Issue 29 / 30 July 2012

LAST week, thousands of Australia’s future doctors received first-round internship offers. However, hundreds of international students now face an uncertain wait for subsequent rounds of offers, as the long foreshadowed mismatch between the number of medical graduates and available internship places begins to take effect.

Latest estimates indicate a shortfall of approximately 370 internship places.

Commonwealth-supported students are guaranteed an internship, so the graduates most likely to miss out will be international students ― many of whom will have paid up to $300,000 during four, five or six years at an Australian medical school.

Ineffective workforce planning, poor policy coordination and a lack of robust national data have led to a situation where internship numbers and health system resourcing have not kept pace with a doubling in the number of graduates of Australian medical schools since 2006.

Health care in Australia faces significant challenges. Residents of some communities experience significant delays in accessing services, rural workforce mal-distribution is a chronic issue and the health system is propped up by vast numbers of overseas-trained doctors.

Recent workforce modelling clearly indicates that, for the foreseeable future, we will need all of the doctors we train in Australia. It is only logical, therefore, that our health services are adequately resourced to provide internships to these graduates.

Without the ability to continue medical training in Australia or to complete their internships to become fully registered doctors, some medical graduates are likely to be forced to seek work overseas or outside of medicine, and thus be lost to the Australian communities so desperately in need of their services.

Understandably, after many years of intense training, significant personal sacrifice and substantial financial investment, this prospect is putting many medical students under undue stress at a time when we should be focused on learning and developing as junior health professionals ready to begin exciting careers in Australia’s health system. This situation could lead to an exacerbation of the already excessive rates of depression and anxiety in medical students and doctors.

Encouragingly, however, there have been recent efforts to ameliorate this problem.

The report from Health Workforce Australia, Health Workforce 2025, mentioned earlier, also models future workforce scenarios and lays the foundations for a coordinated National Training Plan. The report fills the data void in nationally coordinated workforce planning and provides a framework around which workforce bottlenecks may be foreseen, and avoided, in the future.

Effective workforce planning requires leadership and commitment from the highest levels of government. Federal Minister for Health Tanya Plibersek has recently acknowledged the importance of better alignment of all stages of the training pipeline for effective workforce planning and that, when it comes to medical training, quality must not be compromised for quantity.

The internship crisis has also been discussed at recent meetings of the Australian Health Ministers’ Advisory Council (AHMAC), with significant effort from state health departments, and many stakeholders, to work towards its resolution.

The AHMAC has committed to further quantifying the internship shortfall and moving quickly to increase the number of internship places once the extent of this shortfall is known, including possible additional capacity in private and community settings.

While these commitments are welcome, the urgency of this issue must be recognised in order that any new positions are subject to the robust accreditation processes designed to maintain quality training and clinical safety.

No doubt many, including Australia’s future doctors, will continue to follow this issue with interest as subsequent rounds of offers are made in coming weeks. As the size of the shortfall becomes apparent, we must hold health ministers and their departments accountable for following through with the necessary resources and actions, so that their commitments are translated into quality solutions for Australia’s health care system.

Mr James Churchill is president of the Australian Medical Students’ Association (AMSA)

Posted 30 July 2012

7 thoughts on “James Churchill: Internship uncertainty

  1. Anonymous says:

    It is easy to blame “ineffective workforce planning, poor policy coordination and a lack of robust national data” for this problem. In truth, the problem is the result of universities who have trained more and more graduates, for their own financial benefit and in some cases, have misled the students about the availability of intern positions on graduation. Now the Australian public is expected to fund additional intern positions, even though they are not necessary to meet Australia’s workforce needs. What happens to these interns next year? Are there enough HMO2,3 and specialist training positions?

  2. Anonymous says:

    It is interesting to see that the supposed ‘shortfall’ in internship places in steadily falling. Makes one wonder how much of an actual shortage there is and how much is dramatized hype for the sake of demanding unnecessary tax payer funded jobs in the already cash-strapped public health systems. Even more concerning for myself as a domestic undergraduate, is the prospect of being forced into some ‘magically’ created rotation the community or private sector were I will miss out on clinical experience and chance to make the contacts that I should be getting as an intern. Worse still is the prospect that the internship will be spread over 2 years, preventing junior doctors pursuing careers for another year.
    I’m sorry that international students stand to miss out on an internship in Australia but I don’t see why tax payers or domestic graduates should have to foot the cost of our universities’ greed (oh wait I forgot apparently Australia can’t afford to educate our own doctors if we don’t take in absurd numbers of international students…makes me wonder how other countries manage it.

  3. Steve Flecknoe-Brown says:

    Again regional Australia misses out!
    In response to consistent positive feedback from our students, Broken Hill has been preparing to provide the vital link between the student years and postgraduate training for the last five years.
    Our wisers and betters in the city decided we weren’t ready, based on selective and self-interested comments by our feeder hospital which has not yet once succeeded in providing long-term workforce. Yes; I’ll name them. Concord Hospital.
    We are appealing the decision from the NSW Health Education & Training Institute and are confident of success. Any of the current crop of medical graduates interested in learning real, bedside medicine are encouraged to contact me on (08) 8080 1333. We’ll look after you.

  4. Jonathan says:

    I’m not sure what this article is highlighting. International students have never been promised internships in Australia, and the vast majority have always had to return home. Domestic students were at threat of losing internship places, but if Commonwealth students are still being guaranteed places then why is this being raised as if it’s a new issue? Are domestic full-fee students still getting internship places?

  5. Jonathan says:

    Anonymous: the difference between internship places and HMO2/3 places is that you can never be a working doctor without internship – hence you never finish your basic qualification. At least if you miss out on an HMO2/3 spot you’re still a doctor and can seek out other medical work. If you never do internship though, you’re stuck as if you never had a degree at all.

  6. JD says:

    I’ve worked as a locum in many hospitals where there is a inadequate junior staffing at all levels, but administration is grossly over-staffed and over-active.
    The solution is obvious: cut back on administrators who do no real work in healthcare, and employ more of the current crop of interns who have been trained here.

  7. Jon Wardle says:

    I agree with a lot of comments that unsustainable growth in medical schools and graduates not going where they are most needed are large parts of the intern crisis not being discussed. I’ve seen a lot of tweets and comments saying that “if given these places we could fill the gap in rural healthcare, be the doctor in this town that currently has none etc”. This hasn’t happened previously – few doctors go to areas of need and even fewer stay there. Why should we expect this group to be different? I do feel for the international graduates – but they should be directing their anger at medical schools who made false promises, not expect a government bailout. Oversupply of doctors in some areas of Australia is just as much of an issue as undersupply in others.

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