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Oct 5, 2012

No jobs so medical graduates face a life serving doughnuts

It's time for Australia to do something about the 180 Australian-trained medical graduates who face unemployment, writes University of Sydney medical student Benjamin Veness.

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.

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6 thoughts on “No jobs so medical graduates face a life serving doughnuts

  1. MD

    I feel for this individual, as well as others among my friends and colleagues in the same position, however by the same argument all international graduates in engineering, law, arts, pharmacy, science etc should also be guaranteed a job. They are not, and shouldn’t be. Medicine isn’t special, particularly when considering adult students have made an informed choice to pursue their studies in a foreign country.

    I totally agree that the disconnect between university places, intern positions and postgraduate training opportunities needs to be fixed. However, suggesting that all graduates, domestic or international, be guaranteed a job simply encourages the universities to take more international students on, compounding the problem. Having worked at several universities I am confident this is the case.

    As Mr Veness points out the critical problem is at the postgraduate level, not just in terms of providing internships. The intern position issue has been addressed to a degree – there are over a thousand more internships in Australia than there were 10 years ago and so far no domestic graduates have missed out on a job somewhere in the country (although many have missed their first choices, this is not new). However, it’s not a bottomless pit and it’s clear to those of us in the hospital system that the value of the internship is increasingly diminished by the sheer numbers of graduates, to the point where it would be hard to see where many more positions could be created, even if the money was available.

    Our system would be served more efficiently by increasing funding for domestic places, reducing intake of international students and mapping university places with postgraduate training positions. As long as different organisations (universities, state governments and specialist colleges) are controlling the different layers of training mismatches will remain.

    Yet another side effect of the inefficient federal/state divide in health and education.

  2. Gerry Hatrick, OAP

    OK, so only the handsome should get a job?

  3. mardi

    Fantastic article Ben

  4. James Lawler

    MD has some really good points and some really bad ones. Mr Wardle did make a choice to study in Australia, however to say he was informed about the lack of job prospects is incorrect – most international medical students have been assured that the prospects of receiving an internship position was very high, and this is still the case for prospective students.

    As for the argument about law and arts students receiving a job, a few points;
    1. An internship isn’t just a “job”. An arts student might leave his degree and have a job upon completion, whereas a medical student requires internship and specialist training to become a doctor which can operate in this community or overseas. Part of the problem for Mr. Wardle is that he has an Australian degree which is either incompatible in other countries, or ranked very low on a list of preferences for those countries. If he can’t get a job here in Australia, he is effectively stuck in limbo, whilst many of the other professionals have other options.
    2. Jobs for graduating engineers, lawyers etc. are often largely created by the private sector. This isn’t the case for medical students, who must complete an internship in the public system – there is no private sector interest for medical students with no work experience.
    3. HWA2025 has demonstrated that even with the tsunami of medical students in Australia at the moment, Australia’s Healthcare system will still be short of doctors by 2025. The personal interests of Mr. Wardle pale in comparison to the interests of the public which require an adequate health workforce.

    MD is right in saying that there is also a problem at the postgraduate level, but to say that this is THE “critical” issue dangerously oversimplifies the issue – this a complex problem which needs to be tackled from the graduate AND postgraduate level (which is the point that the original author was making I think), and the internship crisis is far from resolved, despite the fact that it has been “addressed to a degree”.

    But I agree that the solution is a coordinated approach to workforce planning which incorporates the universities and the healthcare system. Unfortunately, this is many years away from occurring, if at all, so at the moment Mr. Wardle will be turned away even though this country is critically short of doctors.

  5. MD

    @James Lawler: Fair points, although I would probably argue that the sub-editor’s choice of “doctor or donut salesman for life” simplifies the issue far more than I did.

    When I say that postgraduate training is the critical issue, I mean that this is the point where a much more problematic bottleneck occurs. Given the intensive nature of postgraduate medical training it is much harder to increase training opportunities at this level than at the undergradute level – I can double the number of students in a tute easily enough but not the number of registrars in theatre/clinic/on the ward.

    As a profession we have made significant steps to increase training opportunities including utilising the private sector but there are limits to what the system can achieve, just as there are limits to how many internships can be created.

    The special nature of the medical internship is sometimes overstated. Many other professions (law, accountancy, pharmacy etc) effectively do ‘internships’. However, I totally agree that as our system places internships in the public sector (appropriately) it is an issue for government to be concerned with and it is intensely frustrating seeing the inefficiency and short sightedness of those making the decisions.

    Don’t get me wrong – I don’t want to see any graduates turned away! However, providing a ‘guarantee’ of a job at the end of it will have significant and often unintended consequences for both international and domestic students. There is indeed shortage of doctors in Australia (although probably not a ‘critical’ one), but not in the places or at the levels that are needed. More internships won’t necessarily fix that problem.

  6. Jon Wardle

    Why is this automatically the government’s fault? There are no internships because there are way too many medical graduates, and Australian universities have been supplying them in unsustainable numbers (with unsustainable growth) for years now. We certainly have a primary care shortage, and this needs to be addressed. But this isn’t because we don’t have enough doctors, it’s because not enough doctors are willing to go where they’re needed, and chase the lucrative and elite specialities instead. Less than 30% of Australia’s medical graduates end up becoming GPs.

    No other profession is afforded the luxury of a guaranteed job at the end, and nor should they – but the universities shouldn’t be able to provide these increased training places when there is already oversupply, rather than asking the government to fund more places to improve their students employment prospects. Ask any student graduating from the other kind of doctorate (PhD) about their employment prospects, no-one seems as keen to ask the government to bail them out.