Cap med schools now.

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A number of conspiring circumstances has lead to a doubling of medical student graduation in a decade and has resulted in training and career bottlenecks, as well as contributing stress to our training hospital system which impacts on patients.

The demand for med student places far exceeds supply. Students and families will pay and travel to take a chance on medicine.

Universities in that competitive tertiary market are therefore safe in seeking the prestige and financial gain that a medical school brings. The management consultants will say it is a no brainer and the league tables take into account whether there is a med school in the stable on campus. No-one is stopping them and they take no responsibility for their alumni if the degree is just an expensive print on the wall. Self serving arguments about increasing remote and regional supply are advanced with no evidence that increasing the number of city graduates from wealthy backgrounds that can afford the fees improves workforce distribution.

The idea that MBBS or MD students who miss out on jobs can go find something else to do, like someone with a legal degree perhaps can historically, ignores the special characteristics of medicine. The expense, the focus on preparing to work in a doctor vocation, and importantly the impact on patients, other students and teachers in a stressed teaching environment. Every med student that never uses their skills has wasted the time of everyone in the clinical training setting and diluted the experience for those who will need to work with patients in future. No-one wants to be that student.

The intense competition for specialist training places has seen the rise of CV buffing, an arms race of further activity of marginal relevance that will worsen as we approach 1000 grads with no training opportunity in 2030, even on current numbers. It is not good for anyone to have doctors who cannot work in the sector, as more grads pile in behind them.

Workforce planning though earnest can easily be overwhelmed by a politician’s desire to see a medical school in their electorate. The projected number of doctors that we will need are always wrong. Predictions of an undersupply decades hence usually seems to ignore several important factors and rely on many cumulative assumptions. For example, just because demand for service may increase, it does not follow that it will be funded and the work will be done. Technological innovation such as AI may see rapid reduction in the need for investigative, diagnostic and even therapeutic roles.

The important role of overseas trained doctors to fulfil temporary shortfalls should be acknowledged and used as required, rather than over training domestic city graduates who cannot find other employment to pay off their large debts when they are left directionless in medicine.

Cap med schools NOW.

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