Wednesday, July 15, 2009

Internships: controlling supply

If I find myself again, like the chap above, looking at pretend chemicals in a flask again for a camera (as I did last on a World in Action HepC documentary - fame!) I will be very depressed. But that is what an F1 who taught me in the UK found himself doing for six months of his clinical training. Please, Lord, let the Australians not get so desperate to keep medical graduates off the dole queue that they resort to that.

The good news is that this doesn't seem to be under consideration at first glance. What seems to be being discussed is the following:

  1. Expand the number of public hospital training posts (best outcome, really).
  2. GP experience.
  3. Private hospitals.
  4. Other sites: private rooms, community placements.
  5. Change the composition of the intern year (please, no, not research placements).Bear in mind that all states (ex-South Australia) require an emergency medicine rotation and that these posts are already scarce, prepare for a change there.

Number 1: best outcome if they provide more resources, but otherwise the only way this is going to work is by decreasing resident hours (sounds like the bloody EWTD), job sharing, subspecialty focuses and non-medical placements. This last suggestion puts the willies up me. One, apparently serious, suggestion is a placement in medical administration. This deserves a discussion of its own later. MEDICAL ADMINISTRATION. By the Lord Harry.

But wait: it gets worse. What's this? Clinical research and teaching? No, not coloured liquids in a flask! How on earth will I learn how to take care of patients from more of that. How would a patient feel when being cared for by someone who spent six months trying to get a PCR to work rather than in the ED?

GP training isn't such a bad suggestion for those that fancy being a GP. Unfortunately, Australia seems to be holding up the UK as a reason for why this is good idea: apparently, 50% of FY2 docs spend a term in a GP's practice. Hmm... isn't that because they are short of proper training places too rather than this being a good idea that was generated due to patient need? Unsurprisingly, starting to use GP's rooms all of a sudden to train medics runs into problems with infrastructure and demands on GP's time. But, don't worry, perhaps nurse practitioners can train med grads. Hooray. Oh, and NSW won't provide indemnity for grad in a GP's practice.

Private hospitals aren't such a bad idea but raise other questions of cost and indemnity. Sounds like a proper training, though.

Other: prisons, drug and alcohol services, crisis call centres? Bloody hell.

Suggestion 5 is a cheat: you will change the quality of the output if you make it acceptable to have medical graduates with much reduced medical experience.

Hmm... so, it looks like although Group A graduates are guaranteed an internship, what that internship looks like is currently in the air.

Have to say: I'll be buggered if I'm going back to bench research.


  1. Medical administration? Ye Gods. Maybe to make us "better understand the role of" etc etc.
    ED is an awesome place to learn but like anything, supervision is needed. Not criticising interns at all (it is looming for me) but they are still junior and not registered yet and it is quite a change (so they say) from med school.

  2. It's good to understand the mechanics of a hospital, but I'm not sure you really need to do six months of it.

  3. I think that more posts can be created in ED. At my ED we are having to work overtime because there aren't enough junior doctors to fill all the junior doctor spots, and this will get even worse when more spots are accredited.

    Part of the problem with ED though is that an intern/resident should really be supervised by a FACEM (or equivalent) at least half the time and a ACEM advanced trainee the rest of the time. It's difficult getting people interested in advanced training in ED.

    Dragonfly: in terms of service, interns are worth about half a registrar or less, and RMO1s about 60%, in my estimation. For the same amount of throughput, you could hire two registrars, or a registrar and four interns. Guess which one is cheaper?

  4. Re: medical admin one of my lecturers recently made the joyful observation that one or two percent of us will have this role... through choice I assume.

    On the ED training it sounds like ED is like the other training streams whee the shortage of teachers is going to be the issue as a legacy of the big reduction in med student numbers in the 90s. Would be very happy to hear that there are ED training / internship opportunities: that sort of thing is why most students chose medicine in the first place.