National Internship Crisis Updates

Twitter: #interncrisis

Over a number of years, AMSA has mounted a comprehensive campaign advocating for States and the Commonwealth to work constructively towards a solution which enables all Australian-trained medical graduates to gain an internship in Australia.

AMSA has welcomed the recent announcement of 116 new internships in public and private systems in WA, Queensland, ACT and the Northern Territory. This breakthrough has been made possible through the collaboration of Federal and a number of State Governments. Click here for AMSA’s media release.

AMSA is currently working with Governments and Postgraduate Medical Councils to clarify the allocation, accreditation and other conditions associated with these new positions and will post further information on this page when available.

According to the latest national audit data, as of 16 November there were 162 unplaced Australian-trained graduates. Accordingly, after the allocation of the 116 new positions, there remain approximately 46 unplaced graduates.

Whilst these new positions are a welcome breakthrough, there is still more work to do to place the remaining graduates, and to build a sustainable medical training system for future years.

So why should Governments fund internships for Australian-trained medical graduates?

1. Doctors, patients and Governments know that many of Australia’s regional and rural communities are crying out for doctors. Recent workforce modelling indicates that in order to sustainably meet our future health needs, our health systems must retain as many Australian-trained doctors as we can. It’s telling that a doctor shortfall of approximately 3000 is predicted even based on Australia’s current trajectory of medical workforce development, which relies on the importation of thousands of overseas-trained doctors each year. In this context, it’s madness to even contemplate shipping out Australian-trained doctors.

2. Tens of thousands of taxpayer dollars and health system resources go into training each and every medical student. Aside from the personal time and financial costs of medical training, to deny a medical graduate an internship is a huge waste of these resources.

3. At this stage, the students affected by this crisis are international students studying in Australian medical schools. Such students make up approximately 15% of the medical school cohort and pay tuition fees of up to $300,000 over four to six years. It’s widely acknowledged that Universities are reliant on this revenue to subsidise domestic students and remain sustainable into the future.

4. Higher education is Australia’s third biggest export industry (after coal and iron ore) and was worth $16.3b in 2010-11. State economies (particularly NSW and Victoria) are heavily reliant on international student revenues and are sensitive to issues affecting those students. The majority of the Australian-trained students without internships are international students in New South Wales, Queensland and Victoria. Not providing internships for international students may severely and irreparably damage Australia’s international reputation for medical education. Many other countries actively compete for this lucrative market and if international students are aware that their degrees may be worthless, many will study elsewhere. A 2010 paper models the economic impact of declining international student enrolments. Funding for sufficient internships for all Australian-trained medical graduates (now and in the future) is clearly an excellent return on investment.

5. We know that as a group, international medical students are happy to take up internships in regional and rural areas, meeting our communities’ health care needs. These graduates have much to offer Australia, have been trained in our health system and are ready to work if given the opportunity. Students who do not gain internships will be forced either to continue their training overseas, lost to the Australian health care system, or work in industries outside of medicine. Some will choose to reapply in future years.

6. This is not a difficult problem to fix, provided that the political will to do so can be found. AMSA understands there to be sufficient identified capacity in public and private health systems to accommodate the additional interns and the solutions are affordable, both in terms of the size of health budgets and future return on investment. The issue essentially comes down to money, as Governments blame each other over the appropriate balance of funding between Federal and State, private and public.

This issue is only set to worsen in future years, as graduate numbers continue to climb and pressure rises on the availability of specialty training places.

AMSA calls for all Governments to put aside political blame games and realise the importance of maintaining a sustainable medical training system that provides internships for Australian-trained medical graduates.

The latest updates

The National Internship Allocation Working Party (NIAWP) has conducted numerous robust audits of internship acceptances since August. The NIAWP data is the best available at the current time, collected directly from the jurisdictional offices conducting internship offer processes. As of Friday 16 November, there remained 162 unplaced Australian-trained medical graduates, prior to offers of any of the new internship places announced in November.

Health Ministers met on Friday 9 November in Perth to consider a range of issues in health, including internships and medical training. 116 new internships were announced in WA, QLD, ACT and NT, in public and private systems. Click here and here for the Federal Minister’s media releases.

At this meeting, Volume 3 of the Health Workforce 2025 series was approved, along with a series of policy responses to the entire HW2025 report series. Click here for a summary of the report series.

Medical students around the country are taking action on this important issue. AMSA has prepared a briefing document for students to use when speaking with their Members of Parliament. Click here to access the document.

A group of about 200 NSW medical students gathered in Sydney on 21 October to advocate for internships for Australian-trained medical graduates. Dressed in surgical scrubs, the students called for a resolution of the political standoff threatening to send Australian-trained doctors overseas.

Health Ministers met on Wednesday 26 September to consider proposals for the creation of additional internship positions for Australian-trained graduates; however, an agreement was not reached at this meeting. Significantly, Minister Plibersek committed $10m of Commonwealth funding for 100 internships in private settings, on the condition that State Governments collectively provide $8.2m for the remaining 80 positions in the public sector.

The response from many State Ministers has been disappointing, with Victorian and New South Wales Ministers writing to Minister Plibersek indicating that their states will not fund any additional places, above existing planned expansion. Click here and here for their letters.

The Standing Council on Health (SCoH) and the Australian Health Ministers’ Advisory Council (AHMAC), consisting of Health Ministers and Health Department CEOs respectively, has met repeatedly on this issue in recent weeks and months. Further meetings are scheduled, while Australian-trained medical graduates anxiously await a solution to this crisis.

The Confederatation of Postgraduate Medical Education Councils (CPMEC) has conducted a national audit of applications in June and a series of national audits of acceptances in August and September. The audits indicate that this year, 3326 Australian-trained medical graduates have applied for 3080 internship positions in 2013. The applicants comprise 2828 permanent resident (domestic) and 498 temporary resident (international) graduates.

The CPMEC audit of unplaced applicants, conducted on 18 October, identified that there remain approximately 181 unplaced Australian-trained graduates. The CPMEC has produced reports on the applicant surveys in 2011 and 2012, which provides data on applicants’ perceptions of the internship allocation process.

The background

An internship is a compulsory year of training, following graduation, which is necessary to continue practicing in Australia and to gain general registration.

For a number of years, AMSA has been advocating for numbers for the number of available internships to increase so that all Australian-trained medical graduates have access to an internship. AMSA’s advocacy has significantly contributed to the increased availability internships to accommodate the rapid increase in the numbers of medical graduates from 1660 in 2000 to 3028 in 2011.

However, in 2012 the number of medical graduates will increase by approximately 486. Inadequate action has been taken to accommodate the oversupply of medical graduates and, based on current information, it is now expected that approximately 182 international medical students will miss out on an internship.

Why has this happened?

  • Lack of workforce planning from Federal and State Governments to ensure internships and further medical training places are aligned with the number of medical graduates
  • Lack of regulation from Federal Government allowing universities to determine the numbers of international and domestic full-fee students with no central regulation
  • Inadequate Federal Government funding for medical schools contributes to medical schools’ recruitment of additional full-fee students
  • Medical schools recruiting numbers of international students well beyond the number of available internships
  • Inadequate communication from some medical schools to prospective international students about likelihood of obtaining internship
  • State governments being reluctant to fund internships for numbers of medical graduates they cannot control

Statements from Government and other organisations

In her speech to the AMA Parliamentary Dinner on 22 August 2012, Prime Minister Gillard recognised the issue of sufficient internships for medical graduates, saying, “your pressure on the States to provide more intern places and ease bottlenecks in the system in the years to come is important.” The Prime Minister’s full speech is available on the AMA website.

Health Minister Plibersek has publicly said that it’s “nuts” that Australian-trained medical graduates may miss out on internships, given the public investment in medical training and at a time that the health system is in need of all Australian-trained graduates. The Minister has publicly taken the view that all Australian-trained graduates should be able to gain an internship in Australia.

The Australian Health Ministers’ Advisory Council (AHMAC) consists of the Director General, Chief Executive or equivalent of each State and Territory Department of Health. AHMAC is a top-level decision-making body on health system issues. AHMAC consults regularly with Health Workforce Australia and the Commonwealth Department of Health and Ageing.

On Monday 23 July, AHMAC released a statement, authorised for distribution by AMSA, available here.

On Monday 18 June, the following statement was released by AHMAC:

“The Australian Health Ministers’Advisory Council (AHMAC) has considered the issue of provision of internships to the graduates of Australian medical schools.

It is aware of concerns expressed by the Australian Medical Students Association (AMSA) in relation to the issue of international full fee paying students of Australian medical schools being able to secure an internship.

AHMAC has commissioned urgent work to quantify the extent of any potential shortfall in internships for international full fee paying students and options to address any concerns.

AHMAC is also aware of a change in the Victorian intern selection policy. AHMAC has asked that the impact of this change on the availability and provision of internships across Australia be assessed. It should be noted that the selection of applicants for internships, including selection criteria is the responsibility of each jurisdiction.

Once this work is finalised over the next couple of weeks the outcome will be communicated to medical schools and students applying for internships.”

The Confederation of Postgraduate Medical Education Councils (CPMEC) has released two policy statements on this year’s internship allocation, highlighting the importance of robust accreditation processes. The July statement is available here and the August statement is available here.

Medical Deans Australia and New Zealand (MDANZ) has been lobbying alongside AMSA, and has released statements on 23 July, available here and 25 September, available here. Minister Plibersek and Prof Beilby, President of Medical Deans Australia & New Zealand were interviewed at length on ABC Radio Brisbane on Wednesday 26 September, available here.

What is AMSA doing about it?

  • AMSA is in frequent contact with Federal and State Health Ministers, Chief Executives of Health Departments, each Postgraduate Medical Council, the Confederation of Postgraduate Medical Education Councils, Medical Deans Australia & New Zealand and Health Workforce Australia, to advocate for coordinated action to expand the number of internships available to Australian-trained medical graduates.
  • AMSA has sent its petition, containing almost 6500 signatures, to every Health Minister asking them to commit to providing internships for all Australian-trained medical graduates.
  • AMSA has written to Health Minister Plibersek, the Commonwealth Department of Health and Ageing and Health Workforce Australia urging coordinated action to increase the number of available internships.
    • The letter to Minister Plibersek is available here
    • The letter to Ms Jane Halton, Secretary of the Department of Health and Ageing, is available here
  • Together with Medical Students’ Councils and MedSocs, AMSA has written to all State Health Ministers and called every State Health Department to advocate for resources to be committed for an internship for every Australian-trained medical graduate.
  • AMSA International Students’ Network has release a guide to applying for internship in the USA, read it here.
  • AMSA is regularly posting updates to this page, to keep medical students informed of the latest progress on this important issue.

Meetings and AMSA media appearances

Who is guaranteed an internship?

  • Commonwealth-Supported Place (CSP) students

  • Domestic and International full-fee students are not guaranteed internships (learn more about the options here)

  • Domestic students are generally prioritised above international students in the allocation of internships

The Tasmanian Department of Health and Human Services has provided assurances that it will provide internships for the number of domestic Commonwealth Support Place students who graduate from The University of Tasmania and are unable to gain an intership elsewhere in Australia.

Priority systems

On the 8th of June, the Victorian Department of Health announced changes to prioritisation in the allocation of internships in Victoria. A full description of the changes can be found here. Significantly, domestic students graduating from interstate universities will now be prioritised below international full-fee graduates of Victorian medical schools and students from the Monash University Malaysia Campus.

AMSA is working with the Victorian Department of Health and other relevant stakeholders to clarify the implications of this change for the Commonwealth of Australian Governments guarantee of internships for all Commonwealth-supported students and Australian immigration legislation that protects the employment and training opportunities for Australian permanent residents.

Following AMSA’s advocacy, PMCV has been advised by the Victorian Department of Health that full fee international students who have studied at Monash Universitiy Malaysia Campus will be included in Priority Group 3, behind category 1 and 2 students (domestic and international graduates from Victorian-based medical schools) and preferenced equally to other category 3 students (domestic students who graduate from interstate medical schools) in the internship allocation. Monash Malaysia students were initially included in category 2.

Domestic full fee students

All States and the ACT have provided assurances that they will be able to provide internships for all domestic graduating students in Australia. Domestic full fee students may wish to contact their State’s postgraduate medical council to confirm whether they have committed to provide internships for all domestic graduates, including full-fee students. If your State or Territory does not provide this assurance, students should consider reading Options for international students.

Options for international students

Unless there is dramatic change to the current projected shortages of internships most international students will not be able to complete an internship in Australia. There are several steps that students take to plan for this situation outlined here. The AMSA International Students’ Network (ISN) has also written a letter detailing Information for current and prospective international students including suggestions about applying for internships.

  • Apply in multiple states. There are significant shortages of internships in the majority of Australian states, however applying to multiple states increases the chance of obtaining an internship in Australia. Because some medical graduates move interstate to complete internship, it is difficult to judge which states will accept the greatest number of non-Commonwealth Support students.
  • Take action. Sign the AMSA petition in support of providing internships for all medical graduates here.
  • Have a backup.Based on current numbers the majority of international students will not receive an internship in Australia. It important for international students to have a backup plan in case they are unable to gain internship in Australia.
    • Apply for an internship outside of Australia. More information on applying for internship as an international medical graduate can be found here for Canada, Malaysia (Internship, Guidebook for House Officers, training hospitals), New Zealand, Singapore and USA. Make sure you comply with any additional requirements (eg. MCCEE and USMLE examinations for Canada and the USA respectively).
    • Consider alternative employment next year. Medical graduates are able to make valuable contributions to society through a range of employment options beyond working as a medical professional.
    • Reapply for an internship in Australia next year. Students who do not gain an internship in Australia may consider reapplying next year. Please note that the numbers of medical graduates in Australia is expected to continue to increase, from 3,512 this year to 3,623 in 2013 and 3,935 in 2015. Unless there is a major expansion in internship availability, there will continue to be significant shortages of internships over this period.

Other resources

AMSA International Students’ Network webpage – contains resources for international students addressing internships and many other issues.

The information contained on this page is subject to change. For more information, students should check the website of the Postgraduate Medical Council in each State and Territory. AMSA shall not be held responsible for any errors or omissions in the above information.