Costs of training health professionals – a cost to whom? Response to: The real cost of training health professionals in Australia: it costs as much to build a dietician workforce as a dental workforce DOI: 10.1177/1355819616668202

Segal et al. ¹ explored the return on investment for training health professionals in Australia, by comparing direct training costs to expected career length across several primary care professions. The ‘cost per year of clinical practice’ metric used in the study enables interesting comparisons, such as ‘it costs as much to build a dietician workforce as a dental workforce’.

We commend the authors for their contribution to the knowledge gap which exists around financing and sustainability of the health workforce, as identified in the World Health Organization’s 2013 guideline ‘Transforming and Scaling Up Health Professionals’ Education and Training’. ² However, an additional consideration within this paper, which we feel is important to the readership, is to consider who bears the cost of training, and how it provides context to the authors’ conclusions. Cost sharing in education is currently topical in Australia, with the recent release of the ‘Higher Education Reform Package’ planning to decrease government funding and shifting costs towards educational institutions and individual students. ³

Using the example of university education in Australia, for a dietician versus a dentist, the ratio of private contribution to public contribution is 42:58 and 32:68 respectively (calculated using the ratio of maximum student contribution to government contribution; dietician $9050:$12,641; dentist $10,596:$22,809). ⁴ Therefore, while the total cost per year of clinical practice may be similar, the dentistry workforce may represent a larger cost to the taxpaying public.

In the clinical training phase, there is the added consideration of how costs to the clinical training provider (e.g. public or private hospital, or community health centre) are calculated and attributed between stakeholders. Australian funding for clinical education has typically been based on historical agreements, as prior to the 2016 ‘Independent Hospital Pricing Authority Teaching, Training and Research Costing Study’, there were no thorough investigations into the costs of clinical training. ⁵

Under the current funding model, placement providers receive the same amount for all allied health students, regardless of profession.^6,7 However, different allied health professions cost different amounts to train. For example, the clinical training cost per student per month is $2871 for physiotherapy and $3168 for psychology. ⁸ It is generally thought that the costs of training outstrip the funding received by clinical training sites, ⁵ which may shift costs onto other stakeholders, such as unpaid overtime by clinicians, decreased service provision to the public or costs otherwise absorbed by the clinical training organization.

The rising cost of health professional education is a growing challenge in all countries. ⁹ There is a need for evidence-based decision making in regards to what costs are appropriate and who should bear these costs. ¹⁰ A careful balance is required to ensure that there is satisfactory return on investment for health professionals’ education – from the perspective of all stakeholders.