DEANS of medical schools around Australia have backed calls by angry medical students that intern places need to be guaranteed before students begin their medical degree.

The call follows confirmation of growing fears that the imbalance between university places and hospital internships would result in hundreds of graduates being unable to qualify as doctors.

Last week, more than 100 international students in NSW, who each paid more than

$200 000 for their medical degree, were told they were unlikely to be offered internships in Australian public hospitals.

The Australian Medical Students’ Association (AMSA) wants Australian and international fee-paying students and those in state-funded places – in Queensland and South Australia – to have an intern place lined up from the word go.

AMSA President Ross Roberts-Thomson, who backed the proposal, said that would require a regulatory body, such as Health Workforce Australia, to control the number of medical students being trained.

As an interim measure, the federal government should provide extra money to the states to fund and accredit more internship places, he said.

“Your degree is effectively useless unless you get an internship,” Mr Roberts-Thomson said.

Medical Deans of Australia and New Zealand President Professor James Angus welcomed AMSA’s proposals.

“It really is very, very important that any medical student is given the opportunity (for a place) if they have paid a fee, even if it is a part-paid fee like a Commonwealth-supported place,” he said.

“The students are right to be agitated and we, as medical deans, are very, very concerned.”

A communiqué from federal and state government health ministers in February said that only Commonwealth-supported students would be guaranteed places, leaving about a quarter of medical students without certainty.

Prof Angus said the lack of places was a mess and could be addressed by using private hospitals and community clinics for internships.

“We can’t let [people in] such an important area of our workforce not complete their training. We have got such a shortage and we are bringing in 1400 international medical graduates each year.”

In a letter published in the MJA this week, AMSA called for international, state-funded and local fee-paying students at private universities to be given full and frank information about their internship prospects.

Local full fee-paying students, who make up about 6 per cent of Australia’s 14 500 medical students, and international students, who make up about 17 per cent, pay $150 000

to $290 000 for their degree.

About 2776 students are expected to graduate this year.

Med J Aust 2010; 193: 245-46.

Posted 16 August, 2010

23 thoughts on “Deans back medical student call for certainty on internships

  1. Syd Bell says:

    I recall that when there were changes to the length of undergraduate training and the 2 years postgraduate residency was introduced there was an undertaking (at least in NSW) that the intern year would be 50% continuing education and 50% contribution by the intern to the junior medical workforce. In my experience interns are full-time workers with an an occasional exposure to post-graduate education. If the commitment was honoured and the number of interns was increased there would be adequate places for all medical graduates.

  2. Bill Coote says:

    Surely, during the rapid expansion of medical schools and medical school places during the last decade, it was the responsibility of the deans to either ensure foreign full fee paying overseas students would be able to complete their education by having access to internships or, if that were not possible, to make absolutley crystal clear to applicants that a guarantee of an Australian intership was not part of the deal.

    It is disingenuous of Professor Angus to say, after the universities have pocketed millions in fees, that it is now everybody else’s responsibility to carry the load (busy clinicians, hospitals and taxpayers) of providing internships to everybody from whom the deans chose to extract tuition fees. Is there a risk that all graduates will now suffer if experience during internship is diluted as more and more are accomodated?

    An editorial in The Economist of August 7 2010 discusses “British Universities and foreign students” and suggests that UK universities, if they are to thrive in the market, need to make “a host of small changes and one huge one….The huge change is psychological: stop thinking of foreign students as mugs to be overcharged to subsidise Britons.”

    The story gets worse. It will soon be domestic students who are not able to obtain internships. The 2010 Report of the Medical Training Review Panel (Table 2.12) estimates total graduates in 2010 of 2,776 (2264 domestic, 512 international), in 2011 3135 (2667/468), in 2012 3430 (2912/518), in 2013 3723 (3045/678) and in 2014 3786 (3108/678). That is, most of the growth in graduates in the next 4 years ( an increase of 1000 ) will comprise domestic students.

    Professor Angus is correct: it is a mess.

    Bill Coote

  3. Ben Burford says:

    I agree with the comment that it seems crazy to deny intern places to those international students finishing medical school in NSW (and other States) but meanwhile Australia is still importing doctors to fill workplace shortages…

    These international students are really are guests and we should do our utmost as a country to get them intern positions. If nothing is done what are those following in succeeding years going to do?

    It’s really an emergency to fix the problem this year and in following years.

  4. Rita Moore says:

    Not only does this issue need to be addressed, but what of the career path options and training places post-internship? The push to train more doctors by just opening up medical school places or importing graduates as per what (previous) Government policy seems to have consisted of is simplistic. It should also be done in consultation with training providers and the specialist colleges. Plus also an eye as to the ability to access Medicare provider status once sucessfully through all the training.

  5. Anonymous says:

    Absolutely rediculous situation, most doctors have been noticing for some years. Anyone with any sense would know that a medical degree is only a means to an internship, then perhaps a career. For without this crucial stage how can one be a real doctor? Once again a poor mismatch of state v federal funding, vision and organisation to cordinate the 10yr plus training time from 1st year student to senior training doctor. Short time-frames for government terms and their wayward priorities at both state and federal level allows government to play a cost and blame shifting game, patients ultimately loose!

  6. stewart says:

    Way back, and perhaps more recently, the Accreditation Committee of the Medical Board of Victoria with the Victorian Medical Postgraduate Committee did the job of finding positions for Victorian graduates when compulsory internship was introduced. (How did they get away with introducing the term ‘intern’?). There must be more hospitals where interns would be appreciated. We found many that could use some or “absorb’ more interns with minor changes. I remember only one that we felt was intern unfriendly or not the sort of place interns should be sent. Now, many years later, it rightfully has interns.
    An intern year should compulsorily include 3/12 in general practice and internship could include Tennant Creek if it doesn’t already. Immediately post WW2 1st year residency, as it was properly called, was spread very widely included Tennant Creek. Forget rigid requirements The real world can help.

  7. Kristelle Day says:

    While I agree plans need to be made in order to secure a long term solution to this problem, I feel the focus has been shifted off NSW IMET and their responsibility in devising the priority scheme used to allocate internships for the upcoming interns of 2011. Where in their planning does it seem either fair or logical to deny internships to international students trained in NSW universities while offering what few openings are left, after commonwealth supported students are allocated, to internationally trained doctors? Incidentally, NSW IMET has stated that there was enough intern positions available for all NSW graduates to receive a training position for 2011 – except they employed interstate and internationally trained doctors above NSW trained international students. Disgusting!

  8. Joel K says:

    As the old addage goes ‘hindsight is 20/20’, the problem here is that this 20/20 vision has produced an influx that we weren’t ready for. Surely, it would have occured to the powers-that-be, that if you increase places, there is going to be an influx in the future (I hope this is what was intended from the beginning, and not just an election promise that has now gone haywire). The problem now is, we’ve increased numbers so much that we’ve flooded intern positions and some are now not able to follow up with an internship. I find it both unreasonable and unethical to take someone’s money on the false belief of a job (because really, that’s what the government/medical schools have done – medical training has an inherent silent agreement that it will be followed up with a job/internship. This does need to be addressed for the immediate future and ongoing protocols need to be in place for medical school uptake.

  9. Heather says:

    I am one of the unfortunate international students who has received three rejection letters from IMET, the latest of which I received at 6:30pm on Friday following a long day at my computer continuously pressing the [refresh] button on my browser. I came here to start a life in Australia, knowing that there was a shortage of doctors and being told that getting an internship on completion of my degree would not be an issue. Now, with over $300,000 debt over my head and no job prospects, I can’t help but feel defeated in this whole experience.

    I’ve been made to feel like a second-class citizen, having to fight for the scraps left over once local students have had their pick (forget the most prestigious hospitals, I would be lucky to get any offer). I have completed the same course as your local students and will graduate with an honours degree and an impressive resume, but this means nothing because I was not born here. I have paid full tuition, full transport costs (no concession for us lowly internationals), and have contributed to my local community in the past four years, but this means nothing. I am not eligible for citizenship until I can start working, and I cannot work because I cannot complete my medical training without an internship.

    I am in the process of applying to other countries for internship, but I am very disappointed that the country that accepted me as a student will not accept me as a doctor. Until the internship situation is improved, I am advising other internationals not to come to Australia for school.

  10. Bi says:

    Remember this issue will not only affect internationals, in a year or two, this is going to spill over to the locals.

    The two big attractions for international students to come to Australia to study medicine are: 1) gateway to stay on and migrate to australia. 2) the fees were much cheaper compared to North America.

    Currently, due to the strong Australian dollar and the annual increase in fees (which btw is nearly double the inflation rate), and the lack of guarenteed intern jobs after graduation, both attractive features for studying medicine in Australia have been wiped out.

    In essence you come to Australia to pay slightly less fees, with no prospects of staying on and yet have to face a huge disadvantage to match back at home (be it Canada or US). My question to everyone is, do you think there will be enough internationals coming in the next 5 years to fund the local medical schools?

  11. Rick says:

    These workforce issues are always relatively short-term when considered over length of one’s career. I’m a physician and endured a 10 year period of oversupply. Now there’s a shortage, and I can virtually name my price. These “crises” should be viewed with that sort of perspective, and come and go. One of my teachers used to say “You can do whatever you want in medicine provided you’re prepared to travel”. Some of these young doctors may need to travel. It’s not fair but life’s not fair – look at Pakistan if you want to see how unfair, and some real hardship.
    The culprits who do need to be taken to task, however, are the academics who are always looking for new “course fodder”. How is it possible for brilliant young people to spend 8 years at university (if they do pre-med and post-grad med courses), and not be slightly competent clinicians? And some are being diverted into a PhD on the way!
    Then there’s various Health Departments. The could easily accommodate more interns, and give them safe hours, and reasonable work loads. There’s just no will to fund them. On the other hand, would the prospective interns be willing to job-share or some similar arrangement for a year or two …

  12. Shashidhar Venkatesh Murthy says:

    I foresee a bigger problem in Australian health care in the next few years. There is major mismatch between health education and health care. Current increase in medical school intake – severe shortage of specialist teaching faculty.

  13. Joe says:

    I think that it is ridiculous that medical students should be guaranteed a job. This attitude breeds mediocrity. No other university guarantees jobs on graduation. Medical students should compete on merit for available positions. No one forced them to study medicine in the first place. If they are that committed to the study of medicine, then they need to be prepared for unemployment. Only when the supply of jobs is less than demand can we produce top class doctors who are hungry for excellence and success.

  14. Kristelle says:

    Obviously Joe doesn’t realise that without an internship graduating medical students are only provisionally registered with the Medical Board. That is why all medical students should be guaranteed an internship, because it is a continuation of their studies to allow completion of requirements to become a fully fledged doctor – not a free ride to employment. If a merit-based employment system is to work for medical student graduates, then full registration following completion of their university studies should be implemented, so that should employment not be gained in the public health system they are free to find work elsewhere.

  15. Vera says:

    It concerns me that people think internships should be extended to clinics and private hospitals. Already the entry level for a medcial degree has been significantly reduced, and the degree itself has lost a lot of its science based content. There needs to be a nation wide exit exam for medical students before internships are extended out of tertiary hospitals where interns won’t be exposed to a lot of critical skills they need as doctors.
    Furthermore, the bottleneck isn’t just about internship. It will extend from internships, to residency to registrar levels.

  16. Anonymous says:

    How attractive a career choice will medicine be once people start to realise there’s a good chance of unemployment at the end of university? It used to be that medicine attracted the most academically gifted. This is less the case now with the surge in medical school positions and I suspect once the public gets wind of this debacle the best and brightest will turn to business or perhaps, better yet, they can practice law and sue the pants off the incompetent, poorly trained quacks that will be flooding our public hospitals in about ten years’ time.

  17. Jon Kaplan says:

    For those international students who have come to Australia to study medicine, it should stipulate quite clearly on medical schools’ websites and the contract the student signs on acceptance of an Australian medical school place that internship is not guaranteed by enrolment in an Australian medical program. (At least the ones I have explored so far appear so). In which case there is, nor should there be any legal obligation for postgraduate medical councils to allocate internships on that basis. Any international medical student who comes to Australia not knowing this is naive bordering on stupid. (That being said I am appalled if it was indeed true that an international medical student couldn’t get subsidised public transport)
    However given these students have paid in many instances substantial amounts to study Medicine in Australia there should be some obligation (even if not a legal one) by the medical schools involved to better prepare students to sit the licensing exams of their home country (especially in the case of North American students) so they can return home to do their medical internships and gain registration in their home country. In the meantime while Australian medical schools are compelled to take on more international students to make up the federal funding shortfall, could more work be done by the medical schools, state and federal governments with regional and rural hospitals to accommodate the increasing number of graduates coming through the Australian system.

  18. helen leggett says:

    With regard to the idea that private hospitals should take up the slack in intern training: the private setting does not provide the levels of supervision and experience required by interns and would leave these poor kids in service roles learning little. As an intern you need the experience of seeing sick patients especially in the acute setting, not the essentially well elective surgical patient. Additionally, the patients are paying for specialist care, with precious little contribution from Medicare and funds and would not welcome interns practicing various skills.

  19. GG says:

    Remember, there is NO articulation between universities and the work place. Engineer graduates, law graduates etc all need to compete for positions and not all find employment. Historically Universities do not educate students for a job; they educate them making employment in certain industries possible. Why should medical students be any different? Teachers do not have guaranteed employment at completion of their degree neither do nurses. Full fee paying students, assuming they pass (!), leave with what their dollars paid for – a Medical Degree. The assumption that this fee, paid to a university, in some way also purchases a job in a hospital that receives no funding from the teaching university is an interesting notion. Whilst sympathetic, have many lost the perspective of what Universities actually do?

  20. Glenn Rosendahl says:

    1. In the realm of medicine, including medical training, what OUGHT to happen commonly does not occur. How much ‘training’ does a resident really get these days? If we started with the assumption of ‘really not much’ then medical students might be better prepared for the learning they must do after graduation. Learn to ask intelligent questions, and be self reliant.
    2. Where did the overseas trained doctors that we import learn their skills. Largely in medical training in the third world. If we accept them, then by definition, we should accept their training. If the present surfeit of graduates could provide useful service in the third world, they would learn an incredible amount of basic medicine very fast. And see a range of clinical conditions that in Australia they would see only in textbooks. The cost of such training would probably be less than of equivalent Australian training. Such trainees would be well prepared for ‘a stint in the bush’, and a good proportion of them might be happy to stay there.

  21. Vincent says:

    Working as a registrar in the overstretched NSW public health system I would dearly love to see more training positions all the way from intern to advanced trainee registrars. Having more junior doctors will allow for safer working hours and a return to a more training-based focus at work. Some might be concerned about the amount of supervision available for interns and residents – well I would love to have an intern or resident working with me (we don’t seem to have many of them working in psychiatry), and that will also free up the working hours a bit more to devote to teaching (both in being taught and teaching more junior staff). It’s all a matter of money, unfortunately, and service provision always seems to trump education needs.

  22. John Lancaster says:

    Just another disgusting case of the cynical exploitation of foreign students to encourage them to part with their money in return for a useless piece of paper – shame on you Australia !

  23. Anonymous says:

    There is a simple solution to this. Overseas fee paying students pay for their education in Australian universities. When they finish their education they return to their country to complete their training and then start practising medicine, if they cannot get internship in Australia. Althernatively they stay for interniship in an Australian hospital and pay for their training like they pay for their university education. How’s that for a solution?

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