An Australian junior doctor argues vested interests and apathy are preventing meaningful reform to resolve the medical training crisis in Australia.

We have all heard of the training crisis, and many of us live its effects day to day. Here are 10 reasons why you shouldn’t hope for a resolution any time soon.

1. Your patients might benefit and there is no evidence that they are harmed

Each patient now has an army of juniors fighting to provide them with the best care so that they can impress the team of consultants who control their fate. 

Sadly, juniors are often abused, and patient benefit might be an illusion, because:

2. Consultants benefit directly

You know that audit that needs doing, or that family that needs to be contacted, or that late night surgery that should be done under supervision… no problem, the unaccredited will do it. 

Who cares if you let them know at 10pm the night before a 6am ward round, or if patient safety is put at risk. If they don’t do it you can just sabotage their career with a bad reference, right? 

Oh, and by the way, if they need you when you’re on call, tell them to call your secretary. You’ll be in your private rooms.

Sure, that might be the (common) worst case scenario, but even the good ones are unlikely to actively help because: 

3.  Most consultants don’t care or don’t understand. 

Either your consultant is busy juggling their own private practice, a spouse, young kids, a beach house, whatever. I.e. They’ve got real problems!

Or.

Why are all the juniors complaining about so many years of training? Medical school is 5 years and done straight after school, then 1 year of internship, 1 year of residency, 5 years on the program and you’re done… complete with a sweet private income by 35. Right?

Wrong.

Or maybe it’s because: 

4.  Consultants are afraid of the competition

I found out today that my HMO or unaccredited registrar has 15 publications and a PhD. I don’t want that sort of competition in my private practice, thank you very much. 

Or maybe consultants expect an institutional approach to the crisis, but:

5. Universities and politicians created this crisis

Medical schools come with prestige, funding, and LOTS of student fees. Anyone discounting this as a factor probably isn’t aware of the rebranding of MBBS degrees as MDs, with an associated increase in fees and the reintroduction of the previously abolished full-fee paying domestic student. Why let students pay for one degree, when they can pay for two?  Serious side-eye, Melbourne. 

New medical schools are also expensive to establish and come with great political fanfair and false promises about increasing rural training opportunities. The old saying goes that people stay where they train, and increasing medical student numbers doesn’t equal more rural training opportunities. Alas, anyone hoping for a reduction in student numbers is dreaming. 

Good luck paying off a 6-figure debt as an unemployed, 37 year-old PGY8 with no career prospects.  

Okay, but we’re all doctors, right? Surely our representative bodies will help: 

6. RACS (or any other college) doesn’t care either

In the words of the RACS President of Council and Board Chair in response to the Dr Yumiko Kadota story:

“we have limited influence over unaccredited registrars, whose protection predominantly falls to hospitals’ human resources department”

In other words, "We don't care, it's not our problem." 

Which is partly understandable because:

7. Colleges aren’t responsible to or for non-members

Sorry, you’re not part of the club…and since there is no organisation centred on pre-vocational trainees, you’re also not a part of any other club. 

Bad luck! 

Although maybe it’s also because:

8. The colleges profit from the crisis

So, we can charge juniors thousands to sit the exams, thousands to apply, and thousands once they get on. All without any justification? And then only accept 30% of candidates each year or arbitrarily fail a bunch so they have to re-sit and pay again…. Move over Ponzi scheme, there’s a new kid on the block. 

But surely the AMA will help? Actually: 

9. The AMA doesn’t care either

We know that we have a history of dreadful inaction on this matter. We also understand that due to university debt, postgraduate study, college exams, and yearly contracts, many doctors-in-training are in a precarious financial situation. 

But please give us $1,000 and we’ll think about doing something.

No wonder AMA membership amongst doctors-in-training is at a record lows. 

Okay. So, my consultants won’t help, and institutions won’t help. What about my friends?

10. Your accredited colleagues don’t care… and are probably working against you

“I know we were great friends at med school and during internship, but it’s your fault for choosing the wrong specialty.” 

“I worked hard to get through my exams and deserve the benefits. I know you passed the exact same exams but….” 

And don’t you dare open the flood gates, colleges, this is my time to work in a competition free environment and start paying off my own debt. 

But most importantly:  The system still works for a critical mass 

As of November 2020, the system is still working well enough for enough doctors that it scuppers any meaningful drive for reform. Despite widespread denial, the key metric for this is money. Anyone who dissociates the desire to protect the private incomes of consultants from this crisis is either wilfully ignorant or totally delusional. The broader medical community’s apathy at best and complicity at worst grants our leaders implicit permission to prioritise the masses’ income over the welfare and careers of junior doctors, which they routinely do. Junior doctors suffer as a result, that much is obvious, but no one cares quite enough to do anything about it. 

If this article has raised issues for you, help is available at:

Doctors’ Health Advisory Service - http://dhas.org.au

Lifeline on 13 11 14

beyondblue on 1300 224 636