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Australia ‘needs’ international med students
International medical students should remain part of Australia’s “self-sufficient” health workforce ambitions, says Medical Deans Australia and New Zealand.
Responding to a two-volume report by Health Workforce Australia (HWA), Medical Deans president Professor Justin Beilby said it was evident Australia could not produce enough domestically born and trained doctors to meet future demand. “Increasingly, the deans’ view across Australia is that the international students who we train – and with 70 per cent wanting to stay – are part of the solution,” Beilby told Campus Review.
Health ministers released the HWA report at the end of April. The report says the higher education and raining sectors will need to make innovative shifts in medical offerings to help Australia achieve a self-sufficient health workforce by 2025. It suggests simulated learning environments, standardised hours of clinical training, and consistent approaches to supervision and assessment are among the reforms needed.
Improved national coordination of doctor training is particularly vital, says HWA, to align training flows at the professional entry, post-graduate and specialist training levels. Importantly, the report says post-grad pathways need review, with the goal of reducing the time it takes to complete specialist and GP training.
HWA calls for urgent action, noting long lead times before the outcomes of agreed reforms can take effect. It also emphasises the need for medical graduates to be “work ready” – an issue raised repeatedly by employers during consultations. The report examines scenarios that could bring Australia to a high level of self-sufficiency for doctors, nurses and midwives, or leave it in a severe workforce deficit. It predicts a shortfall of up to 15,200 doctors if the nation stops importing medical practitioners from overseas.
It also addresses a predicted shortage of post-university internships. As recently reported in CR, clinical spots are not keeping up with the volume of medical graduates in Australia. A bottleneck is likely as early as 2013, with international medical students the first expected to miss out.
HWA is a response to Australia’s looming health workforce shortage and its high dependency on internationally recruited health professionals compared to most other OECD countries. The nation’s dependence on migration to supply doctors is particularly stark, with more than twice as many visas granted to medical practitioners in 2009-10 than the 2380 who graduated from Australian universities.
Concerns about the ethical recruitment of doctors, who often come from countries facing their own shortages, have been increasing. For example, the report cites a recent study that shows the medical workforce flow from Sub-Saharan Africa has resulted in billions of dollars in lost local investment – money saved by the developed countries that receive those doctors.
However, the University of Melbourne’s Professor Lesleyanne Hawthorne, who has produced numerous analyses of global migrant and international student movements, told CR that Australia also imported many doctors from uncontroversial source countries. She said a growing domestic cohort of suitable medical students and increasing global competition for overseas doctors were also driving the self-sufficiency goal.
Like the Medical Deans, Hawthorne said Australia would remain dependent on international medical students and temporary migrant doctors into the foreseeable future. “The pipeline to self-sufficiency will be long for Australia,” she said. “Our workforce challenge is getting doctors willing to work in regional or remote clinical sites – a major challenge with domestic graduates.”
Beilby said including international students who paid their own fees into the self-sufficiency mix offered the most ethical and effective way forward. “We are in strong agreement with the general direction of the report and the issues it has identified for the next decade-plus. Importantly, it recognises Australia is now training enough medical students, and that we now need to urgently expand the number of training places for doctors after they have graduated, in a range of areas. This is clearly the major priority now,” he said.
In its report, HWA also states that the new demand-driven system will probably impact on nursing graduates. New student and graduate data will be factored into future modelling and used to update workforce plans.
“Once these training and other workforce reform and innovation policy options are considered and agreed for implementation by government, higher education and training sectors, employers and professions, then the aggregate national training requirements identified in the training scenarios in HW 2025 can be finalised and translated into the more detailed national training plan,” the report concludes.
Susan Woodward
Campus Review
14th May, 2012
Med grads face no-man’s land
Hundreds of international medical students could miss out on internships when they graduate next year due to a “tsunami” of domestic graduates and a shortage of clinical places.
A report on the impact of international medical students on Australia’s workforce needs has found that between 1996 and 2009, international medical students here grew from 960 to more than 3000. During that time, internships were available to virtually every international medical graduate who wanted one. In 2010, for example, 2380 domestic and international graduates applied for 2394 spots, the study shows.
In 2013, however, the situation is likely to change. Lead researcher Professor Lesleyanne Hawthorne, of the University of Melbourne, says the clinical infrastructure that provides the internships required for registration has not kept pace with a huge spike in domestic graduates, creating unprecedented competition for places.
“We’ve built 10 new medical schools in the past decade. What that means is there has been an enormous increase in domestic students studying medicine,” Hawthorne told Campus Review.. “A few years back it didn’t have any impact on international medical students because they were in the [internship] system. But NSW, where the largest number of medical schools has opened, is literally doubling the number of domestic students graduating within the current one-year period. It’s been referred to by some as the ‘tsunami’ of domestic graduates.”
Because states generally gave intern preference to domestic students, she said international students were panicked about 2013 placements. In addition to students from traditional source countries, this was the case for students from North America, whose numbers had grown rapidly since 2009 at the University of Queensland and University of Sydney, among other institutions, Hawthorne said.
“If Canadian students can’t do their internship here, they could be in a no-man’s-land — they can’t get full registration in Australia, nor is there a natural pathway back to Canada, because there isn’t a place for most of them there,” she said. “This is true for students from Malaysia, Singapore, etc. There’s a lot of anxiety amongst international students, who were very confident a few years ago that they had all options open to them.”
The research, which was conducted by teams from the universities of Melbourne and Queensland, found Australia imports about 15,000 medical migrants through various pathways every five years. On average, it takes five years for 53 per cent of these skilled migrants to obtain full-time employment as doctors. On the other hand, the study finds medical students who obtain their degree in Australia have much better outcomes. It shows Australia tripled retention of medically qualified international students between 2006 and 2010. The students were highly motivated to stay, with 78 per cent accepting an internship and then 99
per cent securing full-time medical work within four months of obtaining their qualifications.
Hawthorne said Australia was poised to lose a valuable cohort of up-and-coming doctors, which it had relied on to help address the practitioner shortfall that began about 15 years ago. “The real issue is going to be whether or not Australia wants to prioritise keeping international medical students who qualified in Australia to supplement the importation of foreign medical graduates,” she said.
Health ministers have set a goal that the nation’s demand for doctors, nurses and midwives be met with domestically trained professionals by 2025. Health Workforce Australia has been developing a national training plan to help meet that target, but it is yet to be released.
Meanwhile, Medical Deans Australia and New Zealand says it’s not really clear if international students will be included in the self-sufficiency mix. It argues they should be. “The issue for us as deans is that international students are a significant part of who we train,” Medical Deans president Professor Justin Beilby told CR. “They’re well trained, top quality, and some of them would make outstanding doctors. We believe they should be seriously considered in this discussion.”
Beilby said Health Workforce had been working with the Medical Deans to try to resolve the bottleneck. Places had been found for most international students in 2012, but he said solutions for 2013 and 2014 were lacking. “International students are not just in medicine, [but] medicine is part of the jewels in the crown. If we turn this off, what are the consequences for international students coming for other programs?” Beilby said.
James Churchill, president of the Australian Medical Students’ Association, said although international students may be the first group disadvantaged by the constraints in requisite internships, domestic students were worried, too. “The prospect for students who have paid so much for their medical degrees and then graduate from medical school and are not able to get an internship is a worrying thing,” said Churchill.
The report also unveils the source countries for international students who come to Australia to study medicine. Among the main ones in 2009 were: Malaysia (1134); Singapore (577); Canada (437); the USA (84) and the Republic of Korea (51). “By contrast, Australia’s dominant export education source countries, China and India, were the source of just 20 and 16 enrolments each — medical students from these countries being overwhelmingly Australian citizens or permanent residents (contributing 371 and 410 enrolments, respectively, in 2009),” the researchers write.
Since 1999, international medical graduates have been able to immediately migrate if enrolled as interns. “Should Australia fail to provide [postgraduate intern] places, these graduates seem certain to be recruited by external health jurisdictions, the New Zealand and Singaporean governments being cases in point. Further, the washback could negatively impact on future international medical student enrolments — a devastating prospect for the majority of Australian medical schools,” the report concludes.
The report, The early migration and career trajectories of international medical students qualified in Australia, is believed to be the first of its kind. The Medical Deans commissioned the research, which analysed comprehensive student survey data retained by the organisation.
Susan Woodward
Campus Review
19th March, 2012
Hospital intern plan risks exodus of foreign students
THE decision to guarantee internships in public hospitals only to domestic medical graduates risks forcing thousands of foreign students to leave Australia — while the nation imports thousands of overseas-trained doctors who are often less well-suited to Australian practice.
A report — called the first definitive analysis of medical students who have come to study in Australia — found that 79 per cent of the 546 overseas students secured an intern position in an Australian public hospital after graduating, allowing them to complete training and earn registration as doctors.
But it warns that this proportion is likely to fall given the steep rise in international enrolments, which went up by 223 per cent from 1999 to 2009 compared with the 52 per cent rise in domestic medical students.
The report, commissioned by Medical Deans Australia and New Zealand, representing the heads of the two countries’ medical schools, found that while hospital positions were sufficient to absorb nearly all the international students who remained in Australia in recent years, this was likely to change because of the Council of Australian Governments’ decision to guarantee internships only to domestic students.
Louis Landau, project director of the Medical Schools Outcomes Database, run by Medical Deans ANZ, said the study showed 60 per cent of foreign students were willing to work in under-resourced rural areas, and the fact they had trained in Australia meant they were more familiar with Australian practice and the health system while their English skills were also often better than recent older immigrants.
However, the sharp rise in medical school places — from 1100 a year to 3000, with rises to 3500 planned — meant it would be hard to absorb foreign students in the training system unless extra positions were opened up. “It’s not that we should have an open slather . . . it’s a matter of getting the balance right,” Professor Landau said.
The Australian
First graduates from new medical school
It was with some pride that the University of Western Sydney celebrated its first group of graduates from its school of medicine, which opened in 2007. Ninety-two students – 86 Bachelors of Medicine and Bachelors of Surgery, two Bachelors of Medical Research and four PhDs – made up the first graduating class in December. The school now has a total 582 students.
“It’s only once in your lifetime that you expect to be at the graduating class of the very first course,” said Professor Annemarie Hennessy, the dean of medicine. The school was established with the aim of attracting students from the 14 local government areas that make up western Sydney, an area with a large population from low socio-economic backgrounds.
“We reached that goal fairly quickly,” said Hennessy. Many students were put off studying medicine elsewhere due to the travel and time constraints of travelling to other universities. “We have got students from that area who are attaining equal academic standards of anywhere else. We quickly identified a group of students who were locals, but who may not have taken up a chance to do medicine in the city, and we’ve been able to provide that for them locally,” she said.
“I know that some of those individuals have ambitions to be specialists of the highest order and I have no doubt they will be of the highest order. These guys are your brain surgeons and heart surgeons of tomorrow.”
The university also has a large indigenous student cohort and won the Leaders in Indigenous Medical Education Award for its efforts to engage with Aboriginal students. Western Sydney is a rapidly growing area, but medical services have failed to keep up with the expanding population. Hennessy hopes that the new school will mean more trained doctors in the region.
“Where people study they’re likely to set up and live,” she said. “[Until now] there hasn’t been any growth in medical graduates around the country and the limitations on the number of graduates, in parallel with the rapid growth [in Western Sydney], has meant the growth has outstripped services in the area.”
The university has clinical schools and training facilities at Bankstown-Lidcombe Hospital, Blacktown/Mt Druitt Hospital, Campbelltown/Camden Hospital, Bathurst Hospital and Lismore Base Hospital. Students also spend 30 per cent of the third year of their degree working in the community at general practices, migrant health services, women’s refuges, child health centres and community aged care services.
Hennessy said the students were enthusiastic about the range of services and the clinical opportunities provided. There had also been positive feedback from the university’s nursing school, with which the medical students worked. “We train the students in 57 different locations and the feedback has been extremely positive, in fact quite joyous, about being able to participate in teaching this first group,” she said.
Jennifer Bennett
Campus Review
16 January 2012
Racism continues on campuses
Despite unambiguous university policies to the contrary, indigenous academic and professional staff continue to experience direct discrimination and racist attitudes. In fact, more than 70 per cent do.
That’s the main finding from a recent survey by the National Tertiary Education Union (NTEU). The results, released last week, show that for those indigenous people who experienced the discrimination, less than 20 per cent said their university employer had positively addressed it. “Our report is timely given the federal government’s review of higher education access and outcomes for indigenous people,” said the chair of the NTEU’s indigenous policy committee, Jillian Miller.
“Less than 1 per cent of university staff is indigenous, well down from the population parity figure of 2.5 per cent. Policies aimed at increasing indigenous participation, no matter how well intentioned, will not work unless steps are also taken to tackle racial discrimination.” The survey also found about 60 per cent of indigenous staff had experienced “lateral violence” in the workplace — that is, harmful and undermining actions by other indigenous employees, thought to occur because of marginalisation.
“Racial discrimination, including incidents of lateral violence between indigenous staff, is of great concern because it undermines the ability of indigenous academic and professional staff to do their job and has an impact on the ability of institutions to retain qualified indigenous staff,” Miller said. The survey was conducted between March and August. The resulting 36-page report, I’m not a racist, but …, states the majority of non-indigenous university staff and students are not racist and do not hold prejudices towards Aboriginal and Torres Strait Islander people.
A corresponding survey also delved into the anti-racism, anti-discrimination and equal opportunity policies and procedures in the nation’s 38 public universities. All were found to have adopted such policies, with many implementing stand alone policies, and about 70 per cent of universities had also employed equal opportunity employment officers. The NTEU said a national research project on lateral violence, possibly involving Universities Australia and the Australian Research Council, would be among its next steps to counter racism and discrimination within universities.The full report can be downloaded from the NTEU’s website.
In related news, Medical Deans Australia and New Zealand has renewed its commitment to improving indigenous health by signing an agreement with the Te Ohu Rata O Aotearoa Maori Medical Practitioners Association of Aotearoa.
Building on a 2005 agreement with the Australian Indigenous Doctors Association, the agreement was signed at an international education conference in Auckland last week. Professor Justin Beilby, president of Medical Deans Australia and New Zealand, told CR the deals represented long-term commitments by Australia’s 18 university medical schools and two New Zealand schools.
“This is about the future, the partnership building as we go forward, in a sense of building momentum around indigenous training and indigenous involvement in our medical schools,” said Beilby, who is executive dean of health sciences at the University of Adelaide.
The most significant advancement in Australia had been the introduction of a national indigenous health curriculum into all medical training, he said. And the peak body was increasingly focused on developing new pathways to attract more indigenous students into that training.“We’re just getting to the cusp of indigenous students who are graduating and moving into new career pathways and specialist pathways,” Beilby said.
Susan Woodward
Campus Review
28 November 2011
Lack of internships may send Australian trained doctors elsewhere
Professor Lesleyanne Hawthorne talks to the ABC on the looming intern crisis.
http://www.abc.net.au/am/content/2011/s3355759.htm
Medical Students take expertise offshore
Valuable foreign medical students are being deterred from Australian study by anxiety about the graduate internship bottleneck, says global migration researcher, Professor Lesleyanne Hawthorne.
Professor Hawthorne is associate dean international at the University of Melbourne’s Faculty of Medicine, Dentistry and Health Sciences and says prospective international students are considering the internship – required to complete their qualification in Australia — as fundamental to their choice of where to study
“There’s enormous anxiety about it,” says Professor Hawthorne. “I work across key source regions in North America and Asia and every student asks about internships. It’s absolutely on their radar.”
She says agents in Singapore and Canada in particular have warned of a looming drop in Australian medical school applications as students cast around for more certain global destinations, with many looking to New Zealand as an alternative and some even to the not-so-certain UK system.”
Current numbers suggest that by 2014 there may be just 2014 internship places for a student population of 3786. At this stage, state governments guarantee domestic students an internship placement, but international students have no such certainty and suggestions such as merit-based internship allocation, being put forward by Dean of Medicine at the University of Melbourne James Angus, show little sign of being quick adoption.
President of the Medical Deans of Australia and New Zealand, Professor Justin Beilby from the University of Adelaide says the situation is becoming a financial issue for Australian medical schools and is a potential threat to the whole of campus foreign student market.
“If you turn off the international medical students, what does it do for the attractiveness of the whole tertiary sector for international students? I think that’s high risk.”
Professor Hawthorne’s comments were made after presenting new research about the movement of international medical students at the inaugural research forum for the medical students outcomes database (MSOD) and longitudinal tracking project. Her work on the database, which began tracking the demography, choices and careers of medical students through university and beyond in 2005, shows that by graduation more three quarters of international medical students want to remain in Australia and of those able to complete their internship here, 98 per cent remain.
It’s something the medical deans insist shows that if internships could be provided, the international students would provide a much needed addition to our stretched medical workforce. Those international students most likely to stay are the Americans and the highly skilled and rapidly growing Canadian cohort — now comprising approximately one fifth of all commencing med students at the University of Queensland alone. For those that can’t get internships, New Zealand and Singapore are only too happy to accept them into their programs and Hawthorne says they are already scouting Australian campuses on a regular basis.
Professor Beilby says that careful planning for 2012 – together with the innovative use of alternative placements beyond hospitals in aged care and general practice – means that they are confident there will be sufficient places to accommodate international students – even in the incredibly tight NSW market. But substantial longer term modelling is needed to provide the long-term certainty required for students who are contemplating investing as much as $200,000-plus in an Australian medical degree.
NSW Minister for Health, Jillian Skinner addressed the MSOD research forum and flagged that the issue of funding international gradate internship places would also need proper consideration as part of any long-term plans.
Annabel McGilvray
Campus Review
7 November, 2011
Doctors in demand by poachers
SINGAPORE and New Zealand are lining up to poach thousands of Australian-trained foreign-born doctors because governments and medical authorities can’t guarantee them intern places at the end of their university training, a Sydney conference will hear today.
University of Melbourne health workforce expert Lesleyanne Hawthorne said graduates who couldn’t get internships were likely to be enticed to Singapore, where the future supply of doctors was jeopardised by a very low birth rate.
Professor Hawthorne said the Singaporean government sent several recruitment delegations to Australia each year. “They do the rounds of all the key universities.”
“They will provide the clinical training places and they’re very willing to provide citizenship. They would snap them up without question.”
Professor Hawthorne said New Zealand was also a likely destination. It “registers 1100 overseas-trained doctors a year, yet more than half have gone by the end of the first year”.
Many were “backpacker doctors” on working holidays, she said. The shortage of clinical places was more severe in Australia than in Singapore or New Zealand.
But an explosion in domestic medical training is threatening the availability of clinical training places foreign students who need to obtain residency. Medical Deans Australia and New Zealand said placements looked “reasonably good” for next year, but it had concerns beyond that.
President Justin Beilby said medical authorities had established new placements in areas such as general practitioners’ clinics and community health services. “But long term we’re unclear how international students will figure in the workforce.
“If they’re trained in Australia they should at least be able to do their intern placements (here).
“These are very well-trained students and a significant number of them want to stay.” Australia relies heavily on overseas-trained doctors, who are about a third of the medical workforce and more than 40 per cent in some areas, according to the Australian Medical Association.
Professor Hawthorne said Australia imported 3000-5000 of them each year, but qualification and language constraints meant 53 per cent could not work in the Australian health sector for at least five years.
Locally trained international students, who typically took four to six years to graduate, were generally preferable, she said.
They “had to meet English language standards. Their qualifications are fully recognised. Their average age is 24, and they’ve self-funded to meet exactly the local training requirements.”
Professor Hawthorne’s research, based on a six-year study of overseas medical students’ career aspirations, will be presented today at a research forum at the University of Technology Sydney.
She said the four main source countries were Malaysia and Singapore followed by Canada and the US. North American students were the most likely to want to remain in Australia.
Artilce by John Ross
The Australian, 4 November 2011
Medical schools call for 50% funding boost
http://theconversation.edu.au/medical-schools-call-for-50-funding-boost-1522
Medical Schools seek rise in funding
Medical School heads have warned Canberra that funding for training the next generation of doctors has fallen so far that the system is at a tipping point and big increases are needed to ensure it remains viable.
