To the Editor: In their letter of 5 October 2009, Wong and colleagues highlight the importance of providing training for surgical specialties in the private sector.1 With 64% of surgical activity in Australia now occurring in the private sector,2 and public hospital activity constrained due to ongoing budget imperatives, the Royal Australasian College of Surgeons (RACS) has been actively exploring this idea for some years.

The new Surgical Education and Training (SET) program selects trainees into one of nine specialty programs.3 Currently, there are 1254 trainees in the SET program across Australian, New Zealand and overseas positions. Once selected into a specialty program, trainees who succeed in achieving the educational goals will be able to progress through its entirety. Consequently, to enable completion of training in the program, each SET Level 1 post needs to be matched in the public or private sector with more senior training positions to ensure appropriate progression.

The RACS has worked with a number of private hospitals and the federal government to identify and fund 50 training positions suitable for surgical education across Australia. The funding has predominantly been provided through the Australian Government’s Expanded Specialist Training Program. This program was established following the release of the Medical Specialist Training Steering Committee report4 to encourage training in settings other than public teaching hospitals. The RACS is keen to have this program substantially enhanced and is attempting to identify models with the federal government that can achieve this.

This is where the work by Wong and colleagues1 is so important. The public and private sectors are different. Both can be highly useful for the education of a skilled surgeon. However, all educational environments need enthusiastic supervisors and trainers. The community and our patients also need to be understanding, supportive and enthusiastic for education of surgical trainees to occur. The RACS applauds Wong et al for progressing this discussion and highlighting the benefits that can result from expanding surgical training into the private sector.