This year it is anticipated 100 new medical graduates will go without intern placements in New South Wales. This problem has arisen due to a failure of the State to expand the positions in workforce whilst the Universities have increased training positions under Federal policy.
These graduates don’t need to miss out if we take a closer look at the way hospital medical practice is designed. Traditional inpatient services are built around teams that consist of an intern, plus or minus a resident, a registrar and a consultant. The normal workday would consist of the intern and registrar working a day shift. In the evening and overnight there is a progressive drop in the numbers of interns, residents and registrars providing ‘cover’ of the wards.
This traditional model of practice is inefficient. Once the day ends routine tasks done my junior medical officers are left undone. These include important tasks like discharge correspondence, recharting and ordering medications, etc. These are the tasks that smooth the patient journey ensuring patients move in and out of hospital in time effective manner. In addition the reduction of staff in the evening can reduce patient safety simply by virtue of having inadequate staff numbers available when patients deteriorate.
A different model, which some teams already use, warrants broader adoption. The ‘surplus’ junior medical officers should allow there to be dedicated early morning/day and afternoon/evening shifts that overlap. This means greater doctor coverage of the patient load and also the opportunity to process the routine tasks in a more effective manner. One of the problems of hospitals is that they are open 24/7 but don’t perform their core business functions on a 24/7 basis. Increasing core activities from 8 to 12 or 16 hours a day is a way of increasing productivity, safety and quality.