June 25, 2012
IT MAY seem incredible to the many Australians who struggle to see a GP or specialist at short notice, but in the 1990s an oversupply of doctors was predicted. Federal Labor and then Liberal governments were happy to contain costs and freeze medical school enrolments. It takes a long time and a lot of money to train doctors, so we are living with the legacy of past mistakes. So is the next generation of medical graduates, who must compete for an inadequate number of internships to complete their clinical training.
Another consequence of governments' tendency to underfund tertiary education is that Australia must rely on foreign-trained doctors for more than a third of the medical workforce. Furthermore, tertiary institutions have become financially dependent on international students, who pay about $200,000 each for medical courses in Victoria.
Belatedly, numbers of medical graduates have risen in the past decade to meet public needs, from 1660 in 2000 to just over 3000 last year. Next year's increase is almost 500. The Australian Medical Students Association estimates 495 graduates could miss out on the one-year paid hospital placements that qualify them for full registration. Commonwealth-supported students, but not full-fee-paying students, are guaranteed internships. For the first time, the state government will give international students who studied in Victoria priority over interstate students. The AMSA expects other states to follow suit.
The state government is believed to have been lobbied by universities that feared for their income if missing out on internships affected international enrolments. While local graduates may feel resentful, the bigger picture is that our health system could not function without foreign doctors. Federal and state governments set up Health Workforce Australia to plan for the next 12 years. Its report found that halving intakes of foreign doctors would increase predicted shortages from 2700 to 9300 by 2025. More immediately, it foresees a bottleneck as the internship shortfall widens.
Federal and state health ministers say they are working to create more positions. Victoria hopes to expand internships from the public health system to the private sector from 2014. That makes sense. In the meantime, hundreds of medical graduates are in limbo while many Australians endure unacceptable waits to see a doctor. The failure to coordinate intern positions with predictable graduate numbers is another indictment of the divided responsibilities and buck-passing that bedevil our health and education systems.