Policy Document International Medical Students’ Career Development Policy Background The Australian Medical Student’s Association (AMSA) is the peak representative body of Australia’s medical students. Accordingly, AMSA is uniquely placed to advocate on issues of medical education and make comment on the career development of international medical students. The international education sector represents a significant source of cultural enrichment, as well as income to the Australian economy. Approximately $16.3 billion in export income was generated by the international education sector in 2010-11 [1]. In 2012, 17.7% of the 3686 enrolling medical students were international medical students [2]. These students can each expect to pay over $300,000 in university fees, plus a one-time payment of at least $1,748 for overseas student health cover and anywhere between $16,000 (homestay) and $36,700 (one bedroom, not shared) per annum in living expenses [3]. While many graduating international medical students wish to remain in Australia to achieve full medical registration, they face a variety of obstacles such as securing an internship, achieving permanent residency and gaining experience in rural medicine. Internships Internship is an essential component in the medical training continuum. It is an experiential opportunity to consolidate knowledge and practically apply skills learnt in medical school. Completion of a supervised internship in an accredited Australian public hospital is a requirement for full registration with current State and Territory medical boards and as such, should be viewed as a necessary component of medical training. As the number of internship places has not increased at a comparable rate with the number of graduating medical students, the State and Territory Governments introduced priority lists to allocate internships to some groups before others. In most States and Territories, international students are allocated positions after Australian citizens and permanent residents [4]. Those unable to secure positions will be forced offshore to access prevocational training as foreign-trained doctors in other countries. Such a situation is inconsistent with statements of support for international students made by the Federal Government’s International Education Advisory Council [5]. The healthcare industry ultimately suffers as section 19AB of the Health Insurance Act 1973 restricts access to Medicare provider numbers for doctors who were not Australian citizens or permanent residents at the time of enrolment in medical school and requires practice in a district of workforce shortage for a minimum of ten years. If not rectified, the reputation of Australia’s international medical education industry will be jeopardised and Australia may miss out on doctors in areas where they are needed. It is concerning to note that despite a shortage of internship positions, Australia continues to provide supervised training positions to doctors who completed their basic medical training overseas [6]. Overseas trained doctors lack the same experience in the Australian health system as Australian trained medical graduates, may have completed medical degrees with different standards to those approved by the Australian Medical Council and would generally not be as familiar with Australian culture. The potential issues raised by these factors, such as patient safety, can be avoided by employing locally trained international graduates [6]. There is also a contentious ethical question as to whether Australia should be taking medical professionals from countries where they are more needed. Australian Permanent Residency The established pathway to permanent residency for Australian-trained medical graduates necessitates registration with the State or Territory Medical Board where they intend to practice, which requires the successful completion of a one-year supervised medical internship. However, given that these students look set to be excluded from internships on the basis of their residency status, permanent residency or citizenship may soon be a prerequisite for these positions. Chris Evans, Minister for Immigration and Citizenship, announced in December 2008 that priority for independent migration to Australia would be given to those who have an occupation in critical demand, such as medical professionals [7]. Denial of internships for international graduates of Australian medical schools on the basis of their residency status is inconsistent with this goal. Rural Clinical Schools The Commonwealth Government provides funding for rural clinical schools as part of a broader strategy to recruit doctors to areas of workforce shortages [8]. As part of this arrangement, 25% of Australian medical students must spend a minimum of 12 months or a clinical year at a rural location [8]. Positive experiences in rural medicine and rural lifestyle are predictive of doctors wishing to pursue a rural medical career and make it easier for these doctors to integrate into the community [8]. Given that, currently, international students who want to practice in Australia must usually spend at least 2 years in a specified regional area to be eligible for permanent residency and 10 years to receive an unrestricted Medicare provider number, under the 10 year Moratorium, it is counterproductive to exclude international students with an interest in rural medicine from rural clinical schools. Position Statement AMSA believes that: 1. All Australian trained medical graduates should have the opportunity to complete their internship in Australia to achieve full medical registration; 2. International medical students should be supported in their pathway to internship in Australia, including application for permanent residency; 3. Internships must be prioritised to international graduates of Australian medical schools ahead of supervised training positions for overseas trained doctors; 4. International medical students should not be excluded from extended rural placements; and 5. Australia should encourage the social inclusion of international medical students, as with all international students, wherever possible. Policy AMSA calls upon: 1. Australian medical schools to: a. Make international students aware of their prospects of gaining internship in Australia prior to enrolment; b. Make international students aware of the 10 Year Moratorium and its effect on future training and practice prior to enrolment; 2. Commonwealth, State and Territory Governments to provide all Australian trained medical graduates with an equal opportunity to: a. Undergo clinical rotations in rural settings; b. Complete a supervised internship in Australia; c. Achieve full medical registration; and d. Obtain permanent residency due to the shortage of medical professionals. References 1. Australian Bureau of Statistics (2011). “International students”. Accessed 31/01/14. Available at http://www.abs.gov.au/ausstats/[email protected]/Lookup/4102.0Main+Features20Dec+2011. 2. Health Workforce Australia (2013). “Australia’s health workforce series: Health workforce by numbers”. Accessed 31/01/14. Available at http://www.medicaldeans.org.au/wpcontent/uploads/Health-Workforce-by-Numbers-FINAL.pdf. 3. Australian Government Department of Health (2013). “Overseas student health cover: Frequently asked questions”. Accessed 31/01/14. Available at https://www.health.gov.au/internet/main/publishing.nsf/Content/Overseas+Student+Healt h+Cover+FAQ-1#OSHCcost. 4. Duckett, S. & Ginnivan, L. (2013). “Factcheck: Are international medical graduates given priority over Australian doctors?”. Accessed 31/01/14. Available at https://theconversation.com/factcheck-are-international-medical-graduates-given-priorityover-australian-doctors-16327. 5. International Education Advisory Council (20130. “Australia: Educating globally”. Accessed 31/01/14. Available at https://aei.gov.au/IEAC2/theCouncilsReport/Documents/Australia%20%E2%80%93%20Educ ating%20Globally%20FINAL%20REPORT.pdf. 6. Hawthorne, L. 2012. International medical migration: What is the future for Australia? MJA Open. Vol. 1(3), pp. 18-21. 7. Australian Government Department of Immigration and Border Protection (2013). ”Fact sheet 21: Managing the migration program”. Accessed 31/01/13. Available at https://www.immi.gov.au/media/fact-sheets/21managing.htm. 8. Eley, D.S., Young, L., Wilkinson, D., Chater, A.B. & Baker, P.G. 2008. Coping with increasing numbers of medical students in rural clinical schools: Options and opportunities. MJA. Vol. 188(11), pp. 669-671. Policy Details Name: International Medical Students’ Career Development Policy Category: D - Graduations, Internships and Careers History: Adopted, 2009 nd Amended following review, 2 Council 2014 The previous version of the policy was repealed, and updated version adopted