Recruitment and selection

Each year our networks and training settings generally experience a significant number of medical trainees seeking to enter the Adult Internal Medicine or Paediatric & Child Health Basic Training programs, often in of excess of the positions available. Though this scenario doesn't occur in every part of Australia and New Zealand, a highly competitive environment is created overall for all involved in either side of the recruitment and selection processes.

Recruitment and selection of medical trainees to vocational training positions serves a dual purpose:

  • identify doctors capable of providing services to patients
  • provide doctors with access to a learning environment in which to train as a physician.

The terms recruitment and selection are used interchangeably throughout this guide.

Recruitment implies an activity where employers look for and attempt to get the best candidates amongst a limited pool of supply or it refers to the human resource process to facilitate applicants being employed.

implies an activity where the employer can choose amongst a larger pool of candidates or can be used to refer to the process whereby a decision is made for an applicant to enter a College training program.

Workforce planning

Workforce planning is a process used to align service needs and priorities with those of workforce requirements. Workforce planning can occur at any level, from a local training setting up to a national level. As recruitment of medical trainees in training positions is determined by local organisational needs and/or workforce planning, it is valuable to consult your institution or services workforce plan, if available.

Hospitals in Australia and New Zealand often rely heavily on medical trainees to meet their service needs and advertise a range of positions to attract the right medical staff. Of these positions, training positions (which allow for RACP accredited training) are generally the most desirable for candidates. Therefore, there may be pressure from the employer to increase the number of training positions to attract sufficient staff.

Case Study: Royal Darwin Hospital

The Royal Darwin Hospital (RDH) has many excellent facilities and positions for RACP trainees with 20 to 30 doctors appointed to Basic Physician Training roles per year. Basic Trainees occupy a diverse number of roles across the Top End Health Services. Having chosen to undertake training in a non-conventional training environment, they are often better placed to adapt to challenging resource limitations and complex patient needs.

The demand for skilled doctors continually outstrips the supply of applicants who aspire to physician training. There has been some improvement with the advent of a Northern Territory based medical school, which began supplying graduates to Top End Health Services in 2016.

As is the case in many rural and regional areas, the lure of accredited training positions has in the past been used as a key recruitment tool for RDH. This has led to situations where doctors who have a low likelihood of completing RACP training spend many years employed as a Basic Physician trainee with little hope of career progression.

The Director of Physician Education (DPE) reviewed the system of appointments of Basic Trainees at RDH and discussed it with administration, Human Resources and the clinician body. The result was an increased emphasis on the assessment of clinical expertise, sound clinical process, professionalism and trainability as key criteria for DPE endorsed registration as a Basic Physician Trainee with the RACP. This has meant that some doctors are employed by RDH and work in accreditable positions but are not appointed as Basic Trainees. There is a recognition that a doctor may be entrustable in a particular role but that this does not necessarily make them appropriate for a physician training pathway. This understanding also allows for trainees from other specialties, such as intensive care or emergency medicine, to access excellent training opportunities leading to reciprocal gains.

Doctors are interviewed throughout the year for Basic Trainee positions using a standard process, including standard questions, and an insistence on rigorous verbal reference checks from physicians willing to specifically endorse the applicant in their suitability for training. The candidate is at liberty to choose their own referees but must provide two current practitioners with whom they have worked closely. The idea that merit will form the basis of the best physician training opportunities is openly stated to all prospective candidates.

The revised process at RDH helps to ensure that those appointed to Basic Trainee positions are both able to work in the RDH environment and progress through training, upholding the RACP principle of striving for excellence.

Consultation with many training providers across Australia and New Zealand revealed that there is not one program and/or recruitment system that is alike. Despite many training settings still conducting their own recruitment. Local hospital and health service programs across Australia and New Zealand are increasingly looking to join with other programs, to form large networks that manage recruitment and selection.

Consequently, the majority of RACP Basic Training recruitment processes are occurring regularly and annually with large numbers of positions and applicants, for instance may be 50 training positions and more than 100 people applying for training positions. This process is managed secondary to the annual employee recruitment cycle run by health service employers.

A diagram demonstrating the interview and selection process in health services 

Recruiting in networks

Recruitment of trainees to training networks has several benefits for trainees, training programs and employers and is the model supported by the RACP.

Pros Cons
  • Enhances the ability to provide the required training attachments for trainees
  • Connects larger hospitals with medium, regional and rural for more effective training and workforce distribution
  • Improves the amount of resources available so that recruitment occurs in a more efficient, robust and fair manner, as well as potentially innovating by including newer tools that might increase validity
  • Connects national and regional workforce requirements alongside local requirements, including allowing for development of pathways for critical workforce needs (for example, rural pathways)
  • Allows for more inclusion and diversity of both trainees and positions
  • Risk that those involved in the actual selection become more homogenous and do not adequately reflect employer needs and requirements
  • Large networks will often require more effort in terms of collaboration
  • Often results in a less personalised approach

Training networks can remain reflective and responsive to local employer needs whilst meeting other priorities by reviewing the diversity of their Selection Committee to ensure a good spread of representation of stakeholder interests, as well as paying attention to the employer and service needs in the position design process.

Case Study: Basic Training – Adult Internal Medicine in New Zealand

The employment context for trainee doctors in New Zealand is somewhat different to Australia. The difference notably is a nationwide collective agreement between the Union representing trainee doctors in New Zealand, the New Zealand Resident Doctors’ Association (NZRDA) and all employers, as represented by the 20 District Health Boards (DHBs).

Those who are unsuccessful in getting a training position may be successful in obtaining a service role. Trainee doctors are effectively guaranteed continuous employment by a DHB, with provisions for transferring between DHBs, for the period of their training. There are some provisions for ensuring trainee doctors maintain satisfactory performance, including meeting examination and other training requirements to remain on their training scheme. Entry to initial registrar training roles will be competitive against other qualified applicants.

The competition for entry into Adult Internal Medicine Basic Physician Training is not as competitive as it is for some programs and centres in Australia. Programs in Auckland sometimes find that they have more positions than suitable candidates and may have to recruit additional trainees outside of the normal recruitment cycle.

With most trainee doctors already employed, the role of selection is more aligned with the issue of suitability to undertake RACP training. Generally, most candidates are found to be suitable which changes the focus of recruitment and selection to creating processes that will identify the small number of candidates who are not suitable. As medical trainees have tenure of employment, the situation can arise where it is difficult to transfer between DHBs. This situation can at times create perverse outcomes. For example, it can create a disincentive for doctors to leave larger hospitals to seek out rural training experience as this may jeopardise their chances of being able to return. In other cases, high quality trainees from peripheral centres find themselves ranked for employment selection below more junior incumbent doctors at tertiary teaching centres, who may not be enrolled in a vocational training program at all.

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