ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

“Commencing medical students are projectedto reach 3074 by 2010 (from 1470 in 2002). Thisis a much higher percentage than the increasein commencing nursing students in the sameperiod (from 8042 to 13,895). The flow-on effectof increased medical graduates to vocationaltraining will result in a large increase in medicalspecialist anaesthetists.”(FANZCA) or are well on the way to doingso, has been increasing. For the pastfew years, FANZCAs by this route haveaveraged between 22 and 25 per annum.But the rules are changing again –MTRP is re-inventing itself, and we nowhave the NHWT, the Health WorkforcePrincipal Committee (HWPC), and a recentdiscussion paper raises important issuesabout clinical placement, governance andorganization for all health professionals 10 .Source material included in this paper istaken from the Clinical Training Agency inNew Zealand, and from the UK NHS NextStage Review “A High Quality Workforce”.As would be expected, the clinical trainingdiscussion paper concentrates on theincreased numbers of health professionalsabout to enter the pre-vocational trainingworkforce, and does not yet address theissue of specialist training, althoughputative models are canvassed.Returning to ANZCA, after theAustralian Competition and ConsumerCommission (ACCC) completed its review ofthe Royal Australasian College of Surgeons(RACS), the ACCC and the Australian HealthWorkforce Officials Committee (AHWOC)reviewed the specialist medical Colleges,and published their report in 2005 11 . ANZCAhas done well in complying with allrequirements, and has also participatedin the program recommended by theEnhanced Medical Education AdvisoryCommittee 12 , supporting more applicationsfor training in the private sector than wereeventually funded by the government.With the projected increase in traineenumbers in a very few years time, it seemshighly unlikely that “training in private”will provide an adequate solution, andincreases in funding for trainees in publichospitals, and increases in specialistnumbers to supervise and teach them willbe required.From ANZCA’s perspective, all of theabove movements, combined with nationalregistration and national accreditationfrom 2010 will require serious planning toensure that there are enough anaesthetiststo keep providing the high quality patientcare the community will continue toexpect. It seems likely that the increasingnumber of Fellows in Australia, both bytraining and examinations, and via theIMGS pathways, and the program of theJoint Consultative Committee of ANZCA,the Royal Australian College of GeneralPractitioners and the Australian College ofRural and Remote Medicine (the latter notavailable in the UK) ably assisted by nursesin their traditional, and perhaps expandedroles, will avoid the need for radicalrestructuring of the anaesthesiaworkforce here.It is be hoped that when reviewed inanother year or so, it will be seen thatgovernment and its new agencies havesupported the Colleges, which producemedical specialists of high quality, a solidplank in our health system.Emeritus Professor Garry Phillips AMFormer ANZCA PresidentReferences1. Medical Training Review Panel EleventhReport, Australian Government Canberra 2007.2. Australian Medical Workforce AdvisoryCommittee, The Specialist AnaesthesiaWorkforce in Australia. Supply andrequirements, 2000 – 2011 Sydney 2001.3. Productivity Commission, Australia’s HealthWorkforce. Canberra 2005.4. KPMG, National Health Workforce Taskforce,Health Workforce in Australia and Factors forCurrent Shortages. 2009.5. Jolly R, Health Workforce: a case for physicianassistants? Research Paper 24, Social PolicySection, Parliamentary Library Canberra 2008.6. Thompson WR, Phillips G, Cousins MJ,Anaesthesia underpins acute patient care inhospitals. Australian Health Review 31 (Suppl1) 116 – 121.7. Grayling M, Thomas P, Lillie HJ, WilkinsonD, Physicians’ assistants (anaesthesia) –the Exeter experience. Royal College ofAnaesthetists’ Bulletin July 2008: 2570 – 2573.8. Association of Anaesthetists of GreatBritain and Ireland and the Royal College ofAnaesthetists, Joint Statement on physicians’assistants (Anaesthesia) – supervision andlimitation of scope of practice. www.aagbi.org9. Carver P, National Health WorkforceTaskforce, self sufficiency and InternationalMedical Graduates – Australia,Melbourne 2008.10. National Health Workforce Taskforce,Health Education and Training, clinicalplacements across Australia: capturing dataand understanding demand and capacity,Melbourne 2008.11. Australian Competition and ConsumerCommission and Australian HealthWorkplace Officials’ Committee, Reviewof Australian Specialist Medical Colleges,Canberra 2005.12. Department of Health and Ageing, ExpandedSettings for Medical Specialist Training,Australian Government Canberra 2006.The ANZCA Bulletin June 2009 25