Last night Blaise Wardle, 30, was celebrating the end of four years at Sydney Medical School. Wardle sat five final exams in MacLaurin Hall last week and now has only an eight-week pre-internship term to go. But, ironically, he has no internship to go to.
Like many of Australia’s international medical students, Wardle is Canadian. He completed a four-year degree in human resource management and worked in Toronto before moving to Australia. Since here, Wardle has paid fees to the University of Sydney of $240,000 and, with living expenses, has amounted a debt of $330,000. Tall, broad, and with a strong jawline, Wardle makes for an impressive figure at the bedside, and knows his medicine, having studied hard not just for his exams in Sydney, but also for two demanding United States medical licencing examinations.
“My job prospects aren’t great,” he said, having applied for an internship in every state except Tasmania, and received nothing so far. If the funding impasse between the Commonwealth and the states continues, and Wardle isn’t offered an internship in Australia, he will apply for a job in Canada where he will be considered an international medical graduate and thus his prospects are poor there, too. Worst case scenario, he’ll look to the United States for a job while pulling beers in a bar, or serving doughnuts at Krispy Kreme.
The situation is sad not just for Wardle and his colleagues, but for all Australians. Health Workforce Australia (HWA) released a report earlier this year titled Health Workforce 2025, which predicts how many doctors and nurses Australia will need by 2025 to meet our society’s healthcare needs. In essence, HWA said that if your mum suffers an infarct in 13 years and you want her to have prompt access to an Australian-trained cardiologist for cardiac stenting, Wardle must stay. (Incidentally, the predicted nursing shortage is terrifying.)
This hints at a really important point, and one that’s largely been missed in recent media commentary, which has been focused on internships. While it’s true the Medical Board of Australia only grants full registration after medical graduates complete an accredited one-year internship, our ageing mothers ultimately need not just interns to insert their cannulas under supervision, but consultants who have completed all of their postgraduate training and can practise independently to insert those stents. Band-Aid solutions won’t cut it; this problem won’t be solved by giving Wardle a job just for 2013. Governments urgently need to start clearing entire training pathways from internship through to fellowship of a medical college. Otherwise, this year’s internship crisis will just become next year’s registrar crisis.
Presently, Australia plugs its medical workforce shortage by employing international medical graduates, often from developing countries. Burma, for example. Wardle noted that: “The Melbourne Manifesto [a code of practice for the international recruitment of healthcare professionals] suggests that a developed country shouldn’t steal healthcare resources from countries that need them more than we do, yet that is exactly the opposite of what Australia does.
“And at the same time, we have 180 Australian-trained medical graduates that face unemployment? This is crazy, it’s embarrassing and it’s shameful. There are 180 of us who want to help Australia with their workforce shortage but the states aren’t playing ball.”
So, where to from here? First, the Commonwealth and the states need to apply a few more Band-Aids. Funding for internships must be found for all graduating medical students. These students all spent four to six years being trained in Australia, in Australian hospitals. They are competent, committed and they want to stay. Second, the medical schools, Commonwealth and states need to take HWA’s advice and, starting next year, enrol only the requisite number of medical students.
To date, medical schools have been forced by chronic federal government underfunding of tertiary education to enrol more and more international students to balance their books. Further increases would unfairly treat students as cash cows and unduly stretch training capacity in our hospitals, distracting doctors from patient care. Thirdly, the Commonwealth and states need to look beyond internship and clear that training pathway so our mothers can have cannulas, and stents, when they need them.
Wardle, by the way, notes that he’s an Aries; loves cooking, long walks on the beach; and is single. He really does want to stay, and serve, in Australia.