Australia’s internship crisis: a national process
By Matt Lennon, Vice President, Australian Medical Students’ Association
You’re 23. You’re in your final year of medical school and you’re very worried. It’s now December, and you’re waiting to hear back on your very last chance to obtain an internship in Australia.
It’s been a difficult six year slog that you moved countries to undertake; you’re now $300,000 in debt and, if you don’t obtain this internship, you will never graduate as a fully licenced doctor.
This, sadly, is the reality for many final year medical students around Australia. By the end of 2015, 40 students had contacted AMSA because they had not received an internship. It is the greatest weakness of the current system that we cannot know for sure what has happened to those students since then.
As it stands, there is no public data that tells us how many of them never found a last minute offer in Australia, or what the outcomes have been for those who missed out. This makes workforce planning for internships incredibly difficult. Worst of all, it makes it difficult for these young doctors to make a plan for their lives.
The issue stems from the radical increases in medical student numbers and medical school starting back in the late 1990s. Since 2005, the number of medical graduates around the country have doubled. Despite losing local graduates, Australia still imports more than 2000 overseas trained doctors annually – more than any other developed country – and many of these are only on temporary visas, brought in to plug gaps created by the poor planning decisions of the past. Retaining Australian-trained doctors who are graduating today will help to address the shortages of the future.
An imbalance between supply and demand has made it increasingly difficult for students to secure internships – and as a result, students may seek to maximise their chances by applying to a variety of agencies at great financial, logistical and emotional cost. In 2011, 41 per cent of applicants for 2012 internships applied to more than one jurisdiction.
Agencies are then hampered by applicants who have received multiple offers but may fail to reject unwanted offers in a timely manner, if at all. In 2011, there were twice as many applicants who accepted multiple internships than there were in 2010.
Because of this complexity, State health departments have to meet over several months to manually work out which graduates have one or more offers. This usually lasts from July to September, during which time the rounds of offers for internships are slowly going out. It is this period that is really crucial for medical students who are likely to miss out. They are making decisions around moving overseas and doing further study that will direct the rest of their working lives.
Establishing a National Internship Application Process would solve this. It would mean that, rather than taking several months, all internships in Australia would be sorted out in a single day, and a job that is best done by a computer would not consume hundreds of government staff hours.
The process would not mean that all states would have to align priority systems or methods of application. Rather, in its simplest form, it would be an alignment of the computer systems and portals used by each of the states to detect and prevent any double offers.
States and territories would be relieved of an unnecessary duplication of services, and it would be impossible for applicants to accept multiple places.
There would also be ancillary benefits: collation of internship data would be centralised and more readily accessible and, in light of national registration standards for medical practitioners, the Commonwealth may find benefit in being more closely involved in the internship allocation process.
Most important of all, streamlining the process, aligning dates and providing solid data on those that have missed out from day one would give governments time to ensure spots are created for the remainder.
For many this is a story about bureaucracy and numbers. But for medical students the internship is an indispensable part of our training without which we will never become doctors. For us it is a story about aspirations and a future.