Australia's deans of medicine are defying the federal government and refusing to cut student intakes.
More than 1,500 new doctors are due to start work over the next 12 months. About 1,200 will graduate from Australia's ten medical schools but several hundred others who trained overseas will also start to practise and they, in turn, will send the bills to the national health body Medicare.
The government has tried to cut university enrolments and impose restrictions on foreign doctors setting up in practice. So far, both attempts appear to have failed.
The medical deans have refused to cooperate - arguing that Australia needs more doctors not fewer. And several hundred more foreign doctors are likely to start up than the government wants.
The pressure for action, however, is strong. Federal payments for medical care are about Aus$6 billion (Pounds 3 billion) a year - more than spending on universities - and have been growing at almost 10 per cent annually for the past decade.
In a new study, Monash University sociologist Bob Birrell discovered that in the past five years, the number of full-time GPs increased by 17 per cent. Yet the number of services each provided stayed at 6,500 a year - so that each new doctor costs the taxpayer almost $200,000 per annum.
Three years ago, the government decided to fix a quota of 200 on the number of foreign-trained doctors who could be admitted. The Australian Medical Council, which runs the qualifying examinations, was asked to allow only the top 200 applicants who passed an initial test to go on to the clinical examination.
But an Indian-trained doctor not included in the 200 protested to the Human Rights Commission claiming he and the others excluded were being discriminated against. In August, the commission ruled that the quota system violated Australia's Racial Discrimination Act.
The government and the AMC appealed to the federal court but in the meantime will allow the 280 doctors affected to sit the clinical exam next year. About half are likely to pass, so that possibly twice as many foreign doctors as the government wanted will be able to practise - with a further serious impact on costs.
Earlier, the government had announced that university medical schools would have to cut their student intakes by 200 to bring them down to about 1,000 a year. The medical deans, however, refused to accept the cuts.
They argue there is a maldistribution, not an oversupply, with rural and remote regions short of GPs and some urban areas having too many.
Far from agreeing to cuts, faculties of medicine in Queensland and Western Australia have called for an increase in their enrolments. And when the University of Tasmania expressed alarm that a cut could close its small medical school, the government was forced for political reasons to guarantee its future.
John Young, dean of Sydney University's faculty of medicine, and chair of the national committee of medical deans, said: "If more foreign doctors are to be registered, it means the federal government's strategy is falling apart.
"But if the government tries to impose bigger cuts on student numbers to make up for that, then an entire faculty or a clinical school will have to close."
And, as Professor Young noted, closing a university clinical school in a major hospital would have just as many political repercussions as closing an entire faculty.
Other critics have pointed out that, given the time lag in training a doctor, it could take ten years for any cut in student intakes to be felt and then circumstances might be markedly different.
But Dr Birrell believes the medical schools are facing a much more serious threat than the deans realise. He thinks the government will try to impose bigger cuts, whatever the consequences. That means the proportion of Australian-born doctors - now only about 60 per cent - will continue to decrease while competition for entry to medical schools will become even tougher.
"Australia's medical workforce will become even less representative of the patient population," Dr Birrell said.