Will Milford

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