James Churchill: Internship uncertainty

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