Medical Training Review Panel: thirteenth report

Executive Summary

Page last updated: April 2010

The Medical Training Review Panel (MTRP) was formed under legislation in 1996 to report to the Commonwealth Minister of Health on the activities of the MTRP and provide data on medical training opportunities in Australia. The aim has been over the years to provide a more comprehensive picture of medical education and training, not only reporting data on current training and medical workforce supply, but also sourcing additional data where possible on all levels of training and in topical areas. The report also analyses trends in these over the years and endeavours to provide insight into Australia’s capacity to prepare the medical workforce required into the future.

The thirteenth annual report of the MTRP provides information on university, prevocational and vocational medical training positions, applicants, trainees, examinations and new college fellows. For the first time, more comprehensive information is included on medical practitioners who have trained overseas.

The report was compiled by the Australian Government Department of Health and Ageing, with oversight by the MTRP. Data was provided by the Medical Deans Australia and New Zealand (MDANZ), state and territory health departments, medical colleges, General Practice Education
and Training Limited (GPET) and the Australian Medical Council. Selected administrative data from the Australian Government Department of Health and Ageing and the Australian Government Department of Immigration and Citizenship have also been included.

To aid readability, tables in the body of the report present time series information pertaining to the latest five years and where data is available from previous years, this has been included in Appendix D. For the purposes of the Executive Summary, the latest available data has been
summarised and trends in the data have been examined across all years for which national data is available, where possible back to the first year in which the MTRP reported, 1997.

University Medical Training

Initial medical education is provided by university medical schools in Australia as six-year and
five-year undergraduate courses or as four-year graduate courses. There are 18 universities with accredited medical schools, of which 14 are currently producing graduates. The other four universities have students enrolled in courses of various lengths, but had not produced graduates in 2008. The first medical students graduate from Bond University in 2009. The University of Western Sydney (UWS) and the University of Wollongong commenced teaching in 2007, and Deakin and Notre Dame Sydney commenced in 2008. These universities are expecting their first medical graduates in 2010 and 2011 respectively.

In 2009, there were 14,521 medical students studying in Australian medical schools, an increase of 1,184 (8.9%) from the previous year, 2008.
Of these, 12,097 (83.3%) were domestic students, an increase of 1,069 (9.7%) from 2008.

One quarter of all medical students (23.2%) were fee paying.

Between 2000 and 2009, the total number of first-year medical students more than doubled, increasing by 107.3%. This increase was primarily due to an increase in the proportion of domestic students (117.1% increases compared with 62.9% for international students).

The increase is mirrored in the number of medical graduates each year, but the picture is somewhat different for domestic and international students. Each year the number of domestic medical graduates has increased, with a 39.7% overall increase from 1997 to 2008. Since 1999, when the number of international medical graduates was first published, the number has increased from 144 to 401 in 2008, an increase of 178.5% over the ten years.

While the overall number of medical graduates is projected to increase significantly in future years, the rate of growth is anticipated to decrease by 2014. From 2007 to 2008, the number of graduates increased by 15.0% and it is anticipated that they will increase by a further 11.8% to 2,392 graduates in 2009. By 2014 it is projected that the number of graduates will increase to 3,786, an increase of almost 77% from 2008 and 170.4% from 1999.

Prevocational Medical Training

Medical graduates generally enter the medical workforce through the major public teaching
hospitals as interns or postgraduate doctors. Satisfactory completion of the first postgraduate year (PGY1) is required before these junior doctors can receive full medical registration. After PGY1, and prior to starting vocational training, most doctors spend one or more years working in the public system to gain more clinical experience.

In 2009, there were 2,243 PGY1 trainees. This was an increase of 213 (10.5%) on the previous year (2008) and 467 (26.3%) since 2007.

Two thirds (1,495 or 66.7%) of all PGY1 trainees commencing training in 2009 did so 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 PGY1 training in another state or territory.

PGY1 commencements have increased substantially each year, with the exception of 2007, showing an overall increase of 46.5% or 712 trainees from 2004 (when data was first collated for the MTRP) to 2009.

In 2009, 2,052 trainees commenced in PGY2 supervised medical training positions across Australia with the exception of South Australia, for which data was not available for this year.

Although the number of PGY2 commencements appears to have increased substantially in recent years, the true extent of the increase is unknown due to incomplete data and other data quality issues.

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. Not all PGY1 and PGY2 doctors go on to specialise. A number continue to work in hospital settings in non-vocational career roles, typically as career medical officers (CMOs).

Vocational Medical Training

Most junior doctors will seek entry into specialist training or vocational training, which leads to
fellowship of one of the recognised medical colleges. Each college has its own training program and structure.

There were 12,958 vocational trainees in 2009. This is double the number in 1997 (6,422 vocational trainees), when the MTRP commenced reporting this information.

The education and training requirements of each medical specialty depend on the type of clinical medical practice, but commonly include basic and advanced training. Where required, a trainee can only apply for and compete for a position on an advanced specialist training program after successfully completing a basic training program. Between 1997 and 2008, several of the colleges introduced additional basic training requirements prior to permitting the commencement of advanced training. This led to an increased number of basic trainee positions in recent years relative to advanced positions.

Almost one third (31% or 3,989) of all vocational trainee positions was in the physician specialties (adult medicine, occupational and environmental medicine, paediatrics, public health medicine and rehabilitation medicine) with 21% in adult medicine. The next largest proportions of vocational trainee positions were in general practice (18% or 2,309) and emergency medicine (12% or 1,543).

When medical practitioners finish their vocational training and have met all other requirements of the relevant college, they are eligible to apply for fellowship of the college.

There were 2,257 new college fellows in 2008. This is a significant increase from 2007, when there were 1,677 new fellows, and double the number of new fellows in 2000 (1,126), when these data were first collected.

In 2008, 925 or 41.0% of all new college fellows were female.

The proportion of new fellows in each medical specialty is as follows:
General practice - 39%
Adult medicine - 13%
Paediatrics - 5%
Other physicians - 2%
Surgery - 8%
Emergency medicine - 4%
Anaesthesia 9%
Radiology - 3%
Obstetrics and Gynaecology - 3%
Pathology - 3%
Psychiatry - 7%
Other - 2%

The proportionate split has remained roughly the same across the specialties over recent years.

Female Trainees

In 2009 females comprised just over half (53.7%) of the total first year student commencements (54.8% of domestic and 47.0% of international graduates) and a similar proportion of medical graduates (57.2% of domestic and 54.6% of international gradates).

The proportion of female first-year commencements has varied little across the years (between 53.5% in 2008 and 56.1% in 2004). Data on the proportion of female medical graduates prior to 2007 is not available for examination of these trends more fully. The proportion of females going on to specialise and become new fellows is, however, much lower, remaining relatively stable at around two-fifths of total new fellows each year from 2000 (41.0% in 2008). It should be noted that there is also considerable variation across the various specialties each year with only 9.1% of all new fellows in pain medicine being female in 2008 through to 62.1% of those in obstetrics and gynaecology and 90.0 % of those in dermatology. Considerable variation in the sex ratio is also seen from year to year within specialties, particularly those with smaller numbers.

Rural Practice

Exposure to rural and remote settings, whether through living, being schooled and/or undertaking medical studies or training there, is considered to have a positive impact on the likelihood of medical professionals practising in rural and remote areas.

Data on students who have a rural background is collected by medical schools and is reported in this report for the second year, as is data from the Australian College of Rural and Remote Medicine (ACRRM).

In 2009, 20.7% of first-year domestic students reported that they had lived in a rural or remote area prior to commencing their medical studies.

There is little additional data on the rurality of medical trainees or on aspects of training that may affect decisions of medical practitioners to practise in rural and remote areas. The MTRP will continue to explore avenues to improve this data.

Overseas Supply of Medical Practitioners

Overseas trained medical practitioners form a large part of the medical workforce in Australia, particularly in rural and remote areas.

In 2008–2009 some 4,080 medical practitioners were granted visas in the three main visa subclasses (422, 442 and 457). Almost one quarter of these were applicants from the United Kingdom and Republic of Ireland. India remains a major source of medical practitioners to this country with almost one-fifth (19.4% or 790) of all visas in 2008-2009 being granted to medical practitioners from India. A number of other Asian countries (Malaysia, Pakistan, Sri Lankan and the Philippines) are key sources of medical practitioners, as are South Africa and Iran.

In 2006, COAG agreed to the introduction of a nationally consistent assessment process for international medical graduates and overseas trained specialists. This process now consists of three main assessment pathways: Competent Authority, Standard and Specialist pathways.
In 2009, the AMC assessed 1,599 applications through the Competent Authority pathway. A total of 2,464 applicants passed the Multiple Choice Questionnaire examination, the first examination under the Standard pathway, and 650 applications passed the Clinical examination, the second examination, of the assessment process through the Standard pathway.

In 2008, 1,760 applicants were assessed through the Specialist pathway. Of these applicants 212 overseas trained specialists were approved to practise. Two-fifths of all OTS (90 or 42.5%), who had their applications approved, where trained in the United Kingdom and Ireland.

For the first time information has also been included on medical practitioners who have trained overseas and been given exemptions under Section 19AB of the Health Insurance Act 1973 (the Act), which limits their practice for a defined period to Areas of Workforce Shortage.

At June 2009, there were 5,951 overseas trained doctors granted Section 19AB exemptions restricting their practice to Areas of Workforce Shortage in order to access Medicare Benefits for the services they provide.