Over the last few days you may have become tiresome of my tweets and re-tweets that contain a certain hashtag. ‘#interncrisis’ refers to the current shortage of jobs for newly qualified, first year doctors (i.e. that have just graduated). In Australia, these ‘interns’ shoulder a large responsibility in our public hospitals. They take bloods, write in notes, explain decisions with patients and compile discharge summaries (sometimes within a week of discharge!). Without them, our system fails. So why are we so interested in these P-plater doctors?
During intern allocations this year, it became apparent that close to 182 interns would have no hospital employment in 2013. This is not an unexpected or new issue. Since the mid-2000s, the number of medical student places has increased dramatically to address the shortage of doctors in the workforce. However, the downstream effect of this move wasn’t and still hasn’t been addressed. Even going back in 2009, NSW found that their hospitals were ‘buckling in tsunami of interns’.
Is there an #internsolution?
So what then is the #internsolution you may ask? As many people already realise, there is a large imbalance in the doctor workforce. Rural communities and hospitals are often short staffed and rely on locums to fill vacant positions. For many years, governments have relied on this expensive option to plug these gaps. Often, this has meant an abuse of many international medical graduates (IMGs). But with the current oversupply of interns in our metropolitan hospitals and a need for medical services in the country, it should be a case of simple diffusion.
Already the Prevocational GP Placement Program (PGPPP) exists to enable interns and junior doctors gain experience in a general practice setting. Even for those not interested in a career in GP, it can provide all junior doctors a better understanding of how primary health care works. All of our patients have contact with GPs, so too should our junior doctors. A call for mandatory intern GP terms was made back in 2010, but has yet to be implemented.
To many, it seems that PGPPP may be the answer to our intern crisis. It is therefore unfortunate that in a knee-jerk, myopic decision, the federal Health Minister has decided to pay for an extra 100 intern places by taking funding away from the PGPPP initiative. A single year stop gap measure that degrades for what many junior docs, a valuable entry point into general practice. A faceless spokesperson for Mrs Plibersek responded to Medical Observer, stating that the PGPPP has previously been undersubscribed. I find this hard to believe and will have to check with AGPT. In any case, a move to make intern GP placements mandatory would solve any under subscription issues! I would also be very wary of falling back on using private hospitals and corporations to accommodate interns. Yes they would be employed, but would the level of supervision and ongoing education meet the national curriculum framework?
For the states part, extra intern spots can be created in some of our larger regional centres. These communities have sufficiently sized hospitals so that interns cover the required ED, medical and surgical terms. In fact Broken Hill will host three interns in 2013 to help solve the crisis. Already in South Australia, the town of Mt Gambier currently hosts 6 interns and has done so for the past few years. SA has the ability to fund additional intern positions in towns like Whyalla, Port Augusta and Port Lincoln. There are plenty of other such towns in rural and remote Australia. Of course with any scheme such as this, adequate supervision and training is paramount.
So, what now?
In the meantime we may well have to sit and watch the political hot potato been thrown between state and federal governments. In my view both need to come to the table. On one hand, the federal government is able to fund more PGPPP placements and help free up further hospital placements by also offering additional GP spots. Of course this will cost money, but manageable with a generous surplus handed down by Mr Swan. On the other, state governments can provide additional intern positions in some of our larger regional centres as seen in Broken Hill and Mt Gambier.
These changes need to happen now, before larger numbers of interns are without places. We are talking about 182 missing out in 2013, in 2014 it may be hundreds more. The next step will then be to increase training positions for the different specialities. As it stands, general practice is already oversubscribed with many taking multiple years to enter. If this second step is not addressed, we will be left with a generation of continuing medical officers without career progression staffing our already bursting hospital system. Our very own registrar crisis could be just around the corner.
The key to lowering health spending is in primary health care and it seems that creating more GP placements for junior docs and then increasing GP training spots will solve not one, but two problems.
What can you do to help?
- Like this page: http://www.facebook.com/MedicalStudentActionOnTraining
- Tweet your thoughts: #interncrisis, @Tanya_Plibersek and your local member
- Snail mail: federal and state Health Ministers and your local member
- Discuss: let your family, friends and patients know that this is a real problem and may only get worse if nothing is done.