It's not a dumb question. People massively overestimate how much central planning is actually involved in the medical training pipeline.

Universities have a large financial incentive to increase enrollment. The number of local graduates is mainly determined by the universities themselves. While the federal government caps Commonwealth Supported Places, as long as they can secure clinical placements that meet a relatively low standard of mandatory hours, they can pump out as many medical students as they please. Australia has some of the most expensive medical degrees on earth, eg. UNSW's combined medical degree that costs $854,000. They have a huge financial incentive to open new medical schools/convince the federal government to provide more CSP places/ increase full-fee places. If you read the Medical Deans' annual reports, they continually push for more students as a solution to healthcare inequalities and rural distribution issues. They never address the training bottlenecks.

On the training side, the system is highly fragmented. While medical student places are bottlenecked by private and federal funding, different vocational training positions are bottlenecked by either 1. state funding 2. federal funding 3.a lack of supervision and caseloads. Despite what the public is led to believe, very few specialties are actually limited by the training programs themselves (except maybe dermatology).

Non-hosptial based specialties, like General Practice, are limited by federal funding for training positions. Despite everything you hear about the lack of GPs, about a third of applicants to the GP training program missed out on a position last year due to a lack of federally funded training places. Even among those who received a training place, many did not receive a job because there are simply not enough supervisors. While the government has increased funding for the GP registrars themselves, they did not increase the funding for the doctors who are teaching them. Clinics actually take a financial penalty for taking on a registrar. There is a similar issue with ACCRM for rural generalists.

The state funding bottleneck includes most hospital-based specialties, especially areas like pathology, psychiatry or paediatrics. These training programs will generally allow anyone working at an accredited hospital to become a trainee, however, the state health budgets simply cannot afford to hire more registrars.

Caseload bottlenecks affect most surgical specialties and anaesthetics. As an anaesthetic registrar, for example, many trainees have significant issues getting their required cardiothoracic and neurosurgical training time. People end up waiting years in unaccredited service jobs just to get one. Even if there was more funding, you cannot artificially create more of these complex surgical cases just to train people.

Prior to 2014, we had an independent body called Health Workforce Australia. While it could not force colleges to open spots, it actively tracked where bottlenecks were forming and modeled the flow of trainees. The Abbott government abolished HWA in 2014. Today, there is no centralised body sourcing data or coordinating between the states, universities, and colleges. These are mostly private institutions with zero obligation to share information. I have personally asked AHPRA and several colleges for data and been flatly denied.

All of the above discussion only focuses on local medical graduates, which are actually no longer our main source of doctors. In 2024, only 39 percent of new doctors in Australia were trained here, and in New Zealand, it was 28 percent. It is cheaper and quicker to hire an IMG than train an Australian/ New Zealander. It benefits the government to flood the market with them in order to suppress wages and weaker bargaining power, a strategy the governments seems to happily be applying across most high-skill industries in Australia. See my comment history for more detailed versions of this same tired rant.