A pilot program aimed at trainees hopes to increase radiation specialists in regional areas, but it’s not a quick fix.
Radiation oncologists are a very small club – 433 at last count.
Of these, more than 80% are in major metropolitan centres. To address the long-standing imbalance, RANZCR has launched its Regional and Rural Training Pathway (RRTP) Pilot, offering five-year scholarship training positions for five medical graduates (PGY2+) or trainees at accredited regional and rural training sites, starting from February next year.
Regional and rural areas have always struggled to attract specialists, RANZCR president Clinical Associate Professor Sanjay Jeganathan said.
“There’s a crying need in regional and rural areas, because everyone gets cancer. But unless they’re homegrown, the likelihood of us generating enough workforce for the regions is not going to happen,” he said.
Right now, most training for radiation oncologists occurs in metropolitan areas. Graduates work for three to five years before being recruited as trainees, and another five years training in the speciality. After that, they undertake a further year or two attaining further education in specific cancers. Most people are at least in their mid-30s by the time they finish, Professor Jeganathan pointed out.
“After many years in a reasonably sized city, it’s an effort for them to move. By then the likelihood is they would be settled in, and maybe have children who have started schooling.”
Regional medical schools, which the federal government has recently boosted through additional Commonwealth supported places for rural-trained medical students and capital funding for new facilities, presents an opportunity, he said.
“The best model would be if we can train specialists close to those places. Those students who have gone to regional medical schools are more likely to want to stay there.”
At the Australian Indigenous Doctors’ Association conference last year in the Gold Coast, Professor Jeganathan had students from Darwin telling him they wanted to stay in Darwin and train for the speciality there.
“At present, we don’t have those kinds of arrangements. If we can make that happen with the help of government funding, it’s really a winner. But this is a medium to long term project, and we cannot fix it quickly,” he said.
Professor Jeganathan wants to see ongoing funding for training home-grown specialists. The pilot has four years of funding from the federal government under round two of the Flexible Approach to Training in Expanded Settings program. He would like to see it expand from five trainees this year, to 20 in five years’ time.
“But it all depends on government funding. Even getting funding for four years was a struggle,” he told OR.
“I can understand the constraints on government, but a minimum of five years is needed for any trainee taking up the program. Five is basically scratching the surface.”
Meanwhile, Australia does attract interest from overseas trained oncologists who, Professor Jeganathan assured, go through a rigorous assessment process.
But there are issues with the overall process, he said. There isn’t a coordinated government and hospital plan to attract talent. And it’s not a one-stop-shop for applicants. Once the assessment is complete, doctors need to find their own placement.
“Often they go through agencies. Some are good, some not so good,” he added.
Shortages apply across the health workforce, not just in radiation oncology. According to the Independent review of overseas health practitioner regulatory settings interim report handed to the National Cabinet on 28 April, “Employers and health practitioners report our registration and related immigration processes are slower, more complex and expensive in many instances than our international counterparts. This is especially discouraging skilled health practitioners and heightening workforce shortages”.
The report recommends fast-tracking overseas practitioner registration processes and is scathingly critical of inefficient process, duplication, inconsistencies and little support for applicants navigating a difficult system. In addition to needlessly onerous language requirements (above and beyond those in the UK and NZ), age limits and expensive visas, applicants from most countries – even those with similar regulatory frameworks – are forced to take additional training, exams, and long periods of supervision despite their years of experience.
“Advice provided to the review suggests that mid-career senior clinicians are choosing not to come to Australia due to perceived barriers, costs and uncertainties in the process. As a result, we are missing out on their knowledge and skills. Too often, applicants report that the current process makes them feel undervalued, disrespected and even demeaned,” the report said.
Applicants from “trusted countries” would be fast-tracked using “competent authority pathways (CAPs)” and the assessment of graduates would be undertaken by the Australian Medical Council, rather than the specialist colleges. The process is expected to start mid next year.
Professor Jeganathan agreed streamlining was needed, but he noted there were concerns among the colleges that standards could slip.
“And it’s a double-edged sword, because they’re not coming to work in Sydney and Melbourne and the risk is in the regions there is less supervision, so things can go wrong for a long time and no-one is aware of it.”