Issue 42 / 29 October 2012

SKIRMISHES between the federal and the state and territory governments remain a reliable fixture of Australian politics, particularly in health.

The current flashpoint of the blame game is the funding of internships for medical students graduating from Australian universities.

At the time of writing, all domestic Commonwealth-supported medical graduates have secured internships for next year. However, 182 international full-fee-paying medical students look set to miss out.

The majority are from medical schools in Queensland, NSW, Victoria and Tasmania; WA and SA have committed to employing all graduates of the universities within their states. Unable to access an internship, these graduates will remain ineligible for general registration. They will be forced to complete their training overseas.

This situation reflects the fact that Australian governments are yet to adopt an explicit national strategy regarding the postgraduation employment of full-fee-paying international medical students.

The number of students set to graduate in a given year is known well in advance, and this entire debacle could have been avoided with appropriate coordination and planning.

Ironically, the situation has arisen despite a recent Health Workforce Australia report suggesting that Australia needs to dramatically increase its supply of doctors to get anywhere close to a self-sufficient medical workforce.

In late September, the Federal Health Minister Tanya Plibersek announced that the Commonwealth would provide $10 million to fund 100 additional internships. The money has been redirected from underspent funds allocated to the widely supported Prevocational General Practice Placements Program, with the positions to be found largely within private settings. The funding, however, is dependent on the states resourcing the remaining 82 positions.

A number of state governments remain reluctant to fulfil their side of the deal. In their defence, they cite their willingness to accommodate the rapid escalation of internship positions in recent years. They also assert that the problem is not of their making.

Indeed, that is true. The increased number of graduates primarily reflects decisions of the Commonwealth and individual universities. The latter, of course, have unilateral control over international student intakes.

The current predicament foreshadows a much larger problem — shortfalls in intern positions will be matched by similar shortages at senior prevocational and vocational training levels. There is a serious risk that the recent increases in medical student numbers will not translate into the increases in the fully trained medical workforce envisaged by successive Commonwealth governments.

These challenges are already apparent. For instance, 260 doctors in Victoria have failed to receive a first round offer for second year hospital medical officer positions and several hundred resident medical officers in Queensland are in a similar position. While it is not uncommon for a proportion of applicants to find themselves without a job at this time of year, it is becoming clear that access to training positions is increasingly competitive.

It remains ironic that locally trained doctors cannot obtain general registration in a country that continues to recruit and employ thousands of international medical graduates every year. This raises serious questions about Australia’s willingness to resource a self-sufficient health workforce, prioritising short-term cost savings over long-term health outcomes.

The solution to the immediate problem is straightforward: Australian governments need to work together to accommodate the 2012 graduating cohort. A national intern allocation system, such as that outlined recently in the MJA, should be next on the agenda.

The broader issue of coordination of the medical training pipeline represents a greater challenge, but the case for action is compelling.

This article was coauthored by Dr Rob Mitchell, emergency registrar at Townsville Hospital, a director of Cor Mentes Health Consulting and immediate past chair of the AMA Council of Doctors in Training.

Dr Will Milford is an obstetric and gynaecology registrar at Redcliffe Hospital, Brisbane, and current chair of the AMA Council of Doctors in Training. Dr Michael Bonning works at the Children’s Hospital Westmead Emergency Department and is a director of Cor Mentes Health Consulting.

Posted 29 October 2012

10 thoughts on “Will Milford

  1. Practical says:

    Has anyone thought of offering these graduates official but unfunded posts. This is done in some overseas countries. Obviously anyone relying on an income during their internship year would still need to look elsewhere, but a full-fee paying student might have the financial backing to be able to accept an unpaid internship. This would alleviate the workforce shortage in some areas, and provide the necessary experience for these graduates to register. They might even like their training hospital so much that they elect to stay………..

  2. andiyar says:

    After four-odd years at 50,000 a year plus in fees, I think adding an unpaid year of working 40-80 hour weeks wouldn’t exactly be fair to the international graduates. Not only that but it would kill our international intake (who’ll come if they won’t get paid employment?) which will ruin our domestic placements as the schools rely on international funding to make up the shortfalls from the government, as domestic fees don’t cover the cost of training.

    Add in that most of them already want to stay, and it’s even less fair.

  3. Christine Wade says:

    As a solo rural GP with DWS & AON status struggling to find an IMG willing to work in my practice, I am desperately awaiting the tsunamia of interns to spill out. The IMGs are gobbled up before they hit our shores by the wider metropolitan areas bordering Sydney and Newcastle, I wonder how long can i hang on before these new graduates trickle out into the real world. I can’t even attract any GP registrars as they seem to also get gobbled up into the void of metroplitania.
    is there anybody out there?

  4. Richard says:

    The current situation was predictable by anybody paying attention or who did not have an ulterior motive.
    1)Too many students going through fee paying courses = increased income for the medical training facilities (school is too noble a word for these fact-factories.)

    2)Too many graduates chasing too few jobs = less-to-little political clout and an inability to tell malignant management to go eat it.

    3)The only good side is that new graduates can challenge those who say that they “owe something” to the country that “trained” them.

  5. Medstudent says:

    This is such a disaster and a waste. The inability of the government to consider fixing this year’s intake of interns terrifies me, as I will not graduate medical school for two years, by which time there will be many more graduates, and I fear that domestic students will also soon be missing out on positions. I am hoping to have a career as a surgeon in a rural/regional centre, but at this point it looks like I will not make it to PGY2 even if I get an internship! What a waste of the money that the government spends on my training!!! Might as well drop out and become a flight attendant.

  6. Rose says:

    Is it time to sacrifice the sacred cows – health administrators, other non-clinical staff costs, cars, then spend the savings to increase the small percentage of the health budget which doctors represent, fund training positions, increase the government budgets to medical schools to fully fund training of medical students.
    Have we been so busy seeing patients that we have failed to notice that all the while there are fewer of us working longer hours and more of those having meetings and driving around talking wasting the health budget?

  7. David says:

    I do question the purpose behind pushing for guaranteed internships of international students while hundreds of Australian junior doctors are going without PGY2/3/4 jobs. If the government wants to play hardball with numbers the priority should be for Australian junior doctors to gain employment ahead of international graduating medical students.

  8. M says:

    Yes, it does seem odd that when Australia is so short of doctors, especially in rural areas, that we have to import from overseas, that there are insufficient posts to accommodate the graduating interns. Of course, we did predict this several years ago when the number of medical school places was increased without providing for additonal posts.
    You have to remember that when dealing with the various health departments, logic does not exist. When one of the colleges recently relaxed their rules on the ratios of consultants to registrar posts so that more registrars could be trained, the local health department responded by axing some of the consultants!

  9. docstrange says:

    Foreigner students are invited to Australia to pay for their university studies and fund these institutions just as foreign doctors are invited to work in the departments and regions where Australian doctors don’t want to work. Yet they are practically banned from specializing here by an almost insurmountable array of red tape and regulations made up of ignorance, arrogance and ‘la belle indifference’ including the AMC exams, district of workforce shortage areas, the 10 year moratorium and colleges soundly run by Australian-born docs.

    The fact that overseas-born students get treated differently to Australian-born students in spite of receiving exactly the same training and even paying handsomely for it highlights an unnoticed underlying racism ingrained in this system.

    Why not offer all overseas-trained doctors unpaid positions in the first place? If they really want a piece of the cake – no one forces them after all…

  10. mycosis says:

    Still no-one gets it..”.doctor shortages” are illusory..we have had too many doctors for years, but they all work in special interest (cosmetic,skin cancer,obesity,”natural”..etc ) clinics because genuine general practice is poorly rewarded. This leads to a severe maldistribution of doctors, gleefully embraced by HWA and the universities as justification for importing IMGs which we don’t need and whose countries can’t afford to lose, and absurd increases in medical school students for the financial interests of the universities without any consideration of public interest or the long-term consequences for the students or health system… history will look back and condemn the present crop (or pox) of bureaucrats and administrators

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