St Anywhere is a teaching hospital. Does anyone actually care? What is the difference between a teaching hospital and a non-teaching hospital? The answer to these questions depends on who you ask.
The “bean counters” see only expense from the teaching hospital. They employ extra junior doctors, physiotherapists, nurses and social workers. These individuals take time to supervise, create problems from their inexperience and move on at the end of the year with the arrival of a new crop of inexperienced workers to train. In the case of medical staff, the necessary overtime creates considerable additional expense for the system. The College of Surgeons and other specialist colleges have strict rules about exposure to patients required, library facilities and adequate support for junior staff. Add onto this the need to train undergraduate medical students (unpaid admittedly) but occupying already overburdened staffs’ time and the challenge becomes substantial.
The Federal Government has recently approved and almost doubling of medical student numbers without much planning how they would gain the necessary clinical experience. The so-called tsunami of students is now washing over the system. These students’ demands have been largely absorbed by public hospital staff as part of repaying their “teachers” from before. In the case of medical teachers, until 30 years ago nearly all teaching was done by “honorary” hospital medical staff, unpaid for their contribution to both public hospital patients and students. The new generation of staff and students, however, have grown up in a different system. Students and trainers are more demanding, and staff are less altruistic.
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Last week I was contacted by a trainee surgeon who expected to be paid 150% loading to watch an operation they had not seen before but was to be performed in the early evening. I encouraged the attendance but denied the payment. Without strong, enthusiastic teaching hospitals we will not have a new generation of doctors, nurses and other staff to care for us when ill. However, Government must understand teaching is rarely efficient. I can probably do 50% more surgery without a junior doctor to supervise during a theatre list. Trainees also need to understand that what patients and staff give freely to them should also be valued and a teaching environment does not quite function like a strict clock on-clock off work site.
Departments of Health seem to care only about waiting lists, costs and budgets. They do not seem to understand the huge costs of importing and integrating overseas doctors, the value of a community generating its own “home-grown” workforce and fail to measure the excellence in training provided by a teaching hospital.
Ask any bureaucrat within a health department how the KPIs (Key Performance Indicators) for teaching are measured and reported, and watch the glazed look appear. We need to ensure teaching is valued and measured as much as budget over-runs and surgical waiting lists are revered.
Guy Maddern is professor of surgery at the University of Adelaide