The Intern Crisis

What is the #interncrisis?

  • This year 3326 students will graduate from medical schools in Australia. In order for these students to become doctors, they must complete a compulsory registration year – an internship.
  • Due to a shortfall, 182 students have currently not received jobs.
  • Local students are prioritised, so those missing out are international students who have spent the past 4-6 years in Australia and received the same training as their domestic colleagues.
  • There is plenty of work for these graduates but the state and federal governments need to commit money to fund these jobs.
  • Without internships, these 182 medical students will be forced overseas or into other professions, which is not ideal as Australia currently has a shortage of consultant doctors.
Medical Students, doctors and politicians throughout Australia are rallying together behind the #interncrisis cause and I thought it would be prudent to host some of the information to date to assist in defining the current problems.

A website has been created where you can learn more about the medical student stories and the latest news on the #interncrisis campaign

Political Pressure

Senator Nash has asked the Minister representing the Minister for Health what the Government plans to do fix it’s medical internships problem.

No hospital places for medical interns? That’s an immigration problem, clueless Minister tells Senate

Senator Fiona Nash delivered an impassioned and informed speech in support of medical students that will hopefully make the Government see sense. The big message tonight is don’t give up, there is still hope! With everyone working together a solution has to be found soon.

History of the #interncrisis

In 1996, the Howard government capped medical school places due to a report predicting an oversupply of doctors by 2015.

In the early 2000s, when signs of a doctor shortage began to show, the government:

  • Increased the number of medical school positions, and
  • Recruited overseas trained doctors to fill the gaps in the meantime

Each year the Ministry of Training Review Panel’s (MTRP) annual reports shows the projected increases, so the current situation has been known about for years.

  • In 2000, there were 1660 graduates, in 2012 there are 3326.

The first step is to hold on to all of the Australian-trained medical graduates by providing more internships so all Australian graduates can work in Australia.

Many of the problems arise from multiple bodies being responsible for medical training:

  • Federal government sets the cap for domestic students,
  • Universities decide how many international students to recruit
  • States are responsible for internships
  • Federal government is responsible for specialty training

This disjointed approach to health workforce planning leads to disputes and prevents development of a coherent plan for the health workforce. Australia needs to have a single body responsible for health workforce planning and significant investment into the expansion of training programs at all levels of the system.

The first year of work after graduation is called an internship. In the final years of medical school, students learn the skills required, and internships ensure they are adequately supervised and supported while they take on the responsibilities of being a doctor.
Interns work between 40-60 hours a week and rotate through medical areas such as emergency, surgery, and internal medicine.

The intern is an important part of the hospital and allows doctors with more experience to focus on higher-level tasks while the intern takes care of the routine and administrative work. Without interns, public hospitals would not be able to function.

Without an internship a medical graduate is unable to obtain general registration to work as a medical practitioner in Australia. That means that the medical graduate is forced to apply overseas to do their internship and the pathway to return to Australia is very difficult, thus those forced overseas are unlikely to return as doctors.

Australia has a shortage of doctors. High profile stories like that of Buladelah are just the tip of the iceberg, with the report from Health Workforce Australia 2025 predicting a shortage of over 3000 doctors by 2025.

Currently Australia imports over 2000 overseas trained doctors annually – more than any other developed country – and many of these are only on temporary visas, brought in to plug the gaps created by the poor planning decisions of the past. Retaining the Australian-trained doctors who are graduating today will help to address the shortages of the future.

Logical arguments have been made to the government with little success. Our aim is to raise awareness so that the public understands the issue and puts pressure on the state and federal governments to solve the #interncrisis. We need a short term solution to find places for the 182 graduates we are about to lose, and we need everyone to work together to find long-term solution addressing the training bottleneck that will only get worse.

  • Scrubs on the Street Protest – On Sunday, October 21st over 200 medical students in NSW took to the streets of Sydney to protest medical training issues. Read more about it here.
  • AMSA (the peak body representing Australia’s 17,000 medical students) is working hard to lobby politicians and try to affect change, learn more at their Intern Crisis page.
  • The Australian Medical Association have also been active in trying to force a resolution to the current crisis and to encourage investment for the long term benefit of the health care system.

How you can help

Be part of the movement. Medical Student Action on Training has exploded because of the involvement of people like you but we’re not over the hump yet. We need all the talented, passionate people who study medicine or know people studying medicine to get involved. When we speak with a collective voice we can’t be ignored!

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Comments

  1. BV says

    Thanks for the extra exposure! As someone about to start my internship next year, I’d hate to see my colleagues talent and passion go to waste.

    Now that the NSW government has just found a casual $1b, hopefully this issue will be solved in the very near future.

  2. says

    Thanks a lot Mike, for sharing this. Whilst the Intern Crisis clearly is pertinent to our International Medical Students, it also highlights the greater issues in the future training of our medical workforce.

  3. George Douros says

    On a tangent (of the ‘what’s the actual plan guys?’ sort), there were 500 people sitting the most recent ACEM primary. Neither ACEM or state or federal government have a stated plan for what happens to these guys in 5 years, but ACEM is making quite a bit of cash out of it all.
    That’s future ACEM’s problem….

  4. says

    This problem has existed in Ireland. In the past (not sure if it still happens) international students who had qualified in the same universities with the same degrees had to take supernumerary intern posts and thus work for free alongside their (paid) Irish classmates. The problem was somewhat alleviated by adding extra intern posts in the area of paediatrics and GP.

    Has this issue not been on the horizon for the Aussie healthcare system for a while given that the increased intake in med schools would have happened 5 or so years ago. When I was working in Melbourne back then there was talk of it and I remember the late Andrew Dent in St Vincents was doing some sort of feasibility work on accomodating the increased numbers of graduates.

  5. helen says

    Its only a crisis because no one did anything when they started creating extra positions ten years ago even though they knew at the time the “medical student tsunami” was going to be a problem.

    its not just a funding thing for intern places either…. even if they all had jobs, someone has to be able to supervise and teach all these interns as well. AND they all need to get enough clinical exposure to be able to learn how to be awesome at their jobs. Not much use to the new interns if there are three of them trying to do what was formerly the job of one intern. The upside of this for the colleges is training programs are going to have become longer for people to get adequate clinical experience, so eventually there will be a greater number of spots on training programs. The need for increased number of consultants will come because everyone has to be supervised all the time because they haven’t got the experience to do their job properly.
    See, we aren’t all going to be overqualified taxi drivers after all.
    and no, I’m not cynical at all, not one bit :-P

  6. Jacqui irvine says

    My Ed has less than half the doctors whenever for our volumes at all levels. We can barely keep our heads above water and care (and the dreaded kpi) suffer. But we’ve been told we can’t have funding for more doctors until we improve our performance. Ummmm. Duh.

  7. ivan says

    what a wonderful portal you guys have! all aspects of medicine including political ones.
    i wish there will be some coverage for canadian residency here or elsewhere. canada and usa have the same issues as australia regarding training of the doctors. i think, it is the main reason behind their shortage in all of three countries.
    main reason in canada is the fact that local canadian doctors lobby the number of training spots so people with MDs ofrom outside of canada cannot get into residency. it is done because of limited healthcare budget which can jeopardize their current salaries in case of inflow of licensed medical doctors.
    overall, unfortunately, what is more important (over people) in any system is money.
    btw, posts from usa er doc are wonderful read. i wish states would have more opened minded people like he is.

  8. davie says

    whats ironic is, local bred foreign citizen graduates are without an internship, yet the government keeps shipping in third world country trained doctors. very crazy indeed. BUT honestly, international graduates without an internships is a joke, they should already be laughing they got an offer to a medical school in Australia. Check out how hard it is to get into say USA, UK, or Canada medical school as a foreign citizen. Correct me if i’m wrong, but i thought each specialties or colleges sets the quota for how many position of trainee available? Demand/ supply, tons of patient less supply more money for doctors. Not much incentives to fill the shortage.

  9. Nicholas Parker says

    I am one of the international (Canadian) graduates (of the University of Sydney) affected by this. I am married to an Australian intern, and can not return to Canada without becoming separated. That aside, all I want to do is help people, and apply the training I have spent 400 000$ and four years of my life receiving. My first choice would be to do this in the countryside, yet somehow I am excluded from this area of need.

    My particular interest is anaesthetics, and I feel there are few ways by which you can better help someone than by relieving their pain and suffering. Even as an intern, I would cherish the opportunity to help Australians in neglected regions, in this oft neglected aspect of their healthcare.

    All of my international, domestically educated colleagues have particular areas in which they can make a special contribution to the welfare of Australians. Please give us the chance to do so.

    Please help us help you, Australia.

  10. harry says

    Medical education in Australia is a business. Big dollars are made on subpar medical students from Canada, Singapore,… They have the ability to pay 300000 while our locals are missing the chance to study medicine. If these foreign students are so stellar they should have no problem finding positions in their home nations of Canada, Singapore,….
    The bought their place they did not earn it. By lowering the standards for foreign, Australians will suffer in the future with subpar care.
    We all know full well about Irish standard vs British standard.

    • davie says

      they aren’t subpar medical students, they are just as smart as domestic applicants. (btw i’m speaking g8 universities ONLY) the top medical school has almost same pre-requisite for international and domestic now days. (was significantly lower for internationals back then). I don’t think government has much power with rejecting international medical applicants, but universities sure can. Cut the international quota down, replace with a ton of fee paying students. 30 thousand dollars tuition is a good start. Every single Australian can afford that. Because fee help allows up to 120 thousand dollars in loan, with (20% flat extra repayment). Come on, if you want to be a doctor, you love the job, you can take out that loan from the government. If you live tight budget you can pay off all that debt by the time you finish residency.

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