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Internships are not a privilege to be sold

By | Thursday, October 25th, 2012
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Domestic and international medical students have revolted against suggested international medical students pay for the privilege of working as interns.

Domestic and international medical students have revolted against suggested international medical students pay for the privilege of working as interns. Photo: Supplied

The state Health Minister, Jillian Skinner, suggested in this paper on Monday that my international medical student colleagues ought to pay for the privilege of working as interns in NSW hospitals. Domestic and international medical students alike have revolted in protest – the #interncrisis Twitter campaign taking off like a rabid virus.

Interns are the most junior doctors in our hospitals. They regularly work 16-hour overnight shifts, navigating cannulas through frail, elderly skin into torturous, collapsing veins; assessing agitated patients in the emergency department on Saturday nights; and arriving pre-dawn in readiness for the consultant surgeon’s 7am ward round. Internship is not a privilege to be sold. It is an often gruelling experience, serving a community frustrated by bed closures and long waiting lists.

That a health minister would suggest interns pay for this is astounding. It devalues the hard work that all junior doctors do – very often without being paid the overtime stipulated in their contracts or having enough time to attend the ”pager-free teaching” scheduled over their mythical lunch breaks.

I am a third-year Australian-born medical student who is concerned about the implications of denying international medical students internships. An internship is a requirement to gain general (full) registration with the Medical Board of Australia. Not only is it unfair to send them home unregistered (their degrees were sold to them on the implicit promise of internship), but it will significantly impair NSW universities’ ability to attract international medical students in the future (who subsidise the cost of my medical education). It will also lead to an underservicing of our community’s healthcare needs.

Before switching careers to medicine three years ago, I was a corporate strategist, working shorter hours and earning a living more comfortable than any intern’s, especially one in this state where our award wage is the worst in the country. Medicine has proved to be a fascinating and rewarding field of study for me. I gladly accept having traded my 19th-floor desk with harbour views for often smelly and dark wards. Patients welcome medical students and doctors into their lives, entrusting us to care for them and their family members. Australia’s health and education systems have their problems, but they are generally something to be proud of and maintained – not neglected or abused.

The government’s own modelling, in the Health Workforce 2025 report released in March, shows that to be self-sufficient in meeting future healthcare needs, we need more doctors. The elderly patient from outside Canberra who I met in a general practice last week knows this. She came all the way to Sydney because every one of the doctors near her home has closed their books. Her hypertension will need to be monitored by the local pharmacist.

The fact the federal and state governments dramatically increased the number of places at medical school last decade was no accident. In our state, we now have seven medical schools – there are 13 more across the rest of Australia. The doctor shortage has long been recognised, and up until now NSW has played ball, almost matching the increased number of graduates with additional intern places. It still isn’t enough, though, which is why we continue the morally dubious practice of importing overseas-trained doctors on 457 visas. Figures to the end of August show Australia now has more than 2000 such junior medical officers, many poached from countries like Burma where they need them to stay.

In comparison, our international medical students have trained for four to six years in Australian hospitals. They know our system, they’ve sat our exams. And in the meantime they have each contributed hundreds of thousands of dollars to our universities, making up for some of the federal government’s gross underfunding of medical education. Reminiscent of Australia’s obesity problem, it seems our politicians all want to have their cake and eat it, too.

I am myself the grandson of Italian migrants and son of a nurse who understands the contribution foreigners can make to our healthcare system and country. I believe my international student colleagues would make excellent interns, residents, registrars and consultants. Ms Skinner, please don’t be the first health minister to deny them a chance to stay and serve.

Benjamin Veness is a medical student at the University of Sydney.

By Benjamin Veness
Sydney Morning Herald
25 October 2012

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Foreign medical students fight for right to complete degrees

By | Tuesday, October 23rd, 2012
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INTERNATIONAL medical graduates protested yesterday against being sent home with incomplete qualifications and individual debts of more than $300,000 as the University of Sydney’s dean of medicine warned of a ”catastrophic” impact on the $16 billion education export industry.

The students used a ”car wash” protest at Taylor Square, Darlinghurst, to air their concerns over the impasse between the state and federal governments over who should pay for their year-long internships.

Bruce Robinson, dean of medicine at the University of Sydney, said the negative publicity was potentially ”catastrophic” for Australia’s $16-billion-a-year international education industry. It was estimated the medical students paid up to $84 million a year in fees to NSW universities.

“This [stand-off] will go around the world as being a negative from the point of view of any student wanting to come to study in NSW,” he said.

Canadian Blaise Wardle, 30, completed the final exams of his four-year Sydney University degree a fortnight ago and had a $300,000 debt to show for it.

He said he had formed a strong support network of mentors and friends so it would be “pretty difficult” to “start afresh” in North America. “It is just frustrating … the real issue is that there are 150-180 trained doctors who might have to leave, not because we are not needed, but because no one wants to pay to keep us here,” he said.

The federal Health Minister, Tanya Plibersek, offered $10 million to fund 100 internships in the private sector, provided the states between them funded an additional 80 in public hospitals. But the NSW Health Minister, Jillian Skinner, said the onus to resolve the impasse was with the federal government.

NSW had added 290 internships since 2008 in response to rises in the numbers of domestic and international fee-paying students of 110 per cent and 90 per cent respectively since 2005, Mrs Skinner said.

International graduates should pay the cost of internships themselves, she suggested, noting that “international medical students pay fees to attend university but they have not been required to pay fees to fund the cost of intern training they receive after graduation”.

Although overseas-trained doctors were “plugging a significant gap in the system”, there were “more complaints and mishaps associated with [them]” than locally trained doctors, said Professor Robinson, citing a University of Melbourne study. “So there is data to support the notion we’d be better off having these locally trained international students.”

Medical profession leaders said it made no sense to send the students packing because they were better suited to practise in Australian conditions than the 2500-plus foreign-trained doctors Australia imported annually.

“We need every single one of them to do internships and training positions to become the fully trained GPs and specialists that NSW and Australia needs,” Saxon Smith, vice president of the Australian Medical Association’s NSW branch, said.

Catherine Armitage
Sydney Morning Herald
22 October 2012

Young doctors need a dose of funding

By | Monday, October 8th, 2012
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The current intern crisis has promtped The Age to write an editorial on the situation.

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