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Medical training lottery – get set for another round

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“Medical students do not necessarily translate into doctors” ­ – Penny Shakespeare, First Assistant Secretary, Department of Health, at Senate Estimates hearing, 5 June, Parliament House, Canberra.

This quote is from the Hansard of a Senate Estimates hearing, from one of the many occasions where medical graduate numbers and 2015 internship places have been raised as a matter of national importance.

One of the big challenges confronting AMSA in its advocacy on the issue is the stubborn misconception that medical schools produce functioning doctors, and that all that is needed to ward off future doctor shortages is to admit more medical students.

But, as we know, this is far from true, and medical school is only part of the process of training a fully qualified doctor, which also requires the completion of an internship.

The biggest issue currently facing the future medical workforce is not the intake of medical schools, but the bottleneck in internships, prevocational and vocational training places.

SA Medical Education and Training recently announced that the Government’s decision to abolish the Postgraduate General Practice Placement Program (PGPPP) would result in a cut in the number of internships being offered in South Australia for 2015. The PGPPP funded 23 of South Australia’s 278 intern positions in 2014.

Other states have also been using the PGPPP program to fund internship rotations, but have not yet announced whether axing the PGPPP will cause a similar proportionate decrease in the number of internships they offer. In this context, the current projected national internship numbers are somewhat reassuring.

The 2015 numbers

The first round of 2015 internship places have been offered to Category 1 applicants.

Under the COAG agreement, only domestic students in Commonwealth Supported Places (CSP) are guaranteed an internship.

In recent years, domestic full-fee students have often been designated as Category 1 applicants, and have not yet missed out on places. But if the medical graduate numbers continue to climb, and internship numbers fail to grow in proportion, it is quite possible that some will.

This year has seen 3676 applicants for internships. Of these, 3004 are domestic medical graduates, 480 are international full-fee paying medical graduates of Australian universities, and there are 192 other applicants.

As at June 2014, there were approximately 3210 State and Territory intern positions available for 2015 (some positions are still subject to accreditation), and up to 100 Commonwealth-funded intern positions under the Commonwealth Medical Internship (CMI) initiative.

We are working with the Commonwealth Department of Health to identify exactly how many positions will be offered as part of the CMI initiative this year. We are optimistic that it will be more than the 76 offered last year.  

Furthermore, experience from previous intern recruitment rounds suggests that not all those who apply for an internship are ultimately willing or able to accept and fill a place. This can be for a number of reasons, including the failure to complete their course, eligibility requirements, or acceptance of overseas offers.

Keeping this in mind, it is difficult to identify which graduates left for overseas preferentially, or left due to the current Australian internship climate.

To provide some perspective, in 2013 there were 3430 Australian-trained graduate applicants and 3190 offers accepted. This left 240 applicants unplaced by state offers. The Commonwealth received 185 applications for the CMI positions, but only 76 were ultimately offered. Therefore, potentially 55 graduates did not apply for the CMI and did not get an internship.

We will continue to work with the states and the Commonwealth, and will provide relevant updates over the coming months.