Our Specialist College system has been the benchmark for many other countries in our region, as they progress towards their own unified national standards for specialist accreditation. The Australian and New Zealand College of Anaesthetists (ANZCA), for example, has played an instrumental role in the development of specialist anaesthesia training systems in Singapore, Malaysia and Hong Kong.
I’ve worked in the Hong Kong medical system for close to 10 years, and their College system has played a formative role in guiding the development of a national standard for specialist training in Mainland China. We saw first-hand the difficulties faced by the countries in our region that lacked a single strong unified standard – in many of them, specialist training occurs at a multitude of individual hospital, university or provincial-level departments.
This leads to a fragmented specialist accreditation system, with difficulties for doctors wanting to move between hospitals, cities, and internationally; and significant difficulties for patients wanting to identify appropriately trained specialists. Quality of service always inherently falters under these conditions.
A strong opinion within the Australian medical community is that the Expedited Specialist Pathway (ESP) risks fragmenting our world-leading, unified and nationally recognised College-led specialist accreditation system. Instead of Australian hospitals and patients being able to rely on a single identifiable National Fellowship as an indicator of quality training, we will regress to having a multitude of differently trained specialists, registered under the broad and wide-sweeping assurance of ‘equivalency’.
The ESP’s key driving factor has been to address workforce shortages, with six specialty groups currently chosen: Anaesthesia, General Practice, Psychiatry, Obstetrics and Gynecology, Physician–General Medicine and General Paediatrics. There are many reasons for our current service deficit nationally, but an important contributor is the inadequate number of specialists able to be trained in our public hospitals.
These are our main vehicles for training, and they have been strangled for capacity over the last 25 years. Additionally, some of our smaller specialist Colleges have also been communicating to the Government for some time about their struggle with the financial and human resource requirements to rapidly increase their Specialist International Medical Graduate (SIMG) accreditation pathway numbers. But rather than working within the existing system and assisting these Colleges to achieve this, the decision has been made to create a separate parallel pathway.
Our Specialist Colleges recognise the value that SIMGs bring to the workforce, and the Colleges have developed their own pathways to Australian fellowships for SIMGs. ANZCA has a very robust and efficient system for its SIMG members wanting to attain specialist registration through fellowship, a system which remains more popular with our SIMGs than the ESP. We have not seen evidence that the ESP has been able to allow SIMGs to be registered significantly faster than under the ANZCA pathway. It is difficult to see how the ESP processes can provide the deeply collaborative systems our Colleges currently do, to allow our valuable SIMGs to feel supported and integrated into the wider Australian Specialist community.
Of real concern is the significant risk of creating a perceived second class of Specialists registered under the ESP. Our SIMGs universally speak of the importance of being included in the wider Australian Specialist community, and our Colleges have always benefited from the valuable contribution SIMGs have made to our hospitals and healthcare system overall.
At a time when developing countries around our region are looking to move away from their fragmented Specialist training programs, and towards the Australian College System as their benchmark for a unified national system, these changes risk a significant regressive step for the reputation of Australian healthcare.
We are strongly advocating for the ESP to be a temporary stop-gap measure for increasing required workforce numbers, that should be phased out once there is evidence that the individual Colleges have been able to achieve a comparable capacity and timeframe for accreditation. We would instead like to see initiatives that work with the Colleges, to assist them to expand and enlarge our public health system-based training programs, to achieve our common goal of a safe and accessible medical workforce serving the Australian public.
