Volume 197 - Issue 4
Does it take too long to become a doctor?
Authors: Dev A S Kevat and James M Hillis
Med J Aust 2012; 197 (4): 212. || doi: 10.5694/mja12.11018
Published online: 20 August 2012
Published online: 20 August 2012
To the Editor: We read with interest McNamara’s pieces on the length of Australian medical training. The current training system is more a crude result of historical evolution than the outcome of a strong evidence base. The extra time taken by Australian doctors to become competent at a procedure is likely mirrored in other areas of medical knowledge and skill because of both internal (doctor) ...
To the Editor: We read with interest McNamara’s pieces on the length of Australian medical training.1,2 The current training system is more a crude result of historical evolution than the outcome of a strong evidence base. The extra time taken by Australian doctors to become competent at a procedure is likely mirrored in other areas of medical knowledge and skill because of both internal (doctor) factors including learning attributes and interests, and external (environmental) factors, such as supervisor guidance and “chance” clinical experiences.
With respect to length, Australian training programs are longer than most, but not all, international comparators. In the United Kingdom, general practitioner training takes 5 years (compared with 4 years in Australia) and speciality physician training is usually 9 years long (compared with 7 years in Australia).3 However, North American programs are considerably shorter than Australian equivalents (eg, 5 post-graduate years for a urology or plastic surgery fellowship in Canada4). Some countries, including the United States, allow for general specialists (eg, general paediatricians) to complete their postgraduate training in 3 years (compared with 7 years in Australia).5
Increased medical graduate numbers have created several brewing pressures that threaten to lengthen Australian training further. The growth in graduate numbers is projected to create a 400-position shortfall by 2016, with associated delays in progression in many career paths.6 Increased numbers will likely also decrease doctors’ clinical exposure, and potentially their learning opportunities, as hospitals attempt to employ more trainees in a cost-constrained environment. An increased proportion of time is likely to be spent by doctors on “cover” shifts (typically out-of-hours management of patients on multiple teams), diluting their contact with direct supervisors and their educational experience. This would include the loss of valuable “incidental” teaching, such as consultants asking questions on ward rounds.7 These issues will need to be tackled decisively to prevent Australia’s long road to fellowship becoming even longer.
Competing interests
No relevant disclosures.
References
- McNamara S. Does it take too long to become a doctor? Med J Aust 2012; 196: 528-530. 0_BABIHJDE
- McNamara S. Does it take too long to become a doctor? Med J Aust 2012; 196: 595-597. 0_CHDBGFFC
- National Health Service Medical Careers. Specialty pages. http://www.medicalcareers.nhs. uk/specialty_pages.aspx (accessed Jun 2012).
- Royal College of Physicians and Surgeons of Canada. Credentials and examinations. http://rcpsc.medical.org/residency/certification/ (accessed May 2012).
- American Board of Pediatrics. A guide to board certification in pediatrics. https://www.abp.org/abpwebsite/publicat/certboi.pdf (accessed May 2012).
- Health Workforce Australia. Health workforce 2025: Doctors, nurses and midwives — volume 1. Adelaide: HWA, 2012. https://www.hwa.gov.au/sites/uploads/health-workforce-2025-volume-1.pdf (accessed Jul 2012).
- Temple J. Time for training: a review of the impact of the European Working Time Directive on the quality of training. http://www.mee.nhs. uk/PDF/14274%20Bookmark%20Web%20 Version.pdf (accessed Jun 2012).