Medical Training Review Panel: Seventeenth Report

Executive Summary

Page last updated: 09 April 2014

The Medical Training Review Panel (MTRP) was formed under legislation in 1997 to report to the Commonwealth Minister of Health on the activities of the MTRP and provide data on medical training opportunities in Australia. Over the years the panel has aimed, through its annual report, to provide a comprehensive picture of medical education and training, supplementing this with other data on the medical workforce supply.

The seventeenth annual report of the MTRP, like its predecessors, provides information on university, prevocational and vocational medical training positions, students and trainees, examination results and college fellows. Information is also included on medical practitioners who have trained overseas seeking to and/or currently working in Australia.

The report was compiled by Health Workforce Australia and the Australian Government Department of Health, with oversight by the MTRP.

Data were provided by the Medical Deans Australia and New Zealand Inc (MDANZ), medical colleges, General Practice Education and Training Limited (GPET), state and territory health departments through their postgraduate medical councils and the Australian Medical Council. Selected administrative data from the Australian Government Department of Health and the Australian Government Department of Immigration and Border Protection have also been included.

To aid readability, tables in the body of the report present time series information on the last five years for which data is available. Data for all years, where possible back to 1997, the first year of annual reporting by the MTRP, are included in Appendix D. For the purposes of the Executive Summary, the latest available data have been summarised and trends in the data have been examined across all years for which national data are available.

University Medical Training

Initial medical education is provided by university medical schools in Australia as five-year and six-year undergraduate courses or as four-year graduate courses. There are 18 universities with accredited medical schools. Recently, a number of medical schools have moved to a Doctor of Medicine (MD) program where graduates receive a masters level qualification. University of Melbourne was the first to commence this program in 2011 and is expected to have the first cohort of masters graduates in 2014.

In 2013, there were 16,994 medical students studying in Australian universities. This was an increase of less than one percent (126 or 0.7%) from 2012. Just over two-fifths (7,805 or 45.9%) of these students were undertaking a four-year course. This was slightly higher than in 2012 (7,358 or 43.6%).

Over three-quarters of all places in 2013 were Commonwealth-supported (13,315 or 78.4%). This is similar to previous years, with 78.8% of students receiving Commonwealth support in 2012 and 78.9% in 2011. Figure 1 shows that the majority of these (9,621 or 72.3%) received Higher Education Contribution Scheme (HECS). The remainder was in bonded places receiving assistance through the Bonded Medical Places Scheme (BMPS) and the Medical Rural Bonded Scholarship Scheme (MRBSS), which obligates the student to work respectively in a District of Workforce Shortage (DWS) for a period of time equal to the length of the medical degree, and in a rural area for six continuous years. In addition medical students can be supported by scholarships through a variety of other sources, namely the state or territory, the university or other institutions and, for international students, their home country.

Overall international students occupied 2,727 or 16.0% of places. These students are studying as private or sponsored students and are not Australian citizens, permanent residents or New Zealand citizens. This proportion remained stable from 2012. A small proportion of Australian citizens (871 or 5.1% of medical students) also pay fees. From 2009 new full fee paying undergraduate places for Australian students ceased to be available.

Figure 1: Medical students by type of student place: Number and proportion of places, 2013

Figure 1: Medical students by type of student place: Number and proportion of places, 2013D

Source: Medical Deans Australia and New Zealand Inc

In 2013, 261 medical students identified that they were Aboriginal or Torres Strait Islander. Although this is a small proportion of all medical students, it represents an increase of 15.5% from 2012 and is over two-and-a-half times the number of students who identified themselves as of Aboriginal and/or Torres Strait Islander origin in 2006 (99).

Of the total medical students, 3,669 were in the first year of their medical studies and 3,033 or 82.7% of these were domestic students.

Most students are under the age of 25 years when they commence their medical studies. Data from 2012 shows that just over four-fifths (81.1%) of students were under 25 years (Figure 2). A further 12.6% were aged between 25 and 29 years and 6.3% were 30 years or older. Over half (56.7%) of the medical students commencing in 2012 began their studies after finishing another degree.

Adult medicine and general practice were among the most preferred types of future medical practice for students in their final year of medical school and in their first postgraduate year (PGY1). Males ranked surgery as their most popular preference, while females favoured general practice.

Domestic students who had a rural background comprised just over a quarter of all commencing domestic students (769 or 27.1%), although the proportion of students with a rural background was higher among those enrolled in the Rural Clinical Training and Support Program (29.9%).

Figure 2: Commencing medical students by age groups, 2012

Figure 2: Commencing medical students by age groups, 2012D

Source: Medical Schools Outcomes Database

Over the last decade, the total number of commencing medical students has almost doubled, with the intake increasing by 1,780 or 94.2% from 1,889 in 2003 to 3,669 in 2013. This was primarily due to increases in the number of commencing domestic students, which rose by 100.7% compared with an increase of 68.3% for international students.

These increases are mirrored in the number of medical graduates each year. In 2012 there were 3,284 medical graduates, over double the 1,400 graduates in 1999 (Figure 3). The increase of numbers graduating annually fluctuated slightly up until 2006, but since then there have been marked annual increases of over 10 percent in most years, with the number graduating in 2012 being 10.8% higher than the 2,964 in 2011.

The trend is somewhat different between graduating domestic and international students. International students constituted just 10.3% (or 144 of 1,400 graduates) in 1999, the first year for which data on these graduates were published. Since then the number has more than trebled, rising by 252.1% to 507 graduating international students in 2012. The number has also increased as a proportion of all medical graduates, reaching a peak of 19.5% in 2009. The proportions of graduating international students have seen a downward trend since 2009, where it decreased to 15.4% of all medical graduates in 2012.

The increases in the number of domestic students graduating each year have been far greater over the same period, with domestic medical graduates increasing by 121.1% overall, from 1,256 in 1999 to 2,777 in 2012.

In 2012, 2,612 or 79.5% of medical graduates were Commonwealth-supported, with the majority of these in HECS only places. Three-quarters of fee-paying graduates were international students (76.5%).

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Figure 3: Domestic and international medical graduates, 1999–2012

Figure 3: Domestic and international medical graduates, 1999–2012D

Source: Medical Deans Australia and New Zealand Inc

From 2011 to 2012, the actual number of graduates increased by 10.8% rising from 2,964 to 3,284. It is projected that there will be 3,495 medical graduates in 2013, with further increases anticipated to 2015 (to 3,732). Based on current student enrolments it is anticipated that the number of medical graduates will be 3,796 in 2018 (Figure 4).

Figure 4: Projections of domestic and international medical graduates, 2012–2018

Figure 4: Projections of domestic and international medical graduates, 2012–2018D

Source: Medical Deans Australia and New Zealand Inc

Prevocational Medical Training

Satisfactory completion of the first postgraduate year (PGY1) is required before junior doctors can receive unconditional general medical registration. After PGY1, and prior to starting vocational training, most doctors spend one or more years working in the public, private or community settings to gain more clinical experience.

In 2013, there were 3,118 trainees commencing PGY1 (Figure 5). This was an increase of 168 (5.7%) from 2012.

Just over four-fifths (2,533 or 81.1%) of all PGY1 trainees commenced training in the state or territory in which they completed their medical degree.

PGY1 commencements have increased substantially each year, with the exception of 2007, showing an overall increase of 1,587 or 103.7% trainees from 2004 (when data was first collected for the MTRP) to 2013.

Figure 5: Postgraduate year 1 commencements, 2004–2013

Figure 5: Postgraduate year 1 commencements, 2004–2013D

Source: State and Territory government health departments

In 2013, there were 3,194 doctors who were identified as commencing in PGY2 supervised medical training positions across Australia. This was an increase of 93 or 3.0% from the previous year (Figure 6). This is likely to be an underestimation of the true numbers of doctors undertaking their second year of prevocational training, as unknown numbers may be recruited directly by health services.

The number of PGY2 commencements appears to have increased substantially in recent years. However, it is difficult to ascertain the true extent of the increase due to differences in the way prevocational trainees are actually contracted and methodological issues in obtaining data as a result of differences in the data captured through the various state and territory reporting systems.

Over two-thirds (2,249 or 70.4%) of all Australian trained local PGY2 doctors commenced their second year of training in the state or territory in which they were trained in previously, compared with 354 or 11.1% that came from interstate.

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Figure 6: Postgraduate year 2 commencements, 2004–2013

Figure 6: Postgraduate year 2 commencements, 2004–2013D

Source: State and Territory government health departments

Not all junior doctors go on to train in a Medical Specialty. A number continue to work in hospital settings in non-vocational career roles, typically as career medical officers (CMOs).

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.

Vocational Medical Training

Most junior doctors will seek entry into specialist or vocational training, which leads to a fellowship from a recognised medical college. Training is provided through the specialist medical colleges and, in the case of general practice, General Practice Education and Training Ltd (GPET). Vocational training programs are accredited by the Australian Medical Council. Each college has its own training program and requirements.

Data covers all Australian trainees, as well as international medical graduates who were registered vocational trainees and who were working or training in an accredited training position, post, facility or program.

There were 17,888 vocational medical trainees in 2013 (Figure 7). This is over two and a half times the number reported in 2000 (7,262 vocational trainees).

In total there were 6,056 basic trainees, representing one third (33.9%) of all trainees in 2013. There has been a constant increase in the number of basic trainees since 2004, mainly due to some colleges having introduced basic training as a pre-requisite to entry into their advanced training programs. Of the total number of basic trainees, 1,669 or 27.6% were in their first year.

In total there were 11,832 advanced trainees in 2013, making up the larger proportion of the total number of trainees, 66.1% of the total number of trainees. The increase in basic trainees has resulted in advanced trainees declining as a proportion of all trainees. However total advanced trainee numbers have risen by 85.5% since 2004.

Figure 7: Vocational medical trainees, 2000–2013

Figure 7: Vocational medical trainees, 2000–2013D

Source: Medical colleges

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 or at a minimum PGY2.

Approximately one-third (32.7%) of all vocational trainees positions were in specialties governed by the Royal Australasian College of Physicians (RACP), such as addiction medicine, adult medicine, occupational and environmental medicine, paediatrics, palliative medicine, public health medicine, rehabilitation medicine and sexual health medicine, with 22.3% in adult medicine (Figure 8). Almost one-quarter (22.8%) of all vocational trainee positions were in general practice and 11.5% in emergency medicine.

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Figure 8: Vocational trainee positions by medical specialty, 2013

Figure 8: Vocational trainee positions by medical specialty, 2013D

Source: Medical colleges

Fellowship

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 medical college.

There were 3,134 new college fellows in 2012 (Figure 9). This is a significant increase since 2000, when the data were first collected, with the number of new fellows almost trebling (178.3%) from 1,126.

In 2012, over two-fifths (1,402 or 44.7%) of all new fellows were female.

Approximately one-fifth (676 or 21.6%) of new fellows were overseas trained specialists who were assessed as having qualifications comparable with specialists trained by the medical college in Australia and given fellowship of that college.

Figure 9: New fellows by gender, 2000–2012

Figure 9: New fellows by gender, 2000–2012D

Source: Medical colleges

The proportion of new fellows in each medical specialty is shown in Figure 10. The proportionate split has remained approximately the same across the specialties over recent years, with approximately two-fifths (40.8%) in general practice. General practice had the largest increase over the last five years in terms of absolute numbers, with 438 more new fellows in 2012 than in 2008. There were also large increases in the number of new fellows in adult medicine, radiodiagnosis and surgery (increases of 153, 61 and 46 more new fellows in 2012 than in 2008 respectively).

Ophthalmology had the greatest proportional increase, with new fellows increasing from 14 to 38, or 171.4%, between 2008 and 2012, with radiodiagnosis also showing significant growth in the last five years (113%).

The significance of the increased training activity and consequently the number of new fellows can be put into perspective by looking at it in relation to the total number of college fellows. There were 51,967 fellows of medical colleges reported as actively practising in their specialty.

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Figure 10: Proportion of new fellows by medical specialty, 2012

Figure 10: Proportion of new fellows by medical specialty, 2012D

Source: Medical colleges

Overall new fellows represented 6% of all college fellows in 2012. The proportion of each college’s fellows that were new fellows varied greatly across specialties, with the largest proportions of new fellows in emergency medicine (10.1%), followed by anaesthesia – pain medicine (7.9%) and intensive care (7.7%).

Female Trainees

In 2012 females comprised half (49.0%) of the students commencing medical studies (51.2% domestic and 45.6% international students) and a slightly higher proportion of medical graduates (53.2% domestic and 52.9% international graduates). This proportion has varied little over the last three years, with females representing 54.4% and 53.6% of all medical graduates in 2011 and 2010 respectively.

In vocational training 53.4% of all basic trainees and 52.1% of advanced trainees were female in 2013. This proportion was far higher in some specialties, with females comprising three-fifths or more of advanced vocational trainees in sexual health medicine, obstetrics and gynaecology, rehabilitation medicine, palliative medicine, paediatrics, public health medicine, dermatology, and general practice (70.0%, 69.2%, 68.6%, 67.5%, 67.1%, 64.2%, 63.3% and 63.3% respectively). Ophthalmology and surgery had low proportions of female advanced trainees (27.8% and 28.1% respectively) in 2013.

The proportion of females who became new fellows in 2012 is somewhat lower than the proportion undertaking vocational training, remaining relatively stable at around two-fifths of the total new fellows each year since 2000. There were 1,402 new female fellows in 2012 (44.7%).

In 2012, 17,957 or 34.6% of all college fellows were female.

International Supply of Medical Practitioners

Overseas trained medical practitioners form a key part of the medical workforce in Australia, not only in rural and remote areas, but in all areas of Australia.

In 2012-13 there were 3,090 visas granted to medical practitioners across the two main subclasses – 457 and 442/402. Almost half (42.7%) of visas under the main classes were granted to applicants from the United Kingdom and Republic of Ireland. Just 5.2% and 2.6% of the medical practitioners granted visas came from Canada and the United States of America respectively. More recently, larger numbers of international recruits have come from a number of Asian countries. In 2012-13 almost a third (29.6%) of all applications were granted to medical practitioners from India, Malaysia, Sri Lanka, Pakistan, Iran and Singapore (8.4%, 7.3%, 5.5%, 3.2%, 2.9% and 2.3% respectively of all visas under subclasses 457 and 442/402).

In July 2006 the Council of Australian Governments (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 streams: the Competent Authority Pathway, the Standard Pathway and Specialist Pathway. The Australian Medical Council is responsible for processing applications by international medical graduates and overseas trained specialists.

In 2012, the Australian Medical Council assessed a total of 1,387 applicants through the Competent Authority Pathway, with 520 applicants being granted Australian Medical Council Certificates, allowing them to apply for general registration. Two-thirds of the Australian Medical Council Certificates granted in 2012 were to international medical graduates from the United Kingdom.

Under the Standard Pathway 1,656 international medical graduates passed the Multiple Choice Questionnaire (MCQ) examination and 964 passed the Australian Medical Council clinical examinations.

There were 2,346 overseas trained specialists, who applied to be recognised as a specialist under the Specialist Pathway to registration in 2012. Medical colleges conduct the assessments of comparability to Australian standards for the specialists and found 524 substantially comparable and a further 353 were deemed as partially comparable and requiring further training and/or examinations.

Of these 524 overseas trained specialists that were recognised as substantially comparable, over half (311 or 59.4%) were trained in the United Kingdom and Ireland. This is an increase from the number from these countries approved in 2011 (214 or 45.5%). The next largest number of overseas trained specialists (Figure 11) found substantially comparable in 2012 came from India (61 or 11.6%).

Figure 11: Country of training of overseas trained specialists with approved applications, 2012

Figure 11: Country of training of overseas trained specialists with approved applications, 2012D

Source: Australian Medical Council administrative data, 2011

Under Section 19AA of the Health Insurance Act 1973 (the Act), Special Purpose Training Programs provides for those doctors seeking vocational recognition, but who are not involved in a specialist training program. Some of these programs specifically cover medical practitioners who have trained overseas to assist with their integration into the Australian workforce and to promote them working in areas of workforce shortage.

At June 2013, there were 9,931 overseas trained doctors with section 19AB exemptions restricting their practice to Districts of Workforce Shortage (DWSs) in order to access Medicare benefits for the services they provide.

Although overseas trained doctors comprise a higher proportion of the medical workforce in more remote areas of Australia, the majority work in Major cities and Inner regional areas.

There is considerable variation between states and territories in the overall and relative numbers of overseas trained doctors. Queensland has relatively high numbers of overseas trained doctors across all regions, while Western Australia has relatively higher numbers in Remote and Very remote areas. Victoria continues to have higher number of overseas trained general practitioners in its Major Cities.