Sue Ieraci: Internship dilemma

THE role of intern places in the grander scheme of our medical workforce has dominated the medical media in recent weeks.

On one side are the potential interns themselves, including many fee-paying overseas students who no longer have a guaranteed intern place. On the other are state and federal governments repeating the usual tussle about who is responsible for funding intern places in our public hospitals.

But what about the many other nuances in this debate, and is the general public aware of all these aspects?

Medical internship in Australia is a paid job, combining service and training, as well as a prerequisite for medical registration. With rising expectations in the community, which has also become more safety-conscious, there are increasing demands on senior staff to increase the supervision and teaching of interns.

So, while medical student places have expanded in response to a medical workforce shortage, the contribution interns make to patient care is, by necessity, limited.

And post-internship, what then? It has been a long time since a completed internship was considered sufficient training and experience to enter any form of independent clinical practice.

The result is hospitals need sufficient places for a large number of residents, senior residents and registrars, and many more general practices need to train GP registrars. Do we have the infrastructure, or even the planning, to cope with those requirements?

These are some of the immediate practical issues yet to be resolved in this debate — but what of the ethical and philosophical ones?

While most doctors accept as given that a paid internship should automatically follow graduation, many other professions do not benefit from this arrangement. Does the community hold the same assumptions about public funding of internship as doctors do?

Perhaps it’s time to revisit the concept of the 2-year internship — the same model as the UK Foundation Programme.

When the prerequisites for general medical registration (medicine, surgery and emergency medicine) are spread across 2 years, the burden of supervising those terms is halved, while trainees can continue to accumulate experience.

It may be easier to convince the community that a compulsory, paid internship is a right for every graduate if their second year of hospital service is also compulsory. The reality of contemporary medical training means that the practical changes would be minimal.

And what of the role of universities? Are university medical courses and training linked to the requirements of clinical practice? Can a graduate with a medical degree be assumed to be “work ready”, or even safe to practise?

If paid internship is considered to be an automatic entitlement, then shouldn’t a medical degree certify suitability for that internship?

In these times of workforce flux, it is more crucial than ever that university medical student intake and training is intricately linked to community workforce needs.

We know that full fee-paying overseas students are an important source of revenue for universities, but recruitment must be transparently linked to an ongoing pathway into the medical workforce. This must include the areas of workforce need — not just rural and remote areas but also outer metropolitan areas.

Without linking all these issues, what is the point of this debate?

Dr Sue Ieraci is a specialist emergency physician with 30 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management.

Posted 12 November 2012