24 October 2014
The Australian Medical Students’ Association (AMSA) today reiterated its concerns that burgeoning medical school fees will dramatically skew the medical workforce.
AMSA President, Jessica Dean, argues that governments should be working towards resolving the rural workforce maldistribution, not making it worse.
“The Bradley Review into higher education revealed that there were significant barriers to accessing higher education among students from rural and remote areas,” Ms Dean said.
“We also know from the Mason review that one of the most effective strategies to resolve the rural workforce maldistribution is to recruit students from rural and remote areas.
“The Government appears to want to implement the recommendations of the Mason review, and has invested in rural clinical training accordingly. It is unfortunate that the significant impact that fee deregulation will have is not being considered.”
Medical school places are capped for reasons of clinical training capacity and workforce need. The demand for these places is high. This has led some, including projections from the Grattan Institute, to suggest that fees could rise in excess of $37,000 per student per year in medicine.
“Needless to say, pricing medicine at over $200,000 for a degree would only further weaken our ability to recruit students from rural and remote backgrounds,” Ms Dean said.
“It seems only logical that if the supply of medical school places is capped, the amount that fees are allowed to rise in a deregulated environment should also be capped, to minimise negative public health and workforce consequences.
“If fees are deregulated, AMSA is calling for an independent monitoring authority to be included in the legislation to report on fee increases to the Departments of Education and Health, and the Senate.”
AMSA has expressed its concerns to two Senate hearings – including the Inquiry into the Higher Education Bill – in recent weeks. The suggestion to cap medical school fees in response to capped supply was noted in the Bill’s regulatory impact statement.
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Hok Lim is a fourth year medical student at the University of Melbourne
As medical students we dream large. We enter the profession to make a difference or create a change so that we can live in a better, healthier society. I have attended a number of global health conferences during my medical course. I had been inspired by great leaders in global health: an injection of much needed motivation and context for my medical career. But there is sometimes a feeling of being overwhelmed and dwarfed by their greatness and impact. I felt I had ideas, but lacked a road map on how to create, build and complete a global health oriented project.
AMSA’s GlobalEx conference did just that. GlobalEx sets itself apart from other conferences by creating a learning environment where there are no spectators, only participants. People came from various universities around Australia. Held over three days, GlobalEx was grueling, challenging and satisfying.
Day One provided a platform for students to explore and put forward ideas and form teams. Day Two is where groups developed their projects. Day Three was the day for consolidation and the pitch to a panel of social entrepreneurs and public health professionals.
GlobalEx fostered an exchange of ideas between people in a fun and safe environment. I felt ideas flow from people – which humbled me and showed me how much talent there is in medicine. Each day was interlaced with productive workshops lead by leaders in project development, social entrepreneurship and project management. The projects that were developed were far beyond the expectations I would have had for teams of medical students. The pitches were equally impressive. Several teams caught the eyes of the judges and were given the chance to collaborate with panel members.
The highlight from the social program was the salsa dance lesson at the Provincial bar in Fitzroy. We all got to strut our stuff. Even those who are not usually dancers looked like pros at the end of the night. ‘Salsa Sally’ [Logistics Co-coordinator Sally Gordon] showed she was Salsa Queen with a surprise Salsa display end the dance lesson. The night was topped off with a trip to Messina.
Towards the end of the conference there was a time to reflect. For some it was a great learning experience, for others, GlobalEx stirred deep emotions. Maybe it was a sense of achievement, or a sense of fluid teamwork and solidarity or a discovery of new potentials. I was amazed to see tears in a fellow delegate’s face as she expressed the profound impact the conference had on her.
If you are looking for a global health conference that will challenge you, inspire you and provide you with practical tools; GlobalEx is a must.
Transcript of AMSA’s contribution to the Inquiry into the Higher Education and Research Reform Amendment Bill 2014 (10/10/2014)
Ms Dean : Thank you very much for the opportunity to come here today and share the concerns of Australia’s medical students. We share the concerns of the other students groups about the impact that this is going to have on medical students. Furthermore, we have quite specific concerns regarding the impact of this on medical education and the consequent impact on public health. Those public health concerns are not only shared by our members, the medical students, but echoed by the council of junior doctors and the Australian Medical Association.
To provide some context, medical student places are capped. That means we have a capped supply. We know that the demand for medical student places is incredibly high, so essentially what we are looking at is not a free market. Projections from the Grattan Institute suggest that the cost of a medical education will be around $37,000 per year per student. That is for a four to six year degree. If we look at the current market, the University of Sydney is already charging over $66,000 per student per year. So what we are really looking at is a debt of up to $250,000 for a medical education but considering the lack of true market forces applying in this area our students are concerned that there is no reason that this debt will not skyrocket, given that there is capped supply and unlimited demand.
On the impacts specifically on the students themselves, as already suggested, debt itself acts as a deterrent, regardless of repayment schemes, particularly for those from lower socioeconomic backgrounds. We know from the Bradley review that rural and remote students already suffer significant obstacles to accessing education. Our students are particularly concerned that the interest rate and the impact that that will have on their life choices, particularly on their ability to have children. The nature of medical education is such that training occurs at the prime fertile age for women—more than half of medical students in Australia are female—and your salary does not plateau until after you have specialised. Most specialty training in Australia is not part-time, so most women have to wait until after their training to have children. If they are looking down the barrel of a significant debt with significant interest rates that is going to impact that choice significantly. Further, we know from a beyondblue survey of medical student and doctors’ mental health that financial stresses have a significant deleterious impact on medical students’ mental health and we know that students generally are in the most affected age demographic regarding mental health outcomes.
Turning to the public health issues, we are really concerned about the impact this is going to have on workforce maldistribution. We already have a shortage of rural doctors. We know from the Mason review that the best way to fix this is to take students from rural and remote backgrounds, who will then end up being rural and remote doctors. If this is going to deter individuals from that background it is going to have a significant effect on something we are already trying to battle. We know from studies out of North America that debt drives medical graduates away from primary care. It drives them, potentially, to more lucrative specialties. We do not need more anaesthetists. The impact that this is going to have on our distribution within the workforce is also considerable.
Lastly, where is the money going to come from? Medical students are looking at a $250,000 debt when they graduate. A large proportion of medical graduates—doctors—work in private practice. They have significant discretion not only over what they charge in fees but also over whom they bulkbill. Our concern is that if medical graduates complete medical school and go into practice with such a significant debt the people who are going to end up repaying that debt are the patients. We have significant concerns for the students themselves but also public health concerns for the future patients of Australia.
Senator KIM CARR: I ask you all: what is your view about the level or the adequacy of consultation with student groups?
Ms Dean : We have been to Canberra quite a few times this year but we have not had the opportunity to meet with Minister Pyne. We found the consultation to be quite effective in airing our concerns, but we are quite concerned that they are not being recognised appropriately. The regulation impact statement directly acknowledged the concerns of medical students and the potential impact on medical education, but negated it on the basis that doctors earn a lot of money, which is not really the primary basis of our concerns.
Mr Luthra : The regulation impact statement did not really address any of the public health concerns that we had raised with the minister’s office or with any other members that we have met.
CHAIR: Who else from the government did you meet with if you did not meet with the minister?
Mr Luthra : We have met with the minister’s office, the Treasurer’s office, the Prime Minister’s office and a number of other Liberal and National MPs.
Senator KIM CARR: We heard yesterday from Universities Australia that seeking greater public investment in universities was like flogging a dead horse. What is your view of that evidence?
Mr Luthra : In our view the issue of public funding is a matter of priorities. We have repeatedly identified in that in the past—for example, in their submission to the Lomax-Smith review on base funding, the Medical Deans Australia and New Zealand identified that medical education was underfunded by approximately $20,000 per student per year. Again, the public funding for medical education is well below the OECD average. The way see that is that those other OECD countries are prioritising medical education, the education of students and the health of their populace over politics.
Senator RHIANNON: I was going to ask the same question that Senator Carr has asked…because it is such a contrast. This is the fourth day of our inquiry and, with all the submissions and evidence, and the evidence we have had this morning from vice chancellors, it is such a different message. You all go to universities: it is where your life is at the moment What are your reflections on why there is such a difference, where you have vice-chancellors who have really signed off with a government that has said they are going to take $5 billion off higher education—it is breathtaking? The question is: why?
Ms Dean : In terms of medical education, we are often on the same page on a number of issues with the medical deans and the vice-chancellors regarding the quality of medical education. However, on this particular issue our biggest concerns are the public health impacts and, on that specifically, we found ourselves divided.
Senator XENOPHON: I will direct this to Ms Dean, and I am happy for other members of the panel to chip in. Ms Dean, you made reference to what has been occurring in North America, where there has been workforce maldistribution in terms of the way things work in the US, and your fears that this could happen here with the deregulation proposed. Are there any ways, in the context of the government’s proposals that that could be ameliorated? We heard evidence earlier from the Vice-Chancellor of Flinders University that, in terms of their programs and medical students in the Northern Territory, if you provide further assistance you can keep people working in regions and not become an exodus—not that I have anything against an exodus. Do you see ways in which what you consider to be a bad package could be ameliorated or improved?
Ms Dean : I am going to split that question into two components—maldistribution in terms of geographical location and specialty distribution. In terms of specialty distribution, the studies that we referenced are out of North America and—
Senator XENOPHON: Could you provide the committee with copies of those?
Ms Dean : Yes. The concern there is basically relating to the significance of the debt—that upon graduation the size of that debt is such that individuals are pushed into training pathways that mean they are going to be able to repay that debt sooner. I am not really aware—I will ask Kunal to add to this—of any system that would do anything to ameliorate the size of the debt, other than fixing the system itself.
In terms of maldistribution, as we have said, that is an issue of deterrence. If individuals are deterred from studying medicine that means we are not going to be able to get those individuals back into the areas of need from which they came. That is the basis of our concerns.
Mr Luthra : Thank you for your question, Senator Xenophon. The Mason review regarding rural workforce maldistribution suggested that incentive payments are not an effective workforce strategy to correct that maldistribution. We suggest that, hypothetically, if you provided debt relief to students who were willing to work in rural areas that would not be the most effective strategy to get those students working as rural general practitioners.
Rather, the effective strategies are getting students from those rural backgrounds initially—which this legislation obviously works against—and providing rural training pathways after graduation, which is probably a separate discussion. So we are suggesting a solution in a deregulated environment for medical education. Obviously, we think that deregulation in general is not a good idea, but if there was a deregulated environment, given there is a cap on the supply of medical school places, we think there should be a cap on the fees that universities are allowed to set for medical schools to prevent them from skyrocketing infinitely.
Senator XENOPHON: I understand your opposition to the deregulation model. You are saying that there ought to be an exemption to what the government is proposing by virtue of the capped medical places.
Mr Luthra : Essentially, because it is not a free market.
Senator RUSTON: Discussion about funding in this space is not new. This is not the first time that we have suggested reform in the higher education space around funding. I just wonder whether the organisations that you represent have made submissions to previous proposed changes or budgetary recommendations from previous governments. For example, have any of your organisations responded to the $6 billion worth of savings and funding changes that were proposed by the previous government?
Mr Luthra : The Medical Students Association has made submissions over the years regarding base funding. Whenever there are cuts to university education we believe that that is going to have a negative effect on medical education and on health care.
CHAIR: We are incredibly under the pinch and…it would be useful if we could actually get their stuff on the record. I have a question about internationally fabulous research. Ms Dean, which university are you from?
Ms Dean : Monash University.
CHAIR: So you are all attending incredibly successful Go8 universities. You are in a very privileged position to be at those institutions and you are all arguing on behalf of low-socioeconomic status students. I would like to hear from each of you why you did not go to your local university and yet expect—
Senator LINES: Should we all answer that?
CHAIR: Excuse me, I have listened quietly for an hour.
Senator LINES: For what purpose?
CHAIR: Because it is important. When we argue on behalf of regional students, we need to ensure that regional kids get to go wherever their brains can take them and that we have a system that supports that. I want to go to the NUS submission. The vice-chancellor of CQU, the university that has the highest proportion of low-SES students, is also the most positive advocate. We had him before the committee yesterday. I am interested in that nexus. We are out of time so I would ask each of you to take that question on notice and provide an answer in writing. I would really appreciate that. Medical students, I would also like to put to you the challenge of the maldistribution of the workforce, particularly in the context of regional areas and why we are not uncapping medical places. I would ask you to take that question on notice. Thank you very much for your evidence. It has been great.
Transcript of AMSA’s contribution to a Public Hearing of the Senate Select Committee into the Abbott Government’s Budget Cuts (16/10/2014)
CHAIR: Welcome. We have been talking a lot about the impact of this budget on young people. It is nice to have the voices of some younger people for evidence today. I understand that information on parliamentary privilege and the protection of witnesses and giving evidence to Senate committees has been provided to you. Do you have an opening statement? I invite you to give that now.
Ms Dean: Yes. Firstly, I would just like to say thank you on behalf of Australia’s medical students for the opportunity to voice some quite serious concerns that our members have regarding the budget. These concerns are in three main areas; the higher education impacts, the impact on medical training and the GP co-payment.
In terms of higher education the 20 per cent cut in base funding is devastating to the medical students of Australia. Medical deans in the base funding review showed that medical education was already underfunded by more than $20,000 per student per year. The amount that the government contributes to medical education is lower than other OECD countries. Simply, if we want to produce quality doctors in Australia then we need adequate funding. It is as simple as that.
In terms of the student impact of the debt, medical education is quite unique in that the number of medical student places around Australia is capped. That means we are functioning in an environment with limited supply. The demand on medical education is obviously very high, so the impact of market forces on this area is very dangerous. There is no reason why, with limited supply and a significant demand, the cost of medical education is not going to skyrocket. Already in Australia full-fee students pay more than $60,000 per year and a medical course cost $250,000.
The impact of such a significant debt can be seen both on the students themselves but also on the community. There are significant public health impacts of students and medical graduates carrying such a significant debt. We know that debt aversion is real. Those from lower socioeconomic backgrounds are deterred from studying irrelevant of repayment schemes. We know this from studies from the UK. Furthermore, from the Bradley review we know that there already exist significant obstacles to accessing tertiary education for those from rural and remote backgrounds.
In terms of the public health impacts, the Mason reviews shows that one of the best ways to overcome the rural doctor shortage is to take students from rural backgrounds. Therefore, in order to overcome this rural doctor shortage that we are suffering, we really need to try to ameliorate the obstacles for rural students to access medical education. We know that a significant debt pushes doctors away from primary care. We know this from studies from the US and New Zealand. If medical graduates finish medical school with a $250,000 debt looming over their shoulders, they are going to be more drawn to lucrative specialties and away from primary care, which is where we need them.
Lastly, who is going to pay the debt? A large proportion of medical practitioners practice in private practice. That means they have discretion over what they charge and who they bulk-bill. That means that ultimately this $250,000 debt may end up being paid by the patients themselves, which is not what we want to see in the future.
In terms of impact on medical training, the Prevocational General Practice Placements Program was removed in the budget. It provided GP placement opportunities for junior doctors, including medical interns. The consequence of this cut was that the number of internships were reduced around the country proportionate to this loss of funding. South Australia was particularly hard hit, with the number of internships falling by 23 from 278.
That is almost a 10 per cent cut in the number of internships offered in South Australia. We have to remember that this is occurring in a year when the number of medical graduates has increased. So rather than increasing the number of internships proportionate to workforce need and the increasing number of medical graduates we have seen a cut. This also all occurred in the week of internships applications, leaving final year medical students around Australia in a state of distress.
The abolition of HWA is concerning to our members because what it shows is that workforce planning is not being considered a priority. This is in a climate of a concerning training bottleneck, a rural doctor shortage and workforce maldistribution, where workforce planning is really quite imperative. In terms of the GP co-payment, our members support universal health care as the most equitable and efficient way to deliver health care. We believe any obligatory co-payment to be irreversible step away from this ideal. Furthermore, there is no such thing as a wasteful consult. Non-communicable diseases are our biggest health threat into the future. Prevention is imperative and deterring the community from these consults that provide an opportunity for lifestyle change is a huge backward step, as is the abolition of ANPHA. These budget cuts are going to have deleterious consequences on young people, students and households.
CHAIR: Thank you, Ms Dean.
Senator LINES: Thank you for appearing once again and thank you for your ongoing submissions and presentations. It is very much appreciated. I am sure it comes on top of already very tight work schedules. I just want to go to evidence that Ms Jenny Lambert gave—this is to the three of you—at the Senate inquiry into higher education last week. Ms Lambert said:
I understand the Senate—
and I presume by that she meant the Senate inquiry last week—
has been presented with a range of evidence and it is already in the public domain that a number of private higher education institutions have definitely committed to reducing the fees.
When Open University gave evidence about fees being reduced, the best they could say was that they had a deep hope that fees would come down. Are you aware of any of those comments being made by any institution?
Ms Dean: As I said before, medical education is already so significantly underfunded that we see no possibility that the fees will ever go down. The projections from the Grattan Institute suggest $37,000 per student per year, which is a significant increase from what they are already paying. Like I said, full-fee students already pay over $60,000, so if you are looking for a price signal that may be where it is.
Mr Luthra: If we are placing faith in market forces to reduce fees, the impact of market forces in medicine—as Jessica has already outlined—would be that, with such excessive demand and a capped number of CSP places, it would make sense for all universities to consider an increase are willing to pay as much as it takes to get into medicine.
Senator URQUHART: Thank you. I just wanted to touch on something that you said in your opening statement. It was about the cut in terms of funding to medicine courses. Will that be a disincentive for students to study in medicine courses? Do you think the extra costs, obviously, but also the cuts to the HWA and all that sort of stuff, will have some effect on people thinking, ‘I’d really like to go down that path and study medicine but with all these obstacles there now plus the bigger debt and the cost cuts, I’m not going to do it.’ Do you think that will enter into some students’ minds?
Ms Dean: Definitely. In terms of the impact of the cut to medical education I do not think it is the students themselves who should be concerned; it is the community.
We really should be concerned for the community, and the quality of the doctors that are being produced. If you are cutting corners on medical education it is the community that will suffer. In terms of the students, as I suggested, anyone would be deterred by a $250,000 debt.
That, in itself, is petrifying. Even if you are in medicine as a career, where you can make a good income and where job security exists, it is a significant debt for anyone, and it does have consequences for the individual but also for the community.
Mr Luthra: I was just going to add that, with reference to you point about Health Workforce Australia, and some of the later impacts on the training pipeline, I think that does potentially have relevance in terms of medicine as an international export. We hear a lot from the minister about making Australia’s higher education system an international export. Where we are right now, a number of international students who are currently studying medicine, and who are paying up to $60,000 a year to study medicine, are not able to secure internships and postgraduate training places in Australia. If that continues, and if the government does not address that we will see that situation worsen in future years.
CHAIR: Why is an internship important for medical student?
Mr Luthra: An internship is required for any student scheme to gain full registration as a doctor in this country.
CHAIR: Without it, the degree is pretty much useless, isn’t it?
Ms Dean: Exactly.
Mr Luthra: They would not be able to practice.
Senator URQUHART: You talked a little bit about the $7 copayment. What do you see as the ramifications of that if it is implemented?
Ms Dean: The end of universal health care, put simply.
Senator URQUHART: Describe what that means. What does it mean for the community?
Ms Dean: That means accessing health care. It is pretty simple, in its basic terms. Universal health care is one of Australia’s most prized possessions. To obliterate it in one fell swoop is incredibly disappointing and signifies a significant step backwards in terms of the evolution and development of health care in Australia.
Senator URQUHART: If people are discouraged from going to GPs, for one reason or another, and they are unable to afford the $7, what does that mean for the health system?
Ms Dean: I think the more important question is: what does that mean for the individual as well as the health system? If people are deterred from accessing health care early, particularly their GPs, generally it means you lose the opportunity for preventative interventions, which is what I touched on. Lifestyle change is one of the most effective interventions we can make in terms of non-communicable diseases and long-term, chronic, complex-care conditions. In terms of the healthcare system it means later presentations and more complex presentations.
That means longer hospital stays and, ultimately, more-costly care. Prevention is really the cornerstone of a good healthcare system, and anything that deters presentations to the GP clinic is going to be deleterious.
Senator URQUHART: Certainly it means a huge impact on the health of the individual but it means a bigger impost on the health system, because we will have sicker people presenting to hospitals. They may not have done had they sought interventionist assistance earlier on.
Ms Dean: Yes.
Senator URQUHART: There is even the lifestyle stuff that can generate people requiring hospitalisation when they may not have if they had changed their lifestyle earlier.
Ms Dean: Exactly. We are losing the opportunity for prevention, which is the most cost-effective measure.
Senator URQUHART: We have also heard from witnesses today about the possible restriction of social mobility as a result of the proposed higher education changes. Do you have a view on that?
Mr Luthra: We do. As Jessica mentioned, we think there is evidence out of the UK that suggests that people from lower socioeconomic backgrounds are deterred from higher education purely by the fact that a large debt may exist. Let’s be honest, the majority of medical students—particularly in the Group of Eight universities—are from relatively wealthy backgrounds. They would probably be in the higher SES segment of the community. We think the medical workforce should be representative, as Jessica mentioned.
If we want people to go out and be GPs in outer metropolitan suburbs or in rural and remote areas, we need to recruit people from those areas. We think that, with the higher education reforms, if there is a $250,000 debt facing you and no-one in your family has ever been to university before, that will be a deterrent.
Senator URQUHART: Do we see that now? Do we see where more rural GPs are from rural areas? I know there is a push to get GPs to go out into rural areas because of the lack of GPs particularly in those areas. Would that then become an impediment?
Ms Dean: We know from the Mason review that there are two very effective strategies. One is taking students from rural backgrounds to enter medicine. The other one is rural and regional training pathways, which we are seeing good investment in at the moment. We know that those are the two most effective strategies for increasing doctors working in rural and regional areas and overcoming the shortage.
Senator URQUHART: I know we have a fantastic rural clinical school in Burnie, in my part of north-west Tasmania, that goes out to areas like the west coast, which is very isolated. It gives medical students the feel of that sort of community and what it is like. It is so important to try to get students down into those areas so that that is where they go at the end of the day.
CHAIR: Are you having any conversations within your student bodies and so on about what they see as the consequences of these changes—in particular, I think you mentioned fee deregulation—and whether people are going to make decisions on the basis of the cost of a degree? People make statements about it influencing their choice of degree but we do not yet have any hard evidence. I am looking now for anecdotal evidence among your student cohort.
Ms Dean: I can identify four areas of choice that I think are going to be significantly affected. The first is the decision to enter medicine. A postgraduate woman who will probably be a fantastic doctor told me she already has a mortgage on her house. She has two adult children and made the decision that she wanted to become a doctor. She has very clearly said that she could not take a second mortgage for her university debt. So she is an individual who would not have become a doctor if there had been a $250,000 debt on the other side.
CHAIR: On that point: many medical degrees are now postgraduate degrees, so the intake of new graduates is older. We are talking about older cohorts. People in their thirties, after having had a career and a primary degree and so on, will often come to do degrees at Deakin University. So what you are saying is that that situation—
Ms Dean: Yes. We are essentially deterring those people from studying.
Mr Luthra: And many of those people, having completed a previous degree, would have the opportunity to enter the workforce and start repaying the debt they have already accumulated.
Ms Dean: I will talk about the other three choices that I think are significant. I have already spoken about specialty choice. That is already very significant. Already individuals who are graduating are talking about what a debt would mean. They are considering general practice or any of the other perceived lower paying specialties within medicine. They are reconsidering choosing things like anaesthetics or surgery, which they think yield a higher income potential, because of the consequences of significant debt. I have already suggested that, when they are considering what they can afford in running a GP practice, the fees they are going to charge are going to be contingent on the debt they have to pay. These are all considerations. Lastly, there are life choices. More than half of the medical students in Australia are female. The time they choose to have kids is after that they specialise, which happens to be in their thirties, which is at the latter end of their child-bearing years. The decision to take time off from medicine when you are accruing interest of up to six per cent per year on a $250,000 debt is not a small decision, and I think it is going to have a significant impact on the ability of these individuals to take time off to have kids. I know that there are already significant concerns within the medical student community about how they are going to manage that.
CHAIR: How many medical interns are going to miss out on a place this year? Do we know the total number?
Ms Dean: It is very difficult for us to speculate on those numbers, because they take into account the number that will preferentially go overseas and the number that will not graduate or satisfy the academic requirements or the English language requirements. Based on the number of applicants this year against the number of internship positions, taking into account all those caveats, there was a shortfall of 240 positions. We are optimistic that as the year goes on we will be able to better identify the exact number of those who will miss out this year. It is also difficult because every final year medical student knows the climate. They know that those numbers are what they are, and so there are a significant number of students who are preferentially taking job opportunities overseas, and that we are losing from the Australian medical workforce because the climate is what it is.
CHAIR: What should a student contribute? Obviously there are people who would like to see an entirely user-pays system, and there are other people who would say we should go back to the situation we had when students did not have to pay anything. Is the private-public notion a fair model—that if the private benefit is 30 per cent and the public benefit is 70 per cent, then it is one third-two thirds, which is private contribution versus government contribution? Does AMSA have a position on what a fair fee structure looks like for university students?
Mr Luthra: We have not got an official position on whether the private contribution should be $10,000 or $15,000. We do acknowledge that medical education is significantly underfunded, but we do consider that that underfunding should be corrected through increased public funding, as other OECD countries have approached it.
The current level of private contribution, where a medical student can graduate with somewhere from $40,000 to $60,000 of debt seems reasonable to us, but we have not speculated on a variation at AMSA.
Senator CANAVAN: Do you think that all degrees are created equal, so to speak—do some disciplines provide greater public benefits than others? I did philosophy and economics and I love discussing whether this table exists, but I do not know how much public benefit it has actually delivered to the world. What are your views on that matter?
Ms Dean: I think it is both an issue of public benefit and private benefit and also one of equity. Fairness should underpin a lot of these discussions, and I think that that should really be a priority as well.
AMSA is excited to announce the next round of applications! There are a range of activities and initiatives covering a broad range of interests and skills – check it out!
AMSA Academy opportunities include:
- National Subcommittee
- Let’s Talk About Sex Course Convener
- Electives pre-departure training course convener and subcommittee
- AMSA Global Academy subcommittee
- AMSA Advocates Subcommittee and Convener
Other positions include:
- AMSA Global Health National Coordinator
- AFRAM (AMSA For Refugee and Asylum seeker Mental health ) campaign and Crossing Borders for Health national committee
- LGBTIQ Officer
- AMSA Mentor Network Coordinator
- Vampire Cup Coordinator
- AMSA Global Health Policy subcommittee
- General policy writers and reviewers (NCDs, Indigenous health, refugee and asylum seeker health, ethical events)
All applications due October 31st, 11:59pm AEST.
For more information please click here.
Christopher Lemon is a first year medical student at the University of Notre Dame, Sydney
‘Honesty is the first chapter in the book of wisdom’ – Thomas Jefferson
I really didn’t know what to expect.
He could say, “Christopher, if I somehow found out that you were taking Penicillin, I really wouldn’t care”. On the other hand, he could also say, “anything you put online will be hacked at some stage by someone, somewhere in the world, and it will probably be used against you”.
These were some of the thoughts going through my scattered, terrified brain as I stood on stage in front of 800 fellow Australian medical students at the 2014 Australian Medical Students’ Association Global Health Conference (GHC). I had been given a once in a lifetime opportunity of speaking live with one of the most controversial leaders in global issues on the idea of using electronic medical records in Australia. ‘How did I end up here and what was the meaning of this experience?’ were my final thoughts as the speaker opened his mouth to give his view…
My undergraduate degree was in Arts. I was regularly surrounded by budding entrepreneurs and social activists in my first years at university. I am thus no stranger to grand visions that have changed the world (as well as many that haven’t). Yet when I started medicine at the beginning of 2014, although I had seen and heard all about worldly atrocities and great feats of humanity to do with healthcare, I was still perplexed about the concept of global health.
The 2014 GHC was initially presented as a conference all about understanding the meaning of change in global health. Across four days, delegates were to be immersed in ideas about change in your community, change in your focus, change in yourself and ultimately change in your world. There is no question that on the surface, the whole thing seemed to be of that common, alluring romantic ‘make the world a better place’ ilk, idolised by many but truly actioned by few.
With all this in mind, I decided to attend GHC 2014, not due to being persuaded by the grandeur of the idea of coming away evolved into an enlightened ‘changemaker’, but rather to see how the extremely dedicated team of medical students running the conference could combat cliché and convince delegates of the greater depths of understanding required to achieve change in global health.
The approach implemented was simple. Admittedly, however, it remained illusive to most until a sudden personal epiphany was had either in a confronting plenary, empowering workshop or even in the midst of an eclectic conversation with someone who was also awkwardly cold in the evening air, dressed in a too-short pink tutu in the name of charity. It was all about honesty. You must be honest with yourself and honest with the world around you, your world, before change in global health can ever be realised.
This idea of honesty preceding real global change was subtly and consistently embedded throughout the 2014 GHC program. The revered Nobel Laureate, José Ramos-Horta, spoke plainly about the fact that there might not be much of a role in his area of contribution for all those starry-eyed-super-motivated medical students in the audience. Dustin Leonard from HERO Condoms explained clearly that he had faced an inordinate number of incredibly frustrating initially insurmountable obstacles when trying to sell the idea of safe sex in Botswana through an innovative condom campaign. And in my particular case, Julian Assange responded to my question about whether we should invest in electronic medical records with what he described as a “flamethrower” response, claiming that no matter the underlying intentions, whatever information is put on the Internet, whether by you or someone else, will get hacked and potentially transformed in ways you had never even remotely considered.
I did not fully agree with e-health picture painted by Mr Assange, and for that matter with insights from some of the other speakers also, but by the end of his response, I understood the real impact of this and other interactions at GHC. All those whom we were fortunate enough to encounter were able to create true change across the globe because from the outset, they had ploughed past a superficial ‘clicktivist’ understanding of global health with an unrelenting honesty towards themselves, those around them and their community. They had seen things exactly as they are, developed a realistic vision for change and then empowered people in order to achieve this vision in the best ways they knew how.
It is this realisation more than any other, I believe, that will be the enduring legacy of this year’s Australian Medical Students’ Association Global Health Conference.
Matt McAlpine is final year medical student at the University of Western Sydney. Having a personal experience of mental illness through medical school, he has developed a passion for encouraging young people to be open about their struggles and seek help when needed.
We’re going on a bear hunt, we’re gonna catch a big one…I’m not scared!
Looking back on 5 years of med school, I can honestly say it’s been the most incredible adventure. A bear hunt filled with life-changing experiences shared with the most wonderful people; but at times wrought with obstacles that a savvy medical student must navigate to ensure survival. Whether it’s the egotistical consultants with insatiable appetites for the public humiliation of unwitting students; or the endless onslaught of written exams and OSCEs that always seem to focus on the exact things you didn’t study; or the constant threat of physical, financial and social oblivion that we supposedly consented to. We all eventually learn that -
We can’t go over it. We can’t go under it. Oh no! We’ve got to go through it!
When faced with the heartbreaking reality of mental illness that so many of us will experience, the road to recovery can seem so impossible that you question why you ever embarked on this bear hunt in the first place. If you ever find yourself ready to turn back or give up completely, please believe me that there is no obstacle so great that we cannot find a way through. That is, if we are prepared for the journey, accept the things we cannot control and let ourselves be vulnerable enough to receive help when we need it.
You can’t ‘get over’ depression however hard you try; just like Ronald Weasley and his Devil’s Snare, fighting against it alone can make things much worse.
You can’t go around or avoid anxiety; it arbitrarily devastates and can bring even the strongest and most resilient people to their knees.
Sadly, you can’t dig a hole to bury your head in the ground hoping to wake up on the other side of loneliness and heartbreak unscathed.
When you’re standing at the edge of the world, surrounded by a seemingly endless expanse of hopelessness and despair there is only one way to overcome, and that way is through.
Setting out on a bear hunt, an experienced adventurer will hope for the best, but plan for the worst – and this means having your wits about you even when the sky is clear. If a storm were to rudely interrupt your journey, only a fool would ignore it, or spend all their energy trying to make it stop. It’s also rather silly to blame yourself or somebody else for the weather; it’s completely out of your control. The storm clouds of mental illness can arrive without warning or permission to ruin the most perfect of days, and they certainly aren’t our fault.
And when it rains, it sure as hell can pour.
Like when you find yourself violently sobbing for hours under your bed screaming to the black sky for mercy and reprieve. When you are so physically crippled with fear and panic that you collapse next to your trolley in the cereal aisle. When the ghosts of your past and the demons in your mind haunt the deepest recesses of your being, convincing you that everyone would be better off if you just disappeared.
When every inch of you is soaked through, the wind stinging your eyes and the thunder pounding your ears, please remember that just like the most terrifying storm, these moments will not last forever. With this in mind pack a sturdy umbrella in your knapsack, a woollen blanket for the cold nights and be willing to adjust your speed while waiting for the sun to rise.
When the most elementary functions of being human start to disintegrate like your sleep, appetite, energy, motivation and ability to enjoy everyday things – let these barometers trigger a contingency plan of regular sleep, exercise, healthy eating and mindfulness. When you seemingly lose control over your own body as it launches a full-scale revolt of palpitations, weakness, breathlessness and the mental pandemonium of panic, find the courage and humility to raise an umbrella by accepting help from professionals like your GP, or starting medications for a time if needed. When all hope is lost, and you are certain that your mind and heart are beyond redemption, cling desperately to the warm blanket of close friendships and family. Believe them when they say that you are dearly loved, and life is better when you’re around.
Many seasoned bear hunters will speak of obstacles so immense and frightening that simply surviving becomes a daily battle. Sometimes the mud is so thick, the river so wide and the forest so dark that a wise adventurer must adjust their trajectory and expectations accordingly, even if it means slowing down momentarily to focus on each individual step. This can be remarkably difficult to practice as a medical student, considering most of us have powered through the open fields of life with extraordinary motivation and zeal.
When encountering mental illness the temptation is to maintain the same velocity; keeping all prior commitments and projecting the same external demeanour lest others think you aren’t coping. Realistically, this is not only impossible but also dangerous. If you reach the end of some days thinking, ‘all I have achieved today is getting out of bed, and not killing myself’, you have in fact taken a most momentous step; one requiring a level of courage others may never truly understand. That is accomplishment enough.
Most importantly, never go on a bear hunt alone. Make the excruciating choice to be vulnerable to those who care about you, and share your struggles with them just as you would your triumphs. Silence is deadly. Sitting in your room alone with your heartache and suffering day after day may feel romantic. Setting out on an adventure without needing anybody’s help may seem stoic. But when the lies of your weary mind are the only words you hear, they can be powerfully convincing. Find the strength to open up a window and let the light in. Reach out a hand and let the world help you get through this storm. Your story is so important, and an incredible adventure is waiting for you on the other side.
For those who haven’t experienced mental illness and are running through the open fields conquering any obstacle in your path, and those who have emerged on the other side striding along the road to recovery: I beg you with all that I am to have open eyes and minds to see those struggling to make it through each day. Open your heart to be the light that shines through their window, the hand that pulls them out of the sinking sand and the warm blanket that holds them through the darkest nights.
We’re going on a bear hunt. We’re gonna catch a big one, and I’m not scared.
Because we can get through this.
You will get through this.
If you are in need of urgent assistance, please call LifeLine on 13 11 14. You can also find a range of helpful resources, including our Keeping Your Grass Greener wellbeing guide at our mental health website.
This post is part of AMSA’s National Blue Week – a week dedicated to promoting mental health and wellbeing and breaking down stigma against mental illness. Follow the action on our social media pages this week – and share our mental health infographic to help spread the word.
30 September 2014
The Australian Medical Students’ Association (AMSA) has today obtained figures showing that hundreds of medical graduates will not be able to become doctors in our community.
The National Medical Intern Data Management Working Group has completed an audit of offers, and concluded that approximately 240 Australian graduates will not be offered a State or Territory position.
AMSA President, Jessica Dean, said today that AMSA is very disappointed that such a large number of graduates from Australian medical schools will be unable to practise in Australia.
“As regions of Australia continue to suffer from doctor shortages, it is nonsensical to be wasting another cohort of medical graduates,” Ms Dean said.
“Completing an internship is an essential process for a graduate to work as a doctor in Australia. If the Government is serious about correcting the ongoing doctor shortage, it makes sense to completely utilise the graduating Australian workforce.
“These students have spent up to six years immersed in Australian culture, learning our diseases, and training in our healthcare system. They are perfectly suited to serve Australia. They just need to be given a chance.”
The shortfall is yet to be finalised. The Commonwealth Medical Initiative (CMI) is yet to offer positions for the 2015 intake. This program was developed for international-born Australian graduates to complete an internship in Australia. While the initiative promised ‘up to 100’ places, AMSA was disappointed that only 76 were offered last year.
“The CMI initiative is a welcome addition to the medical training landscape. However, the addition of 76 places may still leave over 160 medical graduates who will be forced to take their skills overseas,” Ms Dean said.
“Last year, the CMI initiative was oversubscribed with 183 applicants for 76 positions. These graduates not only want to work in Australia, they are even happy to relocate to work in areas of need, especially rural and regional Australia. Isn’t this the answer we are looking for?
“By failing to facilitate training opportunities, Australia is allowing itself to become a victim of brain drain.”
“Refusing to train local graduates and then filling the deficit with overseas-trained doctors is remarkably myopic.
“AMSA is calling on the Government to invest in the future of health care and provide Australia with the health care system it needs,” Ms Dean said.
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Emma Ward is a third year nursing student at Monash University.
As a nursing student, I have observed many doctors and med students on my clinical placements – some good and some bad. No doubt by now you have given some thought to what makes a good doctor, but what qualities do nursing students consider to be foundational to making a great med student (and one day, doctor)?
Occasionally I have experienced a hierarchal rivalry between doctors and nurses on placement. I admit this is not something I have witnessed too much of between students, however it is has come up. At an undergraduate morning tea I was introducing myself to a med student whom after discovering I was studying nursing said “Oh! I couldn’t do it. Are you doing nursing because you didn’t get into med?” as if nursing were the ‘scum’ of the health professions. I was a little shocked at first because the truth is I have wanted to pursue nursing since I was eight years old and both doctors and nurses are hugely interdependent on one another. That isn’t a dig at anyone in particular, however I think in general doctors, nurses and other allied health professionals alike can all incorporate a little more respect for one another’s work. After all, respect isn’t a one-way street.
Whether it be communicating to your colleagues or your patients, communication is key. Remember who your target audience is. I understand using medical terminology makes you feel intelligent (I feel that too), and it is fine to flaunt this with colleagues, however remember what it was like when you first started med and it felt like you were learning a new language. I witnessed a med student tell a mother that they were going to have to cauterise her six-year-old son to stop the recurrent epistaxis. She looked pretty concerned over the next five minutes as the student continued to explain the plan. It wasn’t until she was told that he was referring to the recurrent nosebleeds her son had been experiencing that she relaxed. Then of course there is the “doctor’s handwriting” matter. Granted doctors are busy but I have to say I love it when I pick up a patient’s file to see the med student has written the notes because 9 times out of 10, they are legible…at least more so than the doctor’s.
A Sense of Humour
This isn’t so much a quality of a good med student as it is a quality of a good person. It is inevitable that in your field of work you will encounter some pretty bleak situations and carrying a sense of humour with you throughout your career is never a bad thing. Of course there is a time and place for humour, but I honestly believe laughter is the best medicine (at least one of them). I remember on my first placement, a third year med student was assessing a patient who had been experiencing a lot of abdominal discomfort. Upon palpation the patient was embarrassed when they were flatulent. Much to the student’s credit she made a joke of it, saying “well it’s a little bit windy in here today isn’t it”. Humour has the power to return the humanity to your work, ease fear and not to mention it will keep you sane.
Share your knowledge and experiences. As students we share a similar level of enthusiasm towards tasks and procedures which are pretty mundane in the daily lives of our qualified counterparts. Maybe it is just me, but I love coming together with med students and discussing concepts I don’t quite understand to the same level or hearing about the time you got to scrub in on that knee replacement. Despite what you may think, we have more exciting stories to share than that time our patient was incontinent of faeces…though we have plenty of those stories if you are interested.
The Australian Medical Students’ Association (AMSA) has concluded its annual blood drive in conjunction with the Australian Red Cross Blood Service. The annual blood drive encourages medical students to roll up their sleeves and donate blood.
AMSA President, Ms Jessica Dean, said today that the donation of blood is crucial for modern medicine and that Australia’s medical students have donated in record levels this year.
“Australians require 27,000 blood donations every week. Blood donation should be a habit of those who can.
“The AMSA blood drive ensures the future medical workforce is both confident to donate and encourage those in the community.”
Over the two month blood drive, there were 1,414 donations made by students. With each donation on average being distributed to at least 3 recipients, AMSA has saved the lives of 4,242 people.
“This has been the most successful AMSA Blood Drive and we are extremely proud to assist the Red Cross in providing the healthcare system with this valuable resource.”
The university with the most donations per capita is awarded the AMSA Vampire Cup. This year, Deakin Medical Students’ Association was awarded with the Vampire Cup for the fourth year running.
Deakin AMSA representative, Brad Richardson, said today that the university have developed a strong culture of blood donation over the last four years which has resulted in sustained success.
“Deakin students understand the great value of blood donation and are honoured to assist the healthcare system in the Geelong community each and every year,” Mr Richardson said.
Deakin claimed victory with 38% of the cohort donating, following by ANU Medical Students’ Society (18%) and University of Melbourne Medical Students’ Society (16.5%).
Full results can be accessed at https://www.amsa.org.au/uncategorized/20140922-vampire-cup-results/
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