MEDICAL RESPONSIBILITY IN MURDER AND SUICIDE

In the last analysis then, the decision about the "needs" for numbers of specialists may depend on requirements for maintaining clinical competence (as a function of work load) and the capacity of the public, directly or through government, to pay for these specialist services. The utilization of specialist services is costly, since it is frequently associated with complex investigation procedures and hospital admissions. There is clearly a need for much more information about specialist manpower in Australia, and the report acknowledges these continuing deficiencies. However, these data will not in themselves provide any answers to whether we need fewer specialists or more in any particular field. It seems likely, from the information available, that there are many areas of specialist practice in which increasing the numbers of specialists still further will not contribute to the health and welfare of the Australian population generally, and it is possible that such an evolution may even. be inimical to these ends. What could be done about the growth of specialist manpower in certain fields, if this was felt necessary, on the basis of reliable information? The report outlines most of the feasible options. Our medical schools already provide substantially more graduates per unit population than do English or United States medical schools, and while foreign graduates are able to register easily in some States it seems difficult to derive any sensible policy about local graduates whilst there is no quota on this source of manpower. It is equally possible to regulate specialist training after graduation by restricting the number of recognized advanced training posts. This measure has already been instituted with respect to surgical training in South Australia. However, such a programme cannot be car.ried out successfully and without injustice to new graduates unless at the same time there is regulation of migrant registration and university medical school output. Sudden changes in specialist training opportunities, without overall reduction in the number of young graduates, is likely to provide serious problems with general practitioner training schemes such as the Family Medicine Programme. We may even witness a return to the "bad old days" when general practice became the alternative career for failed specialists. The report stresses the need to develop a clear policy with collaborative action between the many institutions and parties concerned. Registration of medical practitioners by State Registration Boards seems now to be wholly anachronistic; an Australian Medical Council should exist to carry out this function. There are no easy solutions to modifying the structure of the medical profession in Australia, even if the profession believes this is necessary. The time scale needed for such modifications is considerable, for the lag period from undergraduate entry to specialist career is approximately