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A horde of untrained doctors is no good for our health

Simon J Green

by Simon J Green

10 Dec 05:45am

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Filed under: Ama, Doctors, Education, Health, Tanya Plibersek, Training

31 comments

A crisis looms. Before November 2012, 181 trained medical students would find themselves without a graduate placement. Without this last step, they cannot practice as doctors in Australia.

Nurse, our medical training system has no pulse!

A medical degree sees a student spend up to six years at university, where they gather a general education in medicine. Once complete, the student must find a graduate internship in a hospital, where they can then move from students to become actual doctors.

According to an audit by the Confederation of Postgraduate Medical Education Councils, 3326 Australian-trained medical graduates applied for 3080 internships in 2013. That leaves 181 graduating students - who have spent between $51,000 and $300,000 - without any option to further their barely-started career.

It’s being labelled the National Internship Crisis, and James Churchill, the president of the Australian Medical Students’ Association says it’s a significant problem over the long term.

“There’s a lot of money that goes into training. It’s a waste of an investment the public makes. A waste of medical professionals to meet our future needs.”

These future doctors are particularly crucial for providing desperately needed healthcare in rural regions. Mr Churchill points out that the rural system is almost in crisis mode itself.

Dr Sean Fabri is International Medical Graduates Subcommittee Chair at the Postgraduate Medical Council of Victoria. He agrees that rural doctoring is important, but is concerned that the flood of students and a lack of appropriate mechanisms to process them is increasing the strain.

“One potential way it could affect patients is the dilution of training. If we just have to find more places for this large number of interns – and the numbers are just going to go up and up with the current government policy – we might end up sharing the jobs or workload against a larger number of people. While some will get the sufficient amount of experience, there’s going to be gaps.”

Dr Fabri and Mr Churchill both say the solution is, like a lot of complex issues that involve state, federal and local co-operation, a long-term, consistent approach. The fact that a cycle of medical education transcends a politician’s elected term doesn’t help.

The breakthrough 116 positions that have been produced by planning between federal Health Minister Tanya Plibersek, and Health Ministers from Western Australia, Queensland, the ACT and the Northern Territory are useful for now, but it’s the lack of plans for further training that makes Dr Fabri and Mr Churchill’s AMSA concerned.

Dr Fabri says there is good data on providing solutions. “There’s actually a World Health Organisation recommendation that was made in 2010 which suggested that first world countries like Australia need to develop a sustainable workforce in medicine, and as part of that we have an organisation called Health Workforce Australia. They’ve released a document called Health Workforce 2025.”

Mr Churchill says that Health Workforce 2025 “is the best workforce planning data we have.” The difficulty to overcome is implementing the data, requiring “coordination of different arms of the medical training pipeline. No one body is clearly responsible for that aspect.”

Mr Churchill suggests that using the Health Workforce 2025 data to estimate numbers is key, making sure the students who enter courses have relatively assured internships ready at the end. An understanding between the public and private hospitals, and universities that supply them with students is necessary to make such numbers useful.

“Hospitals are now inundated with applications, by people desperate for positions,” Dr Fabri admits. His role as part of the team processing these applications has put him in the eye of the storm. “You’d think that initially that would be a good thing, but in fact it’s created a tremendous burden of sorting and shortlisting applicants. When you have nine hundred people who’ve applied, that’s just not a number you can realistically interview. Especially given the short timeframe.”

A study in Queensland has identified a shortfall in ongoing training and positions for doctors, with reports that as many as 400 doctors in postgraduate years will not be offered work in the state in 2013. Meanwhile, the Australian Nursing Federation predicts a “shortage of more than 109,000 nurses by 2025.” (Link) Clearly, Australia’s medical community is in trouble.

Governments are finally at the table, discussing these problems with stakeholders. The 116 new positions extend the lifeline, but only for now. Further investment from governments in required, but that will be tough given the economic climate.

AMSA is pushing for implementation of the Health Workforce 2025 data, and government and private hospitals to engage with universities on the matter. The importance of the issue is not one that is front and centre in the public’s mind, but if adequate achievements aren’t met, and soon, patients will be the ones in crisis.

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31 comments

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    • acotrel says:

      05:39am | 10/12/12

      ‘Mr Churchill says that Health Workforce 2025 “is the best workforce planning data we have.’

      ‘Workforce planning’ - what is that - ‘new speak’ ?

      Reply

    • Gregg says:

      06:19am | 10/12/12

      If you read the preceding paragraph it can be enlightening.
      ” Dr Fabri says there is good data on providing solutions. “There’s actually a World Health Organisation recommendation that was made in 2010 which suggested that first world countries like Australia need to develop a sustainable workforce in medicine, and as part of that we have an organisation called Health Workforce Australia. They’ve released a document called Health Workforce 2025.”

      And then even the best plans are not always achievable and the devil is usually met in the detail.

    • NigelC says:

      08:32am | 10/12/12

      Yes Acotrel - ‘new speak’. Last century my wife worked in a large organisation preparing their workforce plan and there was even a conference in Sydney for workforce planning. Time for you to stop commenting I think because you are at least 15 years out of date.

    • alf says:

      04:15pm | 10/12/12

      The Australian Medical Workforce Advisory Committee, formed in 1995, is how we got this problem in the first place. They decided in their wisdom that we were heading for a massive OVERSUPPLY of doctors and forced all the universities to cut back on the numbers of medical students. This situation was finally changed in about 2007 and they are now trying to “catch up” by graduating larger numbers of doctors.

    • marley says:

      06:18am | 10/12/12

      I was under the impression that it is overseas students who are having trouble finding internships.  I don’t see how funding positions for foreign students who will presumably return home is going to address the problems of rural health care.  I’d rather have Australian students required to do a stint in the regions as part of their training.

      Reply

    • Shelly says:

      08:16am | 10/12/12

      You’re right Marley. It is. The issue only arises because universities accept full fee-paying students on top of the subsidised (HECS funded) places. I believe that the HECS funded graduates are guaranteed an internship but the fee paying students aren’t. There may be spots for them, depending on the number of funded intern places and what the other graduates do.

    • Nick says:

      03:51pm | 10/12/12

      My spouse spends every summer working in rural hospitals and I can assure you that forced rural stints won’t work.  Rural people don’t want half-trained knobs with an attitude problem, they want fully trained doctors who give a toss.

    • marley says:

      06:02pm | 10/12/12

      @Nick - actually, my GP (trust me, rural) takes in med students to do a little stint with him - checking blood pressure, updating charts, nothing that’s going to kill anyone.  The ones I’ve seen have been pretty decent types, trying to learn their trade in the real world.  Maybe some of them might decide a life in a seaside town with good beaches and a golf course, and earning $250,000 and up once they’re qualified, beats living in Sydney or Melbourne.  I hope so, anyway.  Because my GP is 80 now.

    • Gregg says:

      06:28am | 10/12/12

      Trained doctors are certainly one aspect of adequate medical care as are having sufficient numbers of nurses who also need time in hospitals as part of their training.

      That there are more hospital places required may mean a number of things and that being:
      1. Will we be running short of hospitals and hospitals capacities and perhaps advances in medicine and even protection of people in auto accidents may mean even with an increasing population, demand could be stable or even decrease, there also being much more day surgery than there may have been twenty years ago.
      2. The number of university courses may now be higher than needed.

      It also needs to be examined whether the Australian University trained doctors includes international students for then it may be that those international students should get their hospital experience in hospitals of their own countries and that would offer some correction to the imbalance between university study and hospitals demand.

      Reply

    • craig2 says:

      08:06am | 10/12/12

      Greg: one of my clients, a Gp, spent 50000 dollars trying to find a dr only to find the dr, an international, was not skilled enough to practice medicine. Had to send the dr to Tasmania to be re-skilled to Australian standards. No re-course to the money sadly, just wasted. So, my client cannot find qualified drs in Australia who want to practice as a Gp and he’s now given up and practices on his own. Shame the system isn’t working.

    • Gregg says:

      08:31am | 10/12/12

      @craig2
      Seems as though your client could do with a dose of commonsense when it comes to understanding the medical profession requirements for practising in Australia for it is not just as simple as recruiting a doctor from abroad as he has found out.

      Many localities have shortages, especially away from the capitals and larger cities, our coastal strips always being much more popular than inland.
      Our town was without a doctor at one stage for about six months and it even meant travelling 125 km. one way to get a regular prescription and yet now we have a few and I wonder for how long before they decide there is not enough business to go around.

      Like most things in life, it comes down to supply and demand and so even with a national imbalance one way, you could always get localised opposite imbalances.

    • FINK says:

      06:49am | 10/12/12

      It’s a disgrace as simple as that. The blood letting on the Health professionals and system began with Abbott when he was Minister for Health (sarcasm intended). The states did not help the situation by burdening the state health systems with bludging bureaucrat fat cats. Now in NSW you have the Liberal party ripping more cash out of the health system, it is unworkable and lives will be lost because of this of which these so called politicians will never be held to account.
      Go to any E.R at any time of the day and tell me there is no room for new interns, to assist, learn and save lives!

      Reply

    • Gregg says:

      07:54am | 10/12/12

      You might be surprised just how many mummies ( and daddies possibly ) take the little Johnnies and Marys to medical clinics or ERs because of a stomach ache which usually turns out to be junk food constipation upon an Xray being conducted.

      Knowing people working in Xray and having myself spent some time involved, I’d suggest that about 90 percent plus of Xrays are in fact superfluous to medical examinations.

      Like a lot of our world, there is an awful lot of waste and over servicing that occurs, mostly all on the taxpayer tab.

    • George says:

      08:05am | 10/12/12

      WA Liberals have stopped the construction of an Emergency Trauma Unit at the new Fiona Stanley Hospital.  A saving of $440 million, funnily enough that is the same amount the Colon is spending to dig a ditch on the Swan River to try a make a Perth type “Circular Key”.
      Abbott as Health Minister reduced the number of training positions and handed $1 billion from his health budget to add to that “surplus”.  Liberals prove time and time again that a surplus or other spending is more important than Aussie health

    • FINK says:

      08:30am | 10/12/12

      @Gregg,
      That’s probably because there are no local doctor surgery’s open or are overcrowded due to a lack of family practitioners.
      Once upon a time the local family practitioner would stitch you up and send you home, because of litigation and rocketing insurance costs most do not even perform this basic surgical procedure in house anymore.. Nope of to the hospital now.

    • St. Michael says:

      11:24am | 10/12/12

      @ George:

      “WA Liberals have stopped the construction of an Emergency Trauma Unit at the new Fiona Stanley Hospital.”

      No, genius, in fact they haven’t.  Read the WA Department of Health’s materials on the subject.  All they stopped was duplicating the Major Trauma Unit which already exists at Royal Perth Hospital and which services the whole Perth metropolitan area quite sufficiently.  Creating another one given the State’s population and the demand for that unit would have been a pointless waste of your precious taxpayer dollars. 

      There is a big difference between an Emergency Department—which Fiona Stanley will have—and a Major Trauma Unit, which most hospitals do not.

    • Nick says:

      07:04am | 10/12/12

      I’m not convinced by the dilution argument.  Interns and registrars work dangerously high hours with insanely long shifts and many studies have shown that fatigue-related mistakes are frighteningly common; as are depression and other health issues in early career doctors.  There is plenty of work to go around.  Sharing the load and challenging this aspect of the quite frankly stupid culture of the medical profession can be no bad thing.

      Reply

    • Sloan says:

      07:59am | 10/12/12

      This is about foreign fee paying students not being given placements in the public hospital system once they have completed their degree.

      They have received their education and now it is time to return home and help their own communities by completing their internships in their own hospital system. That is why they came here to study medicine wasn’t it?

      Surely only a cynic would suggest that they did not come here to study but in fact came to get permanent residency, a Medicare provider number and the many hundreds of thousands of dollars said number will bring them. Yes, only a cynic could suggest such a thing…

      Reply

    • Philip says:

      08:25am | 10/12/12

      The Universities are part of the problem. They top up their income with fee paying students in a “unique” degree which requires a Government funded post graduate position to complete it’s relevance.

    • NESLIHAN KUROSAWA says:

      08:30am | 10/12/12

      Hi Simon,

      I find the information in your article very surprising to say the least.  And why?  I have to wonder if we really do have far too many young doctors and not enough placements for these graduates in our public hospital system? It just doesn’t make any sense at all considering that all to be doctors should get some kind of practical work experience as interns, unconditionally.  And most interestingly in most European, Middle Eastern nations and the USA, we are actually looking at a good 8-10 years of dedication on the part of students studying medicine before they become fully qualified doctors,  that is if I am not mistaken!

      I am only assuming that after spending close to $300,000 and six years these candidates want to become doctors very quickly and no matter what?  I have noticed that most ambitious plan for many young doctors is to open of their own practice or becoming part of a big medical center.  Do we need to wonder why?  It could be the easiest money they ever made.  I remember a time when most young doctors would practice their profession tirelessly to prove themselves first.  Right now it seems to be all about making money very quickly in any way they physically can. 

      Like it has been said before practicing medicine is about saving lives and can we put a price tag on such a valuable profession?  Only when we allow all these medical students to study, work hard and practice their profession, we can safely say that medical profession is so much more than writing or printing prescriptions for the patients.  Most unfortunately it is just like the usual way of practice and how most modern medical centers operate on a daily basis.  I would like to know where are all the good doctors when you really need them?  Kind regards.

      Reply

    • scott says:

      10:14am | 10/12/12

      So now the Medicine students are being faced with the harsh reality that their university degree does not guarantee them a job?  Who’da thunk it?!

      Having less interships available helps weed out the less capable students from the health system.  The graduates who missed out should have studied harder and improved their people skills.

      Reply

    • Jimbob says:

      11:40am | 10/12/12

      I agree. Why are doctor’s some special category that guarantee them a job.

      Why are not up in arms up the taxpayer money spend on arts degrees that more often than not don’t lead to a job.

    • scott says:

      12:34pm | 10/12/12

      @Jimbob

      Usually because the BA graduates end up working for government departments hmmm

    • Nick says:

      03:27pm | 10/12/12

      Medical graduates are universally bright and motivated people or they wouldn’t be where they are.  People skills are irrelevant, in fact those who spend time developing those kinds of skills are more likely to have lower academic scores.  Ditto those who are prepared to spend significant parts of their training in regional locations where doctors are in desperately short supply.  You’re talking about dumping some of our best performers on a scrap heap because we can’t be arsed letting them complete their training.  At the same time people everywhere are crying out for more doctors.

      Makes sense to a moron I suppose.

    • marley says:

      06:08pm | 10/12/12

      @Nick - people skills are irrelevant for doctors?  Maybe if you’re a surgeon they’re irrelevant, but if you’re trying to figure out what’s wrong with some who doesn’t have bits of bone sticking out or gunshot holes in their chest, people skills can be pretty important.  If you’re trying to explain to someone with cholesterol or blood pressure issues the steps they need to take to avoid ending up in a casket, people skills are damned important.  If you’re trying to do the most important medical skill of all - preventative medicine - then people skills matter a helluva lot more than the ability to wield a scalpel.

    • Anjuli says:

      10:42am | 10/12/12

      @2 Fink. My GP gave us a leaflet which tells us about emergency GP’s open after hours .People where I live don’t really need to go the ED unless it is just that an emergency . My daughter works in ED she has lost count how many paracetamol she has dispensed, which the patient with a bit of common sense could have taken at home.Then again common sense is short supply these days.

      Reply

    • St. Michael says:

      11:37am | 10/12/12

      It sounds a lot like the “articled clerkships crisis” that the legal profession went through a few years ago, albeit there was no pressure group named the “Australian Legal Students’ Union” to whinge about it.  Just as with doctors, the rule used to be that you couldn’t practice as a lawyer until you had suffered what amounted to two years’ indentured servitude with a law firm, as an ‘articled clerk’.  No clerkship, no ability to practice.

      Just as with doctors now, there were too many law graduates and not enough positions for clerks - and law firms themselves didn’t help the situation, more or less seeing taking articled clerks on as an act of charity and seeing them as more or less useless during that time, because they’d had no practical training while in the law schools.

      The legal profession dealt with it by inventing these interesting things called “law college” and abolition of clerkships.  In essence, as a general rule across the country now you either do your undergrad degree as a lawyer, then do a funky “prac ed” course for a few months, and bing, out comes your practice certificate and your licence to sue.  Or in some cases you just do the law college thing for four years and when you come out you can practice.

      It would not surprise me if the training of medical general practitioners at least wound up going in the same direction, because we have governments that are stupid enough to think that’s a good idea.

      The other thing I was wondering about was - how much of this deluge of students and lack of GPs is being driven by the desire to get into specialist disciplines like cardiology or urology, where the money is massively higher and the practices usually only in metropolitan areas?

      Also, how much of it is the same old story of universities just charging for seats without regard to how much demand there is in the world for a given degree? In the US, law degrees are literally a dime a dozen because of this relentless churn-and-burn approach to students.

      Reply

    • Kassandra says:

      12:18pm | 10/12/12

      A few people above are on the right track on this. It is about international fee paying students not being guaranteed internships against a background of the usual government kneejerk incompetent decision making.

      We had a perfectly adequate sustainable system graduating well trained medical graduates until the 1980s when the then Federal government decided that their spiralling health budget could be reigned in by limiting the number of doctors who generated the costs in the system. So they canned plans for two new major medical schools that were in the pipeline and reduced medical student places nationally. Medical bodies warned that there would be a critical shortage in the future but they were ignored as usual. Similar warnings were ignored about a shortage of nurses when their training was switched to tertiary institutions instead of training in hospitals.

      Fast forward 20 years - bingo! Critical shortages in medical and nursing staff. What does government do? It does what all their friends in other advanced OECD countries are doing for the same reasons - poaching doctors and nurses from other countries. Our system at present depends on overseas doctors and nurses to survive (and it’s not as if the countries they come from don’t need them). What does the government do? Creates a swathe of new medical student places, small new medical schools and at the same time screws the universities’ budgets so they rely heavily on overseas students from wealthy families who can pay huge fees to bolster their precarious financial position.

      Now another 10 years on and we have a mini-tsunami of medical graduates coming through the system except the states, whose public hospitals have to provide the postgraduate training for new doctors, don’t have the facilities or the senior staff or the budgets to cater for them because the Federal government, who created the problem, hasn’t funded these things adequately in their grants to the states. Meanwhile the states have wasted huge slices of their health budgets on an army of advisors and analysts and a bloated bureaucracy and have closed hospital beds and reduced front line clinical staff.

      The present situation was entirely predictable and was predicted years ago. The rural shortage is a red herring - there has always been a rural shortage. Most doctors, like other people, want to live in the capital cities and along the coast. The rural shortage is worse when there is a general shortage.

      Reply

    • Andrew says:

      12:46pm | 10/12/12

      “According to an audit by the Confederation of Postgraduate Medical Education Councils, 3326 Australian-trained medical graduates applied for 3080 internships in 2013. That leaves 181 graduating students - who have spent between $51,000 and $300,000 - without any option to further their barely-started career. “

      I’m sorry, when I read an article that, in the first 2 paragraphs, claims that 3326-3080=181, I tend to stop reading.  And perhaps you meant ‘horde’ in the title, not ‘hoard’?  Unless of course, we’re saving all these unemployed doctors for a rainy day?  I realise that spelling and basic arithmetic is hard, but.. oh, hang on, no it’s really not.  Maybe stick to the video thing?

      Reply

    • stephen says:

      05:37pm | 10/12/12

      Are there any professional trained in preventative medicine, only ?
      Doctors diagnose, then they fix, but why not train students specifically in matters physical, biological, sociological, ethical, and who may get knowledge in nutrition, the gym and excercize, time planning, child rearing etc. - such a student doesn’t have to be expert in each, but as preventative measures to general health, well, maybe such a process in schools, for young family members who want to avoid medical problems would be welcome ... especially by insurers.

      Reply

    • bananabender says:

      06:11pm | 10/12/12

      The general consensus is that it takes 2.5 Gen Y doctors to replace one baby boomer doctor due to radically different work ethics. The Gen Y doctor isn’t going to work 80 hours per week and spend three weeks at a time on call.

      Reply
 
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