Renal training and workforce. Nick Gray

Transcription

1 Renal training and workforce Nick Gray

2 RACP Trainees Adult Basic Advanced Paediatrics Basic Advanced Medical graduates: increased from 1195 to 2259 (b/w 2000 & 2010)

3 Renal Trainees Australia National Trainees Overseas Trained Physicians 25 NZ Renal Trainees 2016 Australian data includes 13 Paediatric renal trainees

4 Training sites Australia

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7 %trainees %trainees %trainees 45 PD exposure 6m Reported number of PD patients seen 30 HD exposure 6m 70 Home HD exposure 6m Reported number of HD patients seen Reported number of Home HD patients seen

8 %trainees %trainees %trainees %trainees 45 Biopsies 6m 45 Lines 6m Reported number of biopsies Reported number of lines 45 Acute transplants 6m 45 Clinics per week Reported number of acute transplants >6 Reported clinics/week

9 Average 128 Range

10 Average 93 Range 1-213

11 Average 221 Range

12 Average 17 Range 7-30

13 HWA 369 nephrologists in 2009

14 Health Workforce Australia Vol 3 Manual count currently 598 Australia, 61 NZ (of which 557 are ANZSN members)

15 The end product Where do they go? How does work differ by location? What are opportunities for ongoing education, maintenance of standards, and ensuring ongoing competency? What nephrology do they do? Academic, clinical, general medicine?? What non-nephrology do they do? How many hours work/week? Quality of the end product? Will rural demands be met with current system? How many do we need to train??? Renal AT vs gen med AT vs BPT or non-accredited position

16 Renal trainee numbers Propose no change to accredited training positions but that not all positions are filled with trainees in the nephrology program (minimum 25% reduction). Positions would be filled by general medicine AT s, ICU AT s, DEM AT s, etc Registrars working in non-accredited positions (enables time to demonstrate capabilities for future application for an accredited position) This would increase quality of nephrologists in future but also reduce quantity

17 Clinical Fellowships Propose that after completion of advanced training, option to undertake a further training period to upskill in a particular area Acute transplant, interventional, genetics, dialysis Rural Diploma concept

18 Communication Detail growth in trainee and nephrologist numbers on ANZSN website Detail that trainee numbers are not matched with job requirements

19 %trainees %trainees %trainees %trainees Knowledge Scores Procedural Scores 50 Clinical judgment 70 Research Scores Scores

20 Paediatric trainees (n=9) Sites 6-month exposures 3 NSW 3 Qld 1 Vic 2 Overseas Year AT 4 - year 1 2 year 2 2 year 3 1 year 4 Biopsies 6m Acute transplants 6m PD 6m HD 6m 5 none 1 0 to 5 2 at least 5 2 no transplants 3 2 transplants 3 3 transplants PD patients PD patients 1 - >10 PD patients HD patients 1 - >10 HD patients Knowledge Clinical judgment

21 Recruitment Networks State or region based Set standards considered acceptable for entry to training Selection process must be transparent (and published) Applicants must know if selection is for 1 year or guarantees longer training May facilitate rural rotations Trainees should be encouraged to travel and train interstate/overseas

22 Summary Rapid growth in trainees (reduced exposure leading to capacity to train issues) and nephrologists ATC Propose reduction in trainees Propose Fellowships Workforce vs training conflicts Inconsistent trainee assessments Site accreditation 3 streams of nephrologists Academic Clinical nephrologist General physician (perhaps better trained in general medicine) State based (or large network) selection Improved quality of trainees Need for more (and more accurate) data - ATC and RACP task

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24 Trainee Issues Sarah Stevenson

25 Topics for Sarah Rural vs metro.?mandate rural Should acute Tx be mandatory 2 vs 3 core years Is there enough LKDTx What else do trainees need?

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27 Training time Nephrology 2017; 1: 35-42

28 International comparisons USA (2013) Brown RS. AJKD 2012 Concern that current training involves less clinical care, less complete patient examinations than in the past The expansion of information over the years has raised the minimum base of clinical medical knowledge beyond the scope of the time currently allotted to trainees for patient contact

29 Rural exposure

30 Moving around

31 Acute transplant

32 Home dialysis

33 33

34 34

35 35

36 36

37 Spares

38 Higher degree

39 Procedures Procedures includes biopsy, tunnelled and non-tunnelled lines, +/- PD catheters

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41 ANZSN Workforce Survey completed surveys (329 nephrologists, 86 trainees) Nephrologists M:F = 243:86 Mean age 48.4yrs (M: 49.7yrs, F: 44.6yrs) 28 planning retirement in the next 5 yrs Average working hours 50.5hrs Public:Private = 84% Trainees M:F = 39:47 Mean age 34.9yrs (M 36.1yrs, F 33.9yrs) Average working hours 44.4hrs Public:Private = 100% AHPRA (Apr 2013) 409 specialist nephrologists RACP (May 2013) 98 trainees in Australia (93 adult, 5 paediatric) 23 trainees in NZ 7 OTPs completing peer review

42 Workforce Issues Current workforce capacity Current workforce distribution Current capacity to train Access to training Suitability of current training format Impact of the aging workforce