Your diagnosis is correct. But what is your cure? How will you ensure the cure is not worse then the disease?
How many years do you think it would take to devise a new curriculum? How many more years for the new curriculum to be bedded down? What do you think is the essential knowledge base for a doctor practising in the year 2020 say?

Undergraduate-entry program typically last 5-6 years, you end up with something like a Bachelor of Medicine (BMed).

Then a one year internship in a public hospital. Upon successful conclusion of the intern year, doctors qualify for a full registration in the Medical Board of their State or Territory, and are licensed to engage in independent medical practice.

SO in theory a "Doctor", note the bachelor's degree, can practise medicine after 6-7 years of study.

Of course he then has to be accepted into a "College", you know the Doctor unions, designed to keep numbers small so as to increase wages and conditions for its members. (A nice "closed shop").

Maybe it is time to stop calling them doctors until they have a Phd, which usually requires a bachelors degree with first class honours, then a further 3-4 years study resulting in a thesis.

Becoming a REAL Doctor usually takes 8-9 years.

Steve,

PhDs know a lot about very little. GPs, (the ones who used to be able to set up and practise independently after completing their intern year) are expected to know quite a lot about a great many things. These days doctors who work in general practice but don't have vocational registration (i.e., Other Medical Practitioners) can expect to go broke unless they have extremely loyal patients who don't mind having much larger out of pocket expenses than do people who consult vocationally registered GPs. The Medicare rebate for OMP consultations has risen hardly at all in the last 20-30 odd years.

So in the real world where most people live a qualified GP will have done either an undergraduate degree taking 5 years or a graduate entry degree taking about 7 years (assuming a 3 year undergraduate qualification). Then there's 1 intern year and 3 - 4 GP training years. That adds up to either 9-10 years or 11-12 years; a little more time than it takes to train a REAL doctor - such as yourself, perhaps?

jrm

the 3-4 years you talk about are when "Doctors" work as RMOs then they have to be accepted by a "College" to either work as a GP or as a specialist.

While working as an RMO there is a 38 hr working week, with overtime and working RDOs able to be "banked". (This applies in Qld)

My GP has closed his books taking no new patients, it takes at least a week to get to see him.

No Doctors are not cheap labour, they should realise how good they have things. A closed shop with a well funded and media savvy "union".

Why ,if they are legally allowed to practice after the 12 month internship, does it take another 3-4 years before they can?

I have watched as bureaucrats have taken over wards and over nurse and trainee doctor accommodations and turned them into offices. They've supplied themselves with the latest in computerised systems to check on bed-day-occupation-rates and whatever else it is they check on but they have yet to wake up completely to the fact that computerisation has something to offer in relation to the actual practice of medicine.

Just in the last twelve months or so I saw a newspaper report concerning complaints about doctors' handwriting and the deciphering of prescriptions for patients in a hospital. Good grief! Why, after all this time, are there any hospital doctors at all who are still having to write prescriptions by their own hand rather than by selecting the appropriate item(s) on a computer screen?

Tanveer Ahmed thinks the problem is with the "grey, old men sitting in the colleges". It's not, or it's not entirely. It's also with the bureaucrats who know nothing about the practice of medicine, little about the uses of information technology and, because of both the former and the latter, little about how to use information technology to speed up the training of doctors. Therefore they haven't understood that bigshot medical/surgical specialists might benefit (and benefit us all) from being provided with training on the uses of info tech. (Ah, but they're already so well off - why should we give them anything more without requiring them to pay through the nose for it?)

And then there are the lawyers. It's because of the lawyers that diagnostic decision support systems have languished. Considering that one of the key reasons doctor training take so long is that the medical bigwigs want their trainees to have lots of experience, and considering that the reason they want trainees to have lots of experience is so that they can recognise the strangely abnormal from the normally abnormal, the value of well constructed decision support systems should become clear to any bureaucrat with half a brain. But I'm not betting on any whole-brained bureaucrat achieving a position of influence in the near future.

I started Medicine in 1990 and did not achieve my 'independent' right to practice - an FRACGP until 2005. That's 15 years for my PhD friends. I did not fail any of my degree, but I did go out of my way to try and be the best I could, develop well rounded skills and then to offer what I have for the benefit of my patients. If money was the standard to be measured, then cheap labour is right on the money! I'm a GP, I don't close my books, I make sure one third of my appointments are available at the start of each day, and I often work 12- 14 hour days - in the city! Not because I want the money, but you tell me how you decline to see a sick child at the reception desk, or refuse a home visit on an elderly patient of the practice. Yes, administrators have worked our system such that we are old and jaded before we start, the exuberance of youth a distant feeling. I'd like to go back to the hospital system to gain more skills in palliative care or obstetrics, but I could not afford to drop my pay to one third, as I have long standing debts to clear and new open mouths to feed. Who suffers? Every patient of every doctor.

jrm and S madden seem to be having a little spat on who can really lay claim to the title doctor -it is of little consequence really.

But doctors do seem pretty precious when it comes to titles. Dont mistake a Doctor for a Mr what ever you do.

jrm is also fairly scathing of health bureaucrats - he uses an example of poor medicos hand writing and then accusing bureacrats of failing to apply a technological solution - here is another possible solution -

get the medicos to do as they are bloody well told! - there is a novel idea!

most health agencies request drug orders be written legibly using generic terminology - not the brand names of the drug company who funded the Drs last note pad, pen or trip to Vanuatu - eventually when all hospitals are kitted out with voice recognition software they will not even have to write an entry in the medical record - but until that happens courtesy would dictate they have some consideration for the poor patsy who is responsible for administering the drug. But history can attest to the fact that that is waaaay toooo much to ask

Clearly jrm has all the answers - I suspect he might be a medical practitioner - but health bureacrats do not have a mortgage on dumb decisions - medicos commit their fair share - in fact many health bureacrats are also clinicians - my take on that is jrm thinks these are failed clinicians.

Young doctors are abused because older doctors simply wish to perpetuate the same rights of passage that they were subjected to.

Steve,

Doctors can no longer set up an independant practice after intern year.

Several years ago, the Howard Govt restricted Medicare access as it was thought that there were too many doctors.

So, until a doctor attains Fellowship with one of the Colleges (becomes a consultant) they are not able to bill Medicare (and access the rebate) for seeing pts. Therefore they cannot earn an independant income.

Instead, fully registered "junior doctors" are employed by hospitals as they undergo their College training; they have numerous Medicare Provider numbers linked to the location of the hospitals/clinics where they work, which are only for the purpose of ordering diagnostic pathology and radiology tests. They do not see any money from Medicare - their income is solely from the salary the hospital pays them.

While junior doctors (and yes, i am one) have unions, the pay conditions are far from lucrative. My friends who finished engineering, IT and other professions earn far more than me, and are able to progress far more quickly up the seniority ladder.

Anyone who goes into Medicine for the money would be sadly disappointed!

Undergraduate medical training is undergoing a quiet revolution, and it is time - as Dr Ahmed points out - for post-gradute medical education to do the same.

I do not in any way mean to belittle doctors, heck they keep me alive.

My GP is the most caring person I have ever met, my rheumatologist is a wally and my heamatologist is just incredible.

I talked to my GP about this issue today, he said he had always wanted to be a heamatologist and did well in his college entry exams. He did not get in, not because of ability, but because "they" limit entry.

There are two heamatologists where I live, one has closed his books the other is bordering on incompetence. So I choose to travel to Brisbane to see a specialist in a private hospital. (Mater Private)

What other industry (forget professions, the term is now debased) can set up a new business with guaranteed payments from the Govt?

How many Docs actually work for themselves (I heard Bruce Flegg say he employed 200).

Why is the medical industry not based on talent?

As long as the medical practitioner is the sole 'gate keeper' in the medical model they will be overworked. It suits government policy though.

Many people see medical practioners for advice and treatment that could be provided by others. No, I am not including alternative health practioners but I am thinking that (say) a new mother would be better off seeing a community nurse to resolve some of her concerns than a GP.

It is true though that young doctors are overworked sources of cheap labour in hospitals. It is counterproductive because it contributes to illness and early burnout.

Want a way to make health delivery more efficient in Australia? Easy, cull those bloated health bureaucracies at federal and state level and put the money into community health centres. Why should health have to have such huge management overheads?

There is an imbalance between the number of trained people who directly deliver the services and those who are 'administering, managing and coordinating' - so often these are euphemisims for busywork for salaried fat cats.