National Internship Crisis

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.

On June 26, the following was released, to update stakeholders on the internships situation for 2015:

“The Audit of Applications for 2015 internship has been completed before any offers have been made. The audit identified that there were 3676 applicants for internships: 3004 domestic medical graduates, 480 international full fee paying medical graduates of Australian universities and 192 other applicants. NB: Based on experience from previous intern recruitment it is anticipated that the number of applicants able to accept and commence an internship may be less than those who applied due to failure to complete their course.

As at June 2014 there are approximately 3210 state and territory intern positions available for 2015 (some positions still subject to accreditation) and up to 100 Commonwealth funded intern positions.”

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. Health Workforce Australia’s 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. Even this workforce modelling  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. In the application process for 2014 places, up to 100 Commonwealth Medical Internships were offered. Each of these places had a one year return of service associated with them, and yet there were 183 applicants for the places. 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 fears that the problem may begin to affect domestic full-fee paying students, and then perhaps even domestic CSP students.

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 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 3484 in 2014.

However, inadequate action has been taken to accommodate the oversupply of medical graduates.

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

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.
  • 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 keep medical students informed of the latest progress on this important issue.

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 internship elsewhere in Australia.

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. Contact AMSA to see how you can assist in advocacy for more internships.
  • 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. Unless there is a major expansion in internship availability, there will continue to be significant shortages of internships over this period.

Other resources

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.