ageing population etc.). Using the base of 72,000 Australian doctors, the report suggests an additional 37,000 doctors is required by 2025. The modelling suggests that of the 37,000 new doctors required to meet Australia’s healthcare needs, only one in five is needed outside of major cities. Significant gap in funded positions for registrars, shortage of registrar posts. There needs to be a policy response, with a ‘very loud voice’ from the rural constituency advising the need for a different health care model. Conversations must lead to ‘regional’ and ‘general’. Opportunity exists to make regional and general possible in relation to the Rural Generalist program which is gaining momentum and includes preparing health practitioners to work in a variety of settings, respond to emergencies, to have population and Indigenous health insights, hospitalist and primary care provider (ie the ACRRM curriculum approach). There is an opportunity for early selection out of medical school, a planned process & acceptance into colleges’ training programs, and partnership around mentoring, supporting, arrange training provider.
Engagement with Specialist Colleges – an interest in how to make general, regional training bigger part of agenda. Rural clinical schools have the infrastructure to make it work as ‘match-makers’. Letter has been sent from FRAME Chair to the President of Medical Colleges, inviting engagement with CPMC around vertical integration agenda. ACRRM has formal recognition of advanced specialised training (one year equivalent of advanced specialised training as a rural medical academic with teaching and research mix).
Panel discussion included:
- Strength is student engagement, but there is a need to make clearly articulated, seamless pathway to rural, i.e. aspirational dream.
- JCU & Flinders leading in international links in social accountability.
- Having such a strong dependency on international medical graduates, may be perpetuating shortages within Australia.
- Internships – graduate students are work-ready at Year 3 – it is possible to do community-based rural intern programs. Rural clinical schools should be able to facilitate this.
- Different intentions and expectations of the rural generalist pathway from states and territories (hospital-based with primary care sideline) and the Commonwealth primary care with hospital sideline). HWA’s exercise – to make a national, consistent approach to generalist pathways. The dilemma is agreeing the funding of these placements, and the ultimate position that these placements end up in primary care with hospital exposure or the reverse. GPET selection process and funding is competitive, set up that way be equitable to gain places in GP training program. Proving to be a barrier to collaboration – this is a policy issue.
- From student training perspective, there is a need for a structured mentoring program, that continues beyond training – RCSs as match-makers.
- The key to success is the relationship that is formed in early months of training. Graduates make career choices in PGY1 and PGY2, need to be creative in thinking about junior doctor training program. Community based internships, must consider capacity (PGPPP program, GP registrars), infrastructure, flow-on effects.
- Pathways in North America, much less complex.
- A challenge for FRAME: HWA workforce modelling is the biggest policy challenge in Australia in the past 50 years in health service delivery, we need to get it right.
- There are some perverse incentives/drivers towards subspecialisation in the system such as status, income within profession. Within the community there is the expectation of excellence which is why the North American model exists.
The only group that engages with generalist clinicians is rural clinical schools. There is an opportunity to champion generalism, we are the ones dealing with generalist doctors, physicians, surgeons, rural GPs. Opportunities for researching generalism, what does it mean? and championing that within the profession and the community. Generalism needs to be marketed within the system.