Medical students and their supporters have been running a very active social media campaign around the #interncrisis. 

They’ve also established a website telling the stories of medical students who’ve been unable to get an internship.

We haven’t heard nearly so much, however, about the problems facing other sections of the health workforce, especially nurses. The most recent annual report from Health Workforce Australia makes clear that there are plenty of other supply and demand concerns.

As the chairman of HWA, Jim McGinty, wrote in the report’s introduction:

“We also learned that without reform of the national training system for doctors there will be insufficient specialist training places for medical graduates by 2016. In the case of nurses, short-term supply is relatively stable, but by 2025 there could be a significant shortfall of almost 110,000 nurses if policy settings remain unchanged.”

The report also notes:

“In 2011, there were more new graduate nurses and midwives than suitable graduate positions available in public hospitals. Retaining the skills of these Australian-trained graduates in the wider health system is vital to meet projected nursing workforce shortages in the medium and longer term.”

Meanwhile, in the article below, Professor Bruce Robinson, the Dean of the Sydney Medical School at the University of Sydney, says the lack of intern positions will damage the international reputation of Australia’s medical schools.

Clearly, there will also be financial consequences for universities. And the students will pay the costs of our mish mash of an education and training system rent by “a strife of interests”.


No resolution in sight

Bruce Robinson writes:

As most will be aware, a large number of international medical students graduating from this and other Australian universities do not have an intern position for next year. I wanted to send this letter to all members of faculty and alumni because we are at a critical point. It is important that all know the situation and understand the consequences of the current standoff.

At the moment, about 150 medical graduates of Australian universities do not have an internship for next year. The largest group is in NSW where 90 or more students do not have positions to go to. It is not just graduates of this University who are without places – in NSW, graduates from University of NSW, Wollongong and Newcastle are also unplaced.

Queensland and Western Australia also have significant groups of students without internships. Victoria has placed the majority of its international students but at the expense of domestic intern numbers, resulting in Victorian students looking for places in other states and receiving them ahead of our international students.

If graduates cannot secure an internship locally, they will have no option but to take their chances in the competitive matching programs in their home countries. In some home countries, there are no opportunities. In Canada, US and European Union, the odds are against them.

I don’t have to emphasise the poor outcome if our students/graduates/soon-to-be-alumni do not secure internship places.

The damage to the reputation of New South Wales as a higher education destination is one thing – and I have no doubt our reputation will be damaged and future international student numbers will be affected. Students will continue to use both the local and international media to tell their stories.

In my view, though, reputational damage is less important than the personal consequences for the students, young people who have come here in good faith, worked hard, passed their exams, become alumni of this (or other Australian) university – but now may potentially find the whole exercise was a waste because they have limited opportunities to get their registration.

We are still hopeful that a satisfactory outcome can be achieved but at the moment, internship appears to have become another political football with negotiations and discussions going back and forth between Canberra, state governments and medical school deans, with no resolution.

Over the past several years, we and other medical schools have argued that international students add a great deal to Australian medical education and community. To run through the main arguments again:

1.      International student fees fill funding holes. Medical education is not fully funded, international medical students bring more than $15 million a year into this university alone. That is a lot of salaries and training, which will not be paid for if we don’t resolve this issue.

2.      The 847 international medical students attending universities in NSW contribute the best part of $85 million a year to the state’s economy in university fees and living expenses.

3.      Across Australia, we have a shortage of doctors and recruit internationally to fill workforce gaps. Last year, like most recent years, more than 3000 visas were issued to international doctors to work in Australia. It is nonsensical to reject graduates of our own universities when we are advertising widely for both junior and senior doctors.

4.      In its recent workforce planning report, Health Workforce Australia identified the reliance on internationally trained doctors as a significant area of risk for Australia. HWA has factored into its workforce planning that 70% of international graduates remain in Australia, so we need to find a way to include them and support them in their training.

5.      There is capacity for more interns to work in public and private settings. We know that many public hospitals would greatly appreciate additional interns. We know that many interns do a great deal of overtime and in discussions have said they would prefer to reduce their working hours. Increasing the number of interns and reducing the working hours of others would be more productive, potentially safer, and may actually not require significant additional funds. There is also capacity outside the public hospital system to employ interns.

Medical Deans Australia and New Zealand has been pushing hard to find a resolution and all medical schools have agreed on the need for change to the management of international medical students, including caps on the total number and other points.

The Department of Health and Ageing has put $10 million on the table to avert a crisis with this year’s graduates but that money is contingent on the states contributing a total of about $8 million in addition (approx. $4 million in NSW) for all students to secure a place for 2013.

At this point, we have not been able to engage with NSW Ministry of Health and there is no commitment to provide the additional funds that would allow this year’s graduates to secure positions.

Internships for 2013 are the immediate priority, but clearly this is something that needs to be resolved for the longer term.

All parties will need to work together to achieve fair management of this matter. We all appreciate that NSW has funded an increase in intern places, and that the states generally have had to carry additional costs associated with the rising numbers of medical students and new graduates.

I am hopeful that members of faculty and alumni will be able to assist us to secure a better deal for our graduates. Anything you can do, whether it is to raise the issue with your local parliamentary representatives or with the NSW Minister for Health or in other ways, would be greatly appreciated.

One of the questions I have been asked is whether international graduates have the support of domestic students, suggesting the local students may be more concerned about the training bottlenecks ahead. That is not the impression I have had from any of our domestic students, and the recent rally in Taylor Square in Sydney was well supported by international and domestic students.

Ben Veness in Stage 3 provided a student perspective in last week’s Sydney Morning Herald.

• This post is taken from an email sent to faculty and alumni. It is republished with permission.

The website profiling students affected by #interncrisis

• See here, for previous articles on the health workforce at Croakey.

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