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Lost talent the brutal legacy of a beleaguered training system


Imagine you are a Canadian student studying medicine at the University of Sydney.

Since making the significant decision to cross hemispheres in pursuit of your medical dreams, you have met the same competencies, and passed the same assessments, as all of your peers.

But there are some differences in your medical school experience. One is that you are paying more than $66,000 a year for your studies. Just as strikingly, your chance of achieving full registration as a doctor in Australia may be little more than a coin toss.

The National Medical Intern Data Management Working Group has indicated that 240 applicants for a medical internship in 2014 were not offered a place from the states and territories, out of approximately 480 international full-fee paying graduates of Australian universities.

This year, the abolition of the Prevocational General Practice Placements Program (PGPPP) in the Federal Budget has been a blow to graduate internship hopes.

PGPPP provided rotations to prevocational trainees, including interns, in community general practice. Its axing has meant, in those areas without the funding or capacity to make up for their disappearance, these rotations have been lost. South Australia, for example, announced a reduction of 23 internships in the immediate aftermath of PGPPP’s removal.

This story is familiar to those who have watched this issue in recent years.

The Commonwealth initially increased medical student numbers, but the states and territories were expected to train these students when they graduated. After supporting initial increases, the states have tried to pass the buck back to the Commonwealth, which has been resolute in its insistence that it is not its responsibility.

Australia sorely needs all levels of Government to work together in providing more than last minute band aid solutions when managing workforce issues. The problem does not end with internships. Bottlenecks are appearing throughout the medical training pipeline.

But, while AMSA and the AMA have long foreseen these bottlenecks, a myopic approach by Government has stymied any hope of correcting them. As if to highlight this, in September the Senate passed the Health Workforce Australia (Abolition) Bill 2014 in the name of cutting excess bureaucracy, thereby abolishing the body directly tasked with leading the nation’s health workforce planning.

We know how many medical graduates are coming through. We know that this number is set to plateau after 2016. We know that it will likely stay that way unless the government lifts the cap on medical student numbers, or approves new medical schools, after this date.

Access to an endless stash of funding for training is not practical, but it is also not necessary. We simply require enough initiative to incrementally match the number of internships with the number of graduates until that plateau is reached.

There is capacity in the private hospital system to train more interns.

The Commonwealth Medical Internships (CMI) initiative, introduced by the Coalition as an election commitment, provided 76 accredited internships in the private sector last year. These internships were mostly in rural and regional areas, and included a one year return-of-service obligation. They were oversubscribed. Expanding the CMI initiative will not only ensure interns stay in Australia, but will provide more junior doctors with experience in rural settings.

We cannot afford to ship out doctors when many rural and remote regions in Australia face a doctor drought.

We should not ship out doctors when those doctors are willing to work in areas of need.

And it makes no sense to ship out doctors on one end of a bottleneck, and then import overseas-trained doctors at the other end to fill workforce gaps.

Failure to respond would be a triumph for political blame-shifting at the expense of community health and the careers of young, Australian-trained medical graduates.