Medical Training Review Panel: thirteenth report

Chapter 3: Prevocational Medical Training

Page last updated: April 2010

This chapter reports on the number of junior doctors undertaking postgraduate prevocational training across Australia. Data has been provided by state and territory health departments and is current as at June 2009.

Background

Medical graduates generally enter the medical workforce through public hospitals as interns, also known as postgraduate year 1 (PGY1) doctors. Satisfactory completion of the intern year is required before these junior doctors can receive full medical registration with the relevant state or territory medical board.

Interns have a series of work experiences, or rotations, in order to expose them to a range of clinical situations and training environments. These rotations must be in accordance with guidelines developed by the state and territory postgraduate medical councils. This is part of a structured curriculum largely focused on 'on-the-job' style training.

Prior to commencing a vocational training program, most junior doctors work for at least one or two more years after their intern year, mainly in the public hospital system, to gain more clinical experience. A key aim of this experience is to consolidate the clinical skills developed during university training and the intern year, and to equip junior doctors with the prerequisite experience and procedural skills for entry into specialist or vocational, training programs.

Training at the prevocational level generally involves rotating between clinical departments and between public hospitals. It also may include rotations to regional and rural hospitals and community settings. Such rotations are intended to give junior doctors experience of a broader range of clinical settings while meeting service delivery needs.

While a number of specialist medical colleges may accept entrants to vocational training programs directly following completion of PGY1, most require applicants to have completed the PGY2 year of general prevocational training. Doctors in this period of prevocational 'on-the-job training' are usually referred to as 'resident medical officers' (RMO). The term 'hospital medical officer' (HMO) is used in Victoria.

Not all PGY1 and PGY2 doctors choose to undertake vocational specialist training. Some leave the medical workforce, others pursue a research career, some choose to work as locums and a number continue to work in hospital settings in non-vocational career roles, typically as career medical officers (CMOs). Most CMOs work in hospital settings in acute roles, such as emergency departments. A number of CMOs acquire other postgraduate qualifications related to their roles, such as early management of severe trauma, advanced paediatric support or emergency life support.

Caution is needed in using and analysing the prevocational data. The numbers presented are sometimes estimates, with administration systems often not capturing data in a way that matches the breakdown of information for MTRP reporting purposes. Also, some jurisdictions have different prevocational training processes. For instance, in New South Wales trainees are employed on two-year contracts covering both PGY1 and PGY2 training. This means that the number of PGY2 positions advertised each year and offered does not reflect the total number of PGY2 positions available.

Postgraduate Year 1

Current Data

In 2009, there were 2,243 trainees commencing PGY1. Of these, more than half were female (56.6%) (Table 3.1).

Two thirds (1,495 or 66.7%) of all PGY1 trainees commenced training in the state or territory in which they undertook their medical degree. A further 265 trainees (11.8%) were trained in Australia, but commenced their PGPY1 training in another state or territory.

The number of PGY1 positions in each state and territory closely matched the distribution of the population as a whole.

Table 3.1: Commencing postgraduate year 1 trainees or supervised training positions: Total, females, proportion of females by doctor category and state/territory, 2009
NSWVicQldSAWATasNTACTAust

(a) Total includes 13 carry over positions from 2008.
(b) Approximate numbers only - correct at the end of allocation

Source: State and territory government health departments

All commencing PGY1s
Australian trained local (own state)
420
331
342
125
187
43
12
35
1,495
Australian trained local (interstate)
68
71
43
28
23
7
14
11
265
Temporary resident Australian-trained
98
92
48
61
14
3
na
4
320
New Zealand medical school graduates
6
5
7
5
3
0
na
0
26
Australian Medical Council graduates
76
7
4
27
1
9
1
12
137
Total
668
506
444
(a)246
228
62
27
62
2,243
Females
Australian trained local (own state)
241
195
177
65
111
17
3
25
834
Australian trained local (interstate)
50
45
24
13
13
2
8
7
162
Temporary resident Australian-trained
49
51
28
34
6
0
na
4
172
New Zealand medical school graduates
2
0
4
2
3
0
na
0
11
Australian Medical Council graduates
52
3
3
19
1
4
1
7
90
Total
394
294
236
(b)133
134
23
12
43
1,269
Proportion females (%)
Australian trained local (own state)
57.4
58.9
51.8
52.0
59.4
39.5
25.0
71.4
55.8
Australian trained local (interstate)
73.5
63.4
55.8
46.4
56.5
28.6
57.1
63.6
61.1
Temporary resident Australian-trained
50.0
55.4
58.3
55.7
42.9
0
na
100.0
53.8
New Zealand medical school graduates
33.3
0
57.1
40.0
100.0
0
na
0
42.3
Australian Medical Council graduates
68.4
42.9
75.0
70.4
100.0
44.4
100.0
58.3
65.7
Total
59.0
58.1
53.2
54.1
58.8
37.1
44.4
69.4
56.6

Trends

PGY1 commencements have increased substantially each year, with the exception of 2007, showing an overall increase of 38.3% or 621 trainees from 2005 to 2009 (Table 3.2). The increases over this period have been significantly greater in some states, namely Western Australia (72.7%), Queensland (58.6%) and South Australia (43.9%).

Table 3.2: Commencing postgraduate year 1 trainees by state/territory, 2005-2009
20052006200720082009Increase 2005-2009 (%)

(a) January allocation only, whereas previous years also include mid-year allocation.
(b) SA has 233 accredited positions, plus 17 interns carried over from 2008 and 8 of these share 4 full time positions.
(c) Actual allocation figures not available. Figures based in number of offers made.

Source: State and territory government health departments

New South Wales/ Australian Capital Territory
556
628
(a)533
688
..
29.0
New South Wales
..
..
..
..
688
na
Australian Capital Territory
..
..
..
..
62
na
Victoria
397
406
447
454
506
27.5
Queensland
280
323
357
411
444
58.6
South Australia
171
183
213
227
(b)246
43.9
Western Australia
132
137
155
175
228
72.7
Tasmania
52
71
(c)56
51
62
19.2
Northern Territory
24
23
15
24
27
12.5
Australia
1,622
1,771
1,776
2,030
2,243
38.3
Increase on previous year (%)
..
9.2
0.3
14.3
10.5

Postgraduate Year 2

Current Data

Table 3.3 presents data on the number of PGY2 positions offered by states and territories and, where possible, whether those offered positions were trained in Australia, New Zealand or elsewhere.

Table 3.3: Postgraduate year 2 positions offered by doctor category and state/territory, 2009
NSWVicQldSAWATasNTACT

(a) Approximate number only, including all prevocational trainees. The postgraduate Medical Council of South Australia (PMCSA) is in its first year of managing Training Medical Officer (TMO) recruitment and accurate numbers will be available for the next report.
(b) Breakdown of numbers from all hospitals was unavailable.

Source: State and territory government health departments

Australian trained local (own state)
na
na
306
na
148
na
na
15
Australian trained local (interstate)
na
na
62
na
53
na
na
10
Temporary resident Australian trained
na
na
28
na
13
na
na
1
New Zealand medical school graduates
na
na
13
na
2
na
na
2
Australian Medical Council graduates
na
na
62
na
86
na
na
12
Total
na
540
471
(a)300
302
(b)188
44
40

Data on the doctors actually commencing PGY2 training is provided in Table 3.4. It is not possible to compare PGY2 training across states and territories, as data is not available for all jurisdictions and there are different inclusions in the numbers provided. In fact, the notion of PGY2 is poorly defined both within and across jurisdictions.

Table 3.4: Commencing doctors in postgraduate year 2 positions: Total, females and proportion of females by doctor category and state/territory, 2009
(a)NSWVicQldSAWATasNTACT

(a) Inclusive of all PGY2 positions including continuous two-year contracts.
(b) Inclusive of temporary resident Australian trained postgraduates.
(c) Residency status information not available to separate into categories. Numbers included in Australia trained local own state and interstate commencements.
(d) Includes 83 IMGs working in PGY2 positions registered under the Competent Authority or Standard Pathways. 53 IMGs were female.
(e) Total includes one unknown.
(f) Data is based upon the total number of declined job offers registered in the eRecruitment system.

Source: State and territory government health departments

All commencing PGY2 students
Australian trained local (own state)
(b)399
281
301
na
138
33
na
15
Australian trained local (interstate)
(b)90
81
59
na
41
13
na
10
Temporary resident Australian trained
(c)na
86
26
na
14
1
na
1
New Zealand medical school graduates
14
24
10
na
2
0
na
2
Australian Medical Council graduates
54
14
62
na
81
60
na
12
Total
(d)640
(e)487
(f)458
na
276
107
44
40
Females
Australian trained local (own state)
(b)217
161
165
na
75
20
na
12
Australian trained local (interstate)
(b)48
61
28
na
21
7
na
6
Temporary resident Australian trained
(c)na
53
7
na
8
1
na
1
New Zealand medical school graduates
5
12
7
na
1
0
na
2
Australian Medical Council graduates
37
6
43
na
43
28
na
7
Total
(d)360
293
250
na
148
56
na
28
Proportion females (%)
Australian trained local (own state)
(b)54.4
57.3
54.8
na
54.3
60.0
na
80.0
Australian trained local (interstate)
(b)53.3
75.3
47.4
na
51.2
53.8
na
60.0
Temporary resident Australian trained
(c)na
61.6
26.9
na
57.1
100.0
na
100.0
New Zealand medical school graduates
35.7
50.0
70.0
na
50.0
0.0
na
100.0
Australian Medical Council graduates
68.5
42.9
69.3
na
53.0
46.6
na
58.0
Total
56.3
60.2
54.5
na
53.6
52.3
na
70.0

Trends

Although the number of PGY2 commencements appears to have increased substantially since 2005 (Table 3.5), the true extent of the increase is unknown due to data quality issues. Similarly, comparisons across states and territories and across years should be undertaken with caution.

Table 3.5: Postgraduate year 2 commencements by state/territory, 2005–2009
20052006200720082009

(a) Includes 83 IMGs working in PGY2 positions registered under the Competent Authority or Standard pathways.
(b) Total includes one unknown.
(c) Figure on number of offers made.
(d) Commencement data is based upon the total number of declined job offers registered in the eRecruitment system.
(e) Approximate number only. PMCSA is in its 1st year of managing TMO recruitment and accurate numbers will be available for the next report.
(f) Actual allocation not available. Figures based on number of offers made.

Source: State and territory government health departments

New South Wales/ Australian Capital Territory
416
414
449
..
..
New South Wales
..
..
..
na
(a)640
Australian Capital Territory
..
..
..
36
40
Victoria
412
432
477
467
(b)487
Queensland
337
na
284
(c)441
(d)458
South Australia
134
172
220
161
(e)300
Western Australia
145
172
96
224
276
Tasmania
68
88
(f)28
49
107
Northern Territory
24
24
32
44
44
Australia
1,536
1,302
1,586
1,422
2,352