Issue 9 / 30 August 2010

Students have been warning for years that, without drastic action, the rapid expansion of student numbers over the past decade would outstrip the training capacity of the Australian health system.

So reports of final-year medical students around the country missing out on intern positions should come as no surprise to anyone with an interest in medical education.

In New South Wales, no locally trained international student received an offer in the first or second round of allocations.

After the release of fourth round offers on Friday, roughly 30 of the 120 international students in their final year at NSW medical schools had received an offer in this state. This is an appalling result.

Similar reports have been echoed around the country. International students have been scrambling for positions in any state and territory they can find.

In Tasmania, domestic students are being forced onto the mainland by a state government that does not want to take responsibility for training its own graduates.

I am particularly concerned that in the midst of this unfolding crisis, Curtin University continues to push ahead with plans to introduce a third medical school in Western Australia.

Another medical school would put even more pressure on the health system to provide training positions. Curtin’s perseverance suggests it is motivated by a desire to raise its own profile rather than address a workforce shortage.

People seem to forget that behind the figures and statistics there are real people who are scared that despite passing their exams and forking out over $200,000, they will be left with a huge debt and a useless degree.

Medical students want an internship guarantee for all graduates who train in Australia and wish to serve the long-term needs of the community, regardless of whether or not they are international students.

That said, we do not want a government blank cheque to allow universities to increase student numbers indefinitely.

We want regulation to ensure that the number of students entering medical schools can be accommodated by the health system and we want all current students to receive an immediate interim guarantee of intern training while this mess is being fixed.

We are not asking for a lot, just a fair go.

Jon Noonan is a fourth year medical student at the Sydney Medical School. He is the President of the Sydney University Medical Society and has co-authored several Australian Medical Students’ Association policies on internships and international students. He plans to pursue a career in ophthalmology.

Posted 30 August 2010

6 thoughts on “Jon Noonan: Medical students the victims in training debacle

  1. Horst Herb says:

    As always, it is those who had nothing to do with the creation of the problem that have to suffer the consequence of incompetent politicians that seem incapable of even a minimum of foresight.

    I think luring foreign students into the country to attend overpriced courses *knowing* or having to reasonably suspect at the time of recruitment that they will not be able to complete the degree is nothing short of fraud, no matter how “legal” this fraud might be. Ethically, it remains fraud. Any ethical government would see the obligation for indemnification should they not be able to provide the required training places at acceptable standards

  2. talina says:

    Good on you Jon, someone needs to fight for the rights of students. When I was in 5th year there was a threat that not all of us would get Intern positions, that was in the late 80’s. We need someone in power who really understands the medical situation. I would love to see more Interns come to the country to train. I began the first Intern training program rurally in Cleve SA. I understand your fear that this will be somewhat biased training, (one doctor towns especially) but what better training to provide rural GPs. Could we have each Intern rotating through several country rosters? Do you as undergraduates think that would help?

  3. Anonymous says:

    I have been following this topic closely, since I am one of those students to graduate next year. With over 200,000 in debt, its a scary prospect to be facing. When I initially came to Australia, I didn’t quite realise the extent of the situation. I was excited to hear that medical schools increased medical places (as told during my interview) because this is opposite to what has been going on in training in Canada, hence as a result so many Canadians opt to do medical degrees in Australia. I didn’t realise the extent of the increase in medical students in proportion to stagnant number of intern training spots. Now well into my third year, I have found Australia to be my home. I am now in the process of writing licensing exams to go do residency training in US or Canada, even though I would love to stay here permanently. My Australian partner of almost 3 years is now also facing the prospect of leaving Australia with me once I graduate, and leaving everything he has and worked for behind. The intern allocation process is a random lottery here, especially in Queensland with no merit-based evaluation. It saddens me a bit to be graduating with the same degree as some of my colleagues who are citizens, but at the same time feel angry that its based purely on my country of origin and not any skill or anything else that I have absolutely no control over. Just my two cents.

  4. helen says:

    The current debacle started in 1994 when the then Howard gov Minister for Health, Dr Michael Wooldridge, claimed that there were too many doctors and cut medical student places drastically. He is also the author of the provider number restrictions.
    The truth of this decision on provider numbers was that if doctors couldn’t get a specialty training place they would be trapped in the public hospital system as Career Medical Officers, with no option to work outside the system as their patients could not access medicare without the provider number. Read as cheap labour for the public system.
    The flow on from the restrictions on student numbers was as predicted by medical bodies such as AMA, RDS and the specialty colleges and there was a shortage 6 years later ie 2000-2001. Vocal opposition by above said medical bodies fell on deaf ears and was eventually silenced.
    They then panicked and did what they had done to teacher education in the past, that is vastly over filled intakes and in the case of medicine, decentralised and spent a huge amount of money introducing medicine to a raft of smaller and in my opinion ill equipped universities.
    The upshot of all this is that there are more medical graduates in the coming few years than the teaching institutions can cope with and they are desperately trying to get private hospitals to take up the slack.
    The real kick in the face of this current situation is that Dr Wooldridge will get exactly what he wanted. There will be too many graduates, eventually a large number of you will end up with no specialty training position as there will never be enough places and the only place left will be the public hospital system or publically funded community positions. You can’t even really have your own GP practice without a provider number.
    Specialty training numbers are limited by the systems ability to provide enough supervision and patient/case experience. The rubbish peddled about protectionism is just that, rubbish. There is a standard of practice that must be maintained and that can only be achieved with satisfactory clinical exposure at specialist level.
    And this doesn’t even touch on the task substitution with nurses that the new Australian Medical registration scheme is set up to allow.
    This is all extremely depressing and you have all been sold up the river by immoral government policies.

  5. Anonymous says:

    to add to the “competition”, there are AMC graduates who are also part of the mix … it’s going to be tough

  6. Joel says:

    I don’t think it is about a fair go. I think it’s about a lack of ethical decision making. Shortages in training positions as Jon has mentioned have been foretold since memorandum on increasing positions exponentially. I’m a newly graduated intern, and am appalled to think our government has such lack of foresight to make appropriate decisions like this, who cares if hindsight brings 20/20 vision, the excuse is null and void.
    In the end, it appears to me that universities are willing to take the money, but not to find jobs. Without an internship how do these students become nationally registered? are they simply meant to sit in limbo with a MBBS and a sense of quasi-achievement for passing some exams?
    Serious thought needs go into this, as simply opening positions in smaller hospitals where they will be one of two doctors with an SHO as a supervisor holds obvious inherent risks. Just as overloading already well serviced hospitals. There are options available – they just need to undergo rigorous analysis to find the best solution. A solution that should not have been needed in the first place. I am really quite disappointed, this is unbelievably unethical, I hope people realize this debacle for what it truly is.

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