Bottlenecking by universities is bad for business

Pumping ever more medical students into the health system in Australia will create more problems than it solves, says Rob Thomas

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Medical student numbers are at an all-time high in Australia. While this may appear to some as a good thing, it simply doesn’t translate to the right doctors in the right areas, and may lead to serious problems for the health system and the doctors.

In 2014, Health Workforce Australia, a now-disbanded government initiative, produced projections for the medical workforce, including that medical schools not increase enrolments due to a projected oversupply. Since then, Curtin University has opened in Western Australia, with recent announcements both for Macquarie University in Sydney and an expansion by Griffith on the Sunshine Coast. Beyond this, several universities have slowly increased their intakes, most commonly through more international students.

Australia already produces far more medical graduates than the average OECD nation. In fact, per population size we graduate more than double the United States annually, and have more doctors per capita to start with. On top of that we import more than 3,000 internationally-trained doctors annually: clearly, it’s unsustainable.

There are huge implications for a workforce oversupply. At the student level, we are particularly concerned about the impact on getting an internship, the necessary next step to becoming a doctor. To provide more commonwealth-supported places to Griffith for its Sunshine Coast campus, the government has recently allowed small increases in international student intake at several other universities. 

International students who pay more for their degrees, and are inevitably lower on the priority lists for internships. Already, a dozen or so of our international students can’t find work after graduation, putting their incredibly expensive degrees in a dangerous limbo. 

We believe many of these students aren’t adequately told about their job prospects by the universities, and universities themselves have no mandate to ensure their degrees are leading to jobs.

Of course, even if all these doctors can get jobs, they cost the government a substantial amount through Medicare. It’s important that numbers are regulated for this and for several other reasons.

Macquarie University also represents a new worry within medical schools. By its own admission, the 40 domestic students will be paying $256,000 each for their degrees. This can only skew medical admissions to more wealthy families, and undermines the merit-based education system we work by. 

These students will often come from the inner cities, and be less likely in the long term to practise in areas of workforce need.

Years ago we talked about the bottleneck of internships under the banner of the “intern crisis”. While this crisis is ongoing, the real problem is now emerging down the line. Colleges have been slow to find capacity for more training positions, with increases largely unrelated to projected workforce need.

There are now more than 1,000 junior doctors projected to miss out on training positions in 2030, not because they aren’t good enough, just simply that there are no positions available. 

This, of course, does nothing for the mental health of junior doctors and medicals students. The competition culture increases stress and burnout, problems which we know are more prevalent in our community.

So, how do we fix this mess? 

Firstly, we need to look closely at new medical schools, and urge the government to regulate domestic, full-fee places as with Macquarie. We need to stop seeing a medical school as a status symbol of a university, and start to be responsible with our production of graduates. 

Beyond university, the National Medical Training Advisory Network needs to complete its work projecting workforce need in specialties, and capacity needs to be created for those specialists to be trained. 

In a geographical sense, we need to continue working towards appropriate medical access for all Australians. This includes what I call “soft persuasion”, ensuring that doctors can be professionally and personally supported in rural and regional Australia. 

There is a lot to do on the issue but one thing is clear: more medical students is simply not the answer. 

Rob Thomas is President of the Australian Medical Students’ Association and a penultimate year student at University of Queensland

 Email: rob.thomas@amsa.org.au

Twitter: @robmtom