Intern system “unconstitutional”

THE current priority system of allocating internships in Australia is unconstitutional and needs reform, according to the authors of an article published online today by the MJA. (1)

The article said that the system allows the states to give preference to Australian students graduating from medical schools in their state “over all other applicants, including interstate Australian graduates”.

Dr Dev Kevat, of Monash University’s School of Public Health, who has an interest in human rights law, and coauthor Dr Fiona Lander, a medical intern and lawyer , wrote that the priority system violates Section 117 of the Commonwealth of Australia Constitution Act 1900.

Section 117 states that: “A subject of the Queen, resident in any state, shall not be subject in any other state to any disability or discrimination which would not be equally applicable to him if he were a subject of the Queen resident in such other state.”

The authors wrote that this section of the act could “prevent, for example, an applicant for internship in Queensland who was trained in Tasmania from being treated differently to a candidate trained and residing in Queensland”.

“The departure from the principle of equality access of citizens in competing for jobs promulgates more than mere ‘academic’ concern. Erosion of rights may start with seemingly minor irregularities, tolerated on pragmatic grounds, before further changes increase the differences in treatment between citizens”, they wrote.

The authors highlighted recent changes to the priority system in Victoria as a predictable next step in the process, where international students graduating from Victorian medical campuses were now the second highest priority category.

The Victorian Department of Health (VDOH), and its agency, the Postgraduate Medical Council of Victoria (PMCV), which administers the allocation of interns on its behalf, changed its policy last year to give higher priority to international graduates than to Australian citizens who have done their medical training interstate, even if those graduates were Victorian secondary or undergraduate students.

Dr Will Milford, chair of the AMA’s Council of Doctors-In-Training, said the MJA article highlighted why it was time for decisive intervention from the federal government in the ongoing intern crisis in Australia.

“At the end of the day, there needs to be a high-level decision made about whether international students are offered internships”, Dr Milford told MJA InSight.

He said the Victorian decision on interns was a bellwether.

“We agree with the supposition that what Victoria has done is very good for Victorian interests, but it is not good for everyone else”, Dr Milford said.

“The question now is whether the other states will adopt a similar system to Victoria. Self-interest will likely dictate that they will”, he said.

Medical director of the PMCV, Dr Susannah Ahern, declined an offer to comment on the MJA article, saying only that “Victorian policy is determined by the Victorian Department of Health, which PMCV implements”.

The VDOH was also asked to comment on the article but had not responded before publication.

Dr Milford said although he would welcome a decision from the federal government about international students, if the decision was to stop offering them internships that would also have consequences.

“The trouble is, every one of those students is required”, he said. “A bottleneck has been created at the state level because of funding issues.

“If graduates are forced to go offshore for their internships that’s inefficient and counterproductive.”

The knock-on effect of not giving international students internships would be that they would stop coming to Australia to train, which impacts the budgets of medical schools relying on full-fee-paying internationals, he said.

“And that means closing medical schools, or the quality of the training drops, and that’s probably worse.”

AMA Queensland president, Dr Alex Markwell, said she believed there was enough “political will” to reform the system by the end of the year.

“We have a poorly coordinated intern allocation system”, she told MJA InSight.

“We’ve been calling for a national merit-based system for some time. It’s about finding a way for the different jurisdictions to be comfortable with and accepting of sharing information and a single website that is coordinated nationally.”

- Cate Swannell

1. MJA 2013; Online 11 March

Posted 11 March 2013

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