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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. 

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  1. M comments.
    1.It has been financially advantageous to Universities to enroll OS students in Medical Courses.
    2.It is interesting that Australian students could not buy there way into some Australian programs in the same way OS students could.
    3. Why are universities crying foul now when this situation has been predicted and known to the universities for many years and they are the ones who recruited OS students at the expense of Australian students?
    4. There were medical and political forces at work to cause the workforce shortage of Australian doctors. An oversupply (relative) may be not such a bad thing for some areas and some patients.
    5 Australian undergraduates and graduates are very reluctant to go to non-metropolitan areas of medical need for training and internships. So again there may be some good for patients appear out of the Tsunami of graduates.
    6. Most new graduates will not want to work the traditional long hours as has been done in the past and the changing demographic of students means less full time equivalents.
    7. There are more opportunities for 8.00 to 4.00 jobs in medicine and these are being filled in preference to the unpopular after hours work. A 28 hour week is less that 25% of the time in a week that patients can get sick. Try finding an after hours GP sometime.
    8. Not everyone who studies medicine becomes a practicing doctor and we should not expect them to. This is the same in all professions. It is called competition and doctors may have to accept a degree of that in their life.
    9.In my time in Medicine I have not noticed doctors doing poorly. I think we will survive this well.
    10.The devastating longstanding short supply of doctors in some rural and regional areas of Australia is the real issue and not the concern of medical schools for their OS income stream. I suspect a self interest here.

  2. Melbourne University

    The author should be sensitive about your language use.
    Many people in Japan and their friend outside of Japan still suffer from the 3.11 disaster. ‘Tsunami’ claimed many lives.

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