Medical Training Review Panel: fourteenth report

Chapter 3: Prevocational Medical Training

Page last updated: 11 March 2011

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 2010.

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 could receive full medical registration. Prior to July 2010 registration was through the relevant state or territory medical board. On 1 July 2010 the National Registration and Accreditation Scheme was implemented and from this time junior doctors, and all medical practitioners, must be registered through a single national board, the Medical Board of Australia.

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 or the Institutes of Medical Education and Training. This is part of a structured program 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 in community settings, including general practice. Such rotations are intended to give junior doctors experience of a broader range of clinical settings, as well as meet 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 and the term 'Trainee Medical Offi'cers' in South Australia.

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 refl ect the total number of PGY2 positions available.

Postgraduate Year 1

Current Data

In 2010, there were 2,394 trainees commencing PGY1. Of these, more than half were female (54.9%) (Table 3.1).

Two thirds (67.0% or 1,604) of all PGY1 trainees commenced training in the state or territory in which they undertook their medical degree. A further 323 trainees (13.5%) were trained in Australia, but commenced their PGY1 training in another state or territory.

Of these PGY1 positions 386 or 16.1% were offered to temporary residents of Australia.

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

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Table 3.1: Commencing postgraduate year 1 trainees or supervised training positions: Total, females and proportion of females by doctor category and state/territory, 2010

NSWVicQldSAWATasNTACTAust
All commencing PGY1s
Australian trained local (own state)
422
329
435
108
220
50
0
40
1,604
- Commonwealth supported
397
435
- Full-fee paying
25
0
Australian trained local (interstate)
104
85
47
31
15
6
27
8
323
- Commonwealth supported
84
27
- Full fee-paying
20
0
Temporary resident Australian trained
102
130
61
82
5
2
4
0
386
- Own state
90
114
51
44
0
- Interstate
12
16
10
38
4
New Zealand medical school graduates
5
2
4
(d)na
0
0
0
0
11
Autralian Medical Council graduates
24
(b)11
11
9
0
0
1
14
70
Total
(a)657
557
(c)558
230
240
58
32
62
2,394
Females
Australian trained local (own state)
238
186
227
67
118
28
0
236
887
- Commonwealth supported
223
227
- Full-fee paying
15
0
Australian trained local (interstate)
61
51
23
15
15
1
20
6
192
- Commonwealth supported
51
20
- Full-fee paying
10
0
Temporary resident Australian trained
51
66
36
37
5
1
3
0
199
- Own state
46
57
30
20
0
- Interstate
5
9
6
17
3
New Zealand medical school graduates
1
1
0
(d)na
0
0
0
0
2
Australian Medical Council graduates
16
(b)5
6
na
0
0
1
7
30
Total
367
309
292
119
138
30
24
36
1,315
Proportion female (%)
Australian trained local (own state)
56.4
56.5
52.2
62.0
53.6
56.0
0
57.5
55.3
- Commonwealth supported
56.2
52.2
- Full-fee paying
60.0
0
Australian trained local (interstate)
58.6
60.0
48.9
48.4
100.0
16.7
74.1
75.0
59.4
- Commonwealth supported
60.7
74.1
- Full-fee paying
50.0
0
Temporary resident Australian trained
50.0
50.8
59.0
45.1
100.0
50.0
75.0
0
51.6
- Own state
51.1
50.0
58.8
45.5
0
- Interstate
41.7
56.3
60.0
44.7
75.0
New Zealand medical school graduates
20.0
50.0
0
(d)na
0
0
0
0
18.2
Australian Medical Council graduates
66.7
45.5
54.5
na
0
0
100.0
50.0
42.9
Total
55.9
55.5
52.3
51.7
57.5
51.7
75.0
58.1
54.9

(a) Total number of positions in NSW for 2010 is 680.
(b) Includes 10 IMGs who were Australian Medical Council (AMC) candidates.
(c) Approximate numbers only based on acceptances registered in eRecruitment system.
(d) New Zealand applicants are included in interstate.

Source: State and territory government health departments

Trends

PGY1 commencements increased each year, showing an overall increase of 35.2% or 623 trainees from 2006 to 2010 (Table 3.2).

The increases over the period of 2006 to 2010 have been significantly greater in some states, namely Western Australia (75.2%) and Queensland (72.8%). Only one state, Tasmania, has a lower number of trainees than in 2006, but continues to have roughly the same number of PGY1s commencing training as in more recent years.

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Table 3.2: Commencing postgraduate year 1 trainees by state/territory, 2006-2010

20062007200820092010Increase 2006-2010 (%)
New South Wales/Australian Capital Territory
628
(a)533
688
..
..
14.5
New South Wales
..
..
..
668
657
Na
Australian Capital Territory
..
..
..
62
62
Na
Victoria
406
447
454
506
557
37.2
Queensland
323
357
411
444
(d)558
72.8
South Australia
183
213
227
(b)246
230
25.7
Western Australia
137
155
175
228
240
75.2
Tasmania
71
(c)56
51
62
58
-18.3
Northern Territory
23
15
24
27
32
39.1
Australia
1,771
1,776
2,030
2,243
2,394
35.2
Increase on previous year (%)
0.3
14.3
10.5
6.7

(a) January allocation only, whereas previous years also include mid-year allocation.
(b) Includes 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 on number of offers made.
(d) Approximate numbers only based on acceptances registered in eRecruitment system.

Source: State and territory government health departments

Postgraduate Year 2

Current Data

Data on the doctors commencing PGY2 training is provided in Table 3.3. 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.

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Table 3.3: Commencing doctors in postgraduate year 2 positions: Total, females and proportion of females by doctor category and state/territory, 2010.

(a)NSW(e)VicQldSAWATasNTACTAust
All commencing PGY2 doctors
Australian trained local (own state)
(b)444
305
329
92
184
36
1
32
1,423
Australian trained local (interstate)
(b)93
99
57
31
25
4
33
19
361
Temporary resident Australian trained
(c)na
85
47
60
0
1
1
0
194
New Zealand medical school graduates
12
16
8
(h)na
4
0
2
0
42
Australian Medical Council graduates
52
(f)11
33
0
28
38
8
11
181
Total
(d)686
(g)543
474
183
241
79
45
62
2,313
Females
Australian trained local (own state)
(b)246
183
171
57
95
16
1
23
792
Australian trained local (interstate)
(b)56
58
37
15
14
4
18
11
213
Temporary resident Australian trained
(c)na
54
22
34
1
0
111
New Zealand medical school graduates
3
5
5
(h)na
2
0
1
0
16
Australian Medical Council graduate
35
(f)7
22
0
19
20
5
3
111
Total
(d)402
307
257
106
130
41
25
37
1,305
Proportion female (%)
Australian trained local (own state)
(b)55.4
60.0
52.0
62.0
51.6
44.4
100.0
71.9
55.7
Australian trained local (interstate)
(b)60.2
58.6
64.9
48.4
56.0
100.0
54.5
57.9
59.0
Temporary resident Australian trained
(c)na
63.5
46.8
56.7
0.0
100.0
0.0
0.0
57.2
New Zealand medical school graduates
25.0
31.3
62.5
(h)na
50.0
0
50.0
0.0
38.1
Australian Medical Council graduates
67.3
(f)63.6
66.7
0
67.0
52.6
62.5
27.3
61.3
Total
(d)58.6
56.5
54.2
57.9
54.1
51.9
55.6
59.7
56.4

(a) Inclusive of all PGY2 positions including continuous two-year contracts.
(b) Inclusive of temporary resident Australian trained postgraduates.
(c) Numbers included in Australian trained local own state and interstate commencements.
(d) Includes 85 IMGs working in PGY2 positions registered under the Competent Authority or Standard Pathways. 62 IMGs were female.
(e) Not all PGY2 positions in Victoria are allocated via Computer Match as some PGY2 positions are directly recruited by hospitals or filled by IMGs already working in the health service and completing 12 months supervised practice.
(f) Includes 2 IMGs assessed under the Competent Authority Pathway.
(g) This total represents the number of PGY2 positions in the Computer Match that were accepted. There were additional 23 PGY2s recruited directly by health services, origin unknown.
(h) New Zealand applicants are included in interstate.

Source: State and territory government health departments

Trends

Although the number of PGY2 commencements appears to have increased substantially since 2006 (Table 3.4), 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.

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Table 3.4: Postgraduate year 2 commencements by state/territory, 2006-2010

20062007200820092010Increase 2006-2010 (%)
New South Wales and Australian Capital Territory
414
449
80.7
New South Wales
..
..
na
(a)640
(g)686
..
Australian Capital Territory
..
..
36
40
62
..
Victoria
432
477
467
(b)487
(h)543
25.7
Queensland
na
284
(c)441
(d)458
(i)474
..
South Australia
172
220
161
(e)300
183
6.4
Western Australia
172
96
224
276
241
40.1
Tasmania
88
(f)28
49
107
79
-10.2
Northern Territory
24
32
44
44
45
87.5
Australia
1,302
1,586
1,422
2,352
2,313
77.6
Increase on previous year (%)
21.8
-10.3
65.4
-1.7

(a) Includes 83 IMGs working in PGY2 positions registered under the Competent Authority or Standard pathways.
(b) Total includes one unknown.
(c) Figure based 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. The South Australian Institute of Medical Education and Training (SA IMET) was in its first year of managing Trainee Medical Officer (TMO) recruitment and accurate numbers were not available.
(f) Actual allocation not available. Figures based on number of offers made.
(g) Includes 85 IMGs working in PGY2 positions registered under the Competent Authority or Standard Pathways.
(h) Although there were 543 HMO2 positions included in the Computer Match (the Match), only 503 were matched. There were 13 unmatched candidates who accepted vacant positions. Total number of doctors who started their PGY2 training via the Match was 516. The remaining 27 positions were filled outside the Match (e.g. by IMGs).
(i) Commencement data is approximate and is based upon the total number of acceptances registered in the eRecruitment system.

Source: State and territory government health departments