To the Editor: Three recent articles discuss Australia’s medical education arrangements,1-3 but do not propose a way forward.

Dahlenburg notes “at least 10 different agencies are involved in postgraduate training”, leading to a “modern Tower of Babel”, but proposes eight more “independent” entities. McGrath et al comment timidly that a Productivity Commission suggestion for a national advisory council “has merit”, and Dowton et al simply comment: “It is time to comprehensively review the oversight and governance of postgraduate medical education and training.”

None of these articles even mentions General Practice Education and Training (GPET), an innovative Australian initiative. GPET was established in 2001 as an incorporated entity with a board appointed by the federal Minister for Health. GPET has established regional training providers (RTPs) across Australia. GPET is required under its constitution and government funding arrangements to provide postgraduate training according to standards determined by medical colleges.

For general practice, GPET provides features these authors find lacking in Australia’s medical education arrangements, such as “overarching governance and coordination”, “integrated mechanisms to draw together the interests of stakeholders”, “alignment between workforce planning, education and training needs” and “alternatives to teaching hospitals”.4 GPET manages the interaction between autonomous colleges and a funding agency, and conflict between the focused desires of young doctors and workforce policies, while organising training outside public hospitals.

Change is difficult, perhaps more so in medicine than in other sectors. Michael Foot, once leader of the British Labour Party, reflecting on political differences with the British Medical Association, wrote: “Much the strongest bent in the medical mind was a non-political conservatism, a revulsion against all change, a habit of intellectual isolation which enabled them to magnify any proposals for reform into a totalitarian nightmare. Nothing good could ever come from the meddling of outsiders.”5

GPET was a political response to effective lobbying from rural doctors rather than imposition of some grand centralist plan. Nevertheless, the imagined threat to professional autonomy evoked gloomy foreboding about “training standards spiraling downwards”.6 Maybe Dahlenburg, McGrath and Dowton realise controversy would follow any proposal for a medical education system with attributes they see missing, such as overarching governance, more coordination, alignment of workforce needs with trainee numbers, and wider distribution of training resources. It might require some consolidation of organisations, common structures and processes across disciplines, and some direction in the distribution of training resources.

Maybe these authors do enough by raising the issues and are wise to leave others to debate whether centralised control and coordination could solve the problems they describe. Maybe they took the advice of a well known Englishman and decided not to mention the war.7