It is an interesting time in the history of higher education in Australia. Not only has the federal government proposed to withdraw 20% of universities' funding, it has introduced legislation to deregulate fees. At a time of great uncertainty for the higher education sector, it hardly seems appropriate to advocate a greater role for universities in emergency medicine (EM) specialty education and training. Simultaneous with these reforms, the responsibilities of the health sector in relation to medical education have been clarified. National implementation of activity-based funding has highlighted hospitals' inextricable and now routine involvement in clinical teaching, training and research, with the result that governments and hospitals better understand their commitments to education and training for the clinical workforce.1 In addition, substantial government support for medical specialty training, including EM, has resulted in the expansion of training into a slew of public and private hospitals that were previously unengaged in clinical education activities.2, 3 In a strong endorsement of college responsibilities for specialty education, the Australian Government has provided significant funding to colleges to expand training numbers, sites and supervision. In the case of the ACEM, this has amounted to approximately A$12 million per year since 2011 to facilitate the roll out of the Emergency Medicine Education and Training (EMET) programme, with additional funding provided for the Specialist Training Program.2, 3 Clinical training takes place in an increasingly challenging environment. The continual evolution of medical education has seen an increase in the breadth and depth of curricula, increased community engagement in relation to what a doctor should learn, an expansion of workplace-based assessment, lengthening of the training pipeline and an overhaul of medical school selection. This has occurred alongside large increases in the numbers of medical schools and full fee-paying students, resulting in skyrocketing numbers of medical students needing supervision and training in clinical settings. As a result of these changes, ACEM trainee numbers have grown significantly. EDs are also increasingly busy; however, whole-of-hospital efficiency gains and increased support for clinical education and supervision have, perhaps surprisingly, maintained capacity for workplace-based education and training. In 2014, the Australian Medical Association found that high numbers of trainees are satisfied with their training and career pathways, and this is testament to the quality of training provided by medical colleges in the face of increased workforce and training pressures.4 Within ACEM, development of the Curriculum Framework, a fundamental revision of specialist training and assessment via the Curriculum Review, increasing educational content provision, and development of the non-specialist certificate and diploma qualifications have seen a major refocus of educational activities towards the workplace. The introduction of teacher training, cultural competency, mentoring and leadership programmes have also supported better alignment to contemporary patient, physician and health system needs.3, 5 So why not transition to more specialty education provision by universities? The central question is whether more vocational education provision by universities will better equip graduates for their eventual clinical roles. Nursing education moved from hospitals into universities in the 1990s in Australia, accompanied by a decoupling of education and clinical care. Since then, issues including preparedness for clinical practice have been problematic. Graduate nurses report feelings of stress, anxiety, isolation and uncertainty on entering the workforce, with resultant workforce turnover being high. Some reports suggest that up to 20–50% of graduate nurses leave their position within the first year after graduation. In response to these observations, hospital-based graduate nurse programmes now support transition into the clinical workplace.6 At the postgraduate specialty level, nurse practitioners (NPs) complete university-based Master's level courses for authorisation to practice in the NP role. Graduates state that these courses sometimes fail to deliver the extended clinical skills required for advanced practice, and their education should instead be clinically focussed with an emphasis on workplace-based training.7 Unlike national college training programmes, university courses vary significantly in terms of programme content, course duration and teaching faculty. For example, medical schools have no national curriculum for anatomy instruction, and content, instruction methodology and assessment differ between institutions. This raises important questions: Is there also variable depth of understanding of anatomy between graduates of different medical courses, and does this impact on clinical practice?8 Before entering the realm of specialty training, perhaps universities should first improve their consistency in delivering primary medical education? University teaching in other domains is problematic, where experiential learning – observing good professional practice in a clinical setting – is a better option. Students have a low opinion of the way professionalism is taught at their universities, with little regard for professionalism being taught by someone other than a doctor. Clinical learning situations have more impact than classroom-based learning, and situations experienced in clinical placements appeared far more complex than the ones students were presented in didactic teaching sessions, which they considered superficial or trivial.9 With a greater role in the delivery of EM specialty education and training, universities will increasingly compete with colleges (and hospitals) for clinical teachers. By focusing on courses extending rather than replicating college curricula, universities can instead (and do) provide opportunities for developing professional interests and deepening expertise. It is easy to understand why universities wish to enter or expand their activities in vocational medical education. Targeting high-income, highly motivated doctors makes sense against a need to make up funding shortfalls. It is worth looking at the numbers when assessing comparative value. In 2015, the annual registration cost for ACEM trainees was $902 and the fee for sitting examinations ranged from approximately $2500 for the primary examination to $3200 for the fellowship examination.10 By comparison, the recently launched Master of Medicine (Critical Care Medicine) offered through the University of Sydney will cost $26 800 per year of full-time study of 48 credit points.11 A more extreme example of pricing discordance with ACEM's fees comes from Macquarie University's Master of Clinical Sciences, which is priced at $46 336 per year full time (although it is worth noting that EM is not listed as one of their clinical specialties).12 Although this is not comparing apples with apples, it does provide a good indication of how universities price postgraduate medical education. Recently, the motives of universities have been questioned due to their promotion of alternative medicine or ‘pseudoscience’ courses.13 Unfortunately, funding pressures might be driving universities away from their role as stewards of knowledge advancement and scientific rigour. Although some colleges have linked discrete components of their education with university courses, this might not ultimately deliver the outcomes expected. ACEM's Trainee Research Requirement by university coursework has seen an exodus of trainees from participation in research, with just under 10% doing research projects to meet the requirement.14 Irrespective of quality of projects or aptitude for research, experience of designing and conducting a study, negotiating resources and ethics approvals and collaborating with other participants is valuable experience for performing or supporting future research. Through its Quality Framework, ACEM promotes research participation in EDs, so it must now reflect on how it supports ‘doing’ research. Workplace-based education is highly effective, providing that appropriate scaffolding is in place (structured, clear outcomes, clinically focussed, appropriately balancing medical expertise and non-technical skills, trained teachers), and both learners and teachers are well supported.5 Continuing evolution of specialty education with increased use of technology and simulation, better coordination of the training pipeline, and further expansion of training to where patients are will effectively position EM for the future. ACEM and other specialist colleges already provide excellent education and training, lifelong collegiality, and professional opportunities at relatively low cost to trainees. University courses might be valuable, but they should aspire to expand individual trainee and specialist horizons, rather than duplicate core training at higher cost with unknown quality. SM is immediate past president of ACEM and Chair of ACEM's National Program Steering Committee, which oversees the Specialist Training and EMET programmes. She is the Committee of Presidents of Medical Colleges representative to the Independent Hospital Pricing Authority Teaching, Training and Research Working Group (TTRWG). SM also completed an MBA at the Australian Graduate School of Management (UNSW and USyd) while working full time as an ED Director.