[Undergrad] Medical Student Tsunami - how it affects premedschool students

[lordgarlic]

As far as I'm aware your PGY1 year is your internship year and this is done in hospital to get your general registration. From PGY 2 you can branch out a bit more with some programs I think opening applications for PGY 2 (I think FRACP? Chinaski can correct me on this one). Others are PGY 3.

At the moment your internship will take one year but I think there has been talk in the past to expand the internship process to two years.

But this isn't just a problem for graduates, I think medical students will also start feeling the effects with increased class sizes and who knows, maybe even reduced learning quality.

 

[scarah]

Hopefully the oversupply of graduates will see the elimination of unpaid and paid overtime and a resulting increase in junior medical positions will be effected to ensure the health facilities get the same number of doctor hours....

I reckon if re-rostered junior medical staff to a system of 8 and 10 hour shifts and a 40 hour week, you'd create more places simply to cover what was previously covered as overtime.

I see no reason that junior medical staff couldn't be rostered on a similar shift system to nurses meaning 24 roster coverage and an overlap for handover and education. Oh except that you'd have to pay people for hours previously covered by unpaid over time.

I think I'm dreaming ^_^ but it would be nice

 

[steve mate]

Basically across the board funding for actual training places specifically excepting capital acquisitions and indirect costings was my understanding.

NSW Health have publicly said they're in negotiations with private hospitals about the feasibility of funding pgy1s there, and that things were looking very positive for pgy2 training in the private sector as well. $10,000,000 is being spent this financial year looking at new settings and structures for postgraduate pre-voc training in NSW I think it's silly to say they're not doing anything until that process is finalised.

I'll breath a lot easier when they can come up with figures saying how many positions the different settings will be able to hold, and how that will fit in with post graduate training. I'm not comforted by the dollars. They still haven't actually put any plans in place, and that is what i have been getting at...

Are the actual training places pre vocational ones?

 

[chinaski]

Hopefully the oversupply of graduates will see the elimination of unpaid and paid overtime and a resulting increase in junior medical positions will be effected to ensure the health facilities get the same number of doctor hours....

I reckon if re-rostered junior medical staff to a system of 8 and 10 hour shifts and a 40 hour week, you'd create more places simply to cover what was previously covered as overtime.

I see no reason that junior medical staff couldn't be rostered on a similar shift system to nurses meaning 24 roster coverage and an overlap for handover and education. Oh except that you'd have to pay people for hours previously covered by unpaid over time.

I think I'm dreaming ^_^ but it would be nice

I can think of a very good reason why: junior doctors - particularly interns and residents - need to be taught and supervised, and that doesn't happen after hours, when most consultants and registrars aren't in the hospital. As such, day shift would be the only meaningful time for junior doctors to work - evening and night shift is all about service provision. Consequently, I can see a far more vile scenario: accredited junior doctors (ie interns who get lucky on an internship ballot, and registrars who are on an accredited training program) working mainly days, with the unpopular evening and night shifts filled by those who couldn't get a job otherwise.

 

[cnda]

steering the thread back to the topic...

from the posts #1 and #13:

i have been reading a range of material on the medical student tsunami and as a student ready to go into med school next year, the situation have made me quite worried.

As most of you would know, the no. of graduates will double by 2012 and the intership available will not match that.

It means that some med graduates will not get an internship. It probably also means that the graduates who will get the intership will have to put up with bad conditions.

I am not sure how far this problem gets.
Does it mean the specialist courses will be harder to get into?
Is the prospect of being a doctor less attractive now?
*Should this deter me from going into medicine?*

i spoke to my career advisor about this problem and he asked me if i would consider similar careers like dentistry.

In addition to the question in the first post, how would you compare dentistry with medicine? What are the pros and cons of each? and are they actually similar?

 

[scarah]

I can think of a very good reason why: junior doctors - particularly interns and residents - need to be taught and supervised, and that doesn't happen after hours, when most consultants and registrars aren't in the hospital. As such, day shift would be the only meaningful time for junior doctors to work - evening and night shift is all about service provision. Consequently, I can see a far more vile scenario: accredited junior doctors (ie interns who get lucky on an internship ballot, and registrars who are on an accredited training program) working mainly days, with the unpopular evening and night shifts filled by those who couldn't get a job otherwise.

I wasn't suggesting permanent night shift but a more structured shift breakdown over the day which recognises that the current structure tends to result in loads of overtime. A well divised roster would ensure fair distribution of all shift types. It would take a culture shift but the whole point of more doctors is reduced workload to a manageable level - why not start at the bottom and allow change to filter through as those doctors progress.

 

[chinaski]

I wasn't suggesting permanent night shift but a more structured shift breakdown over the day which recognises that the current structure tends to result in loads of overtime. A well divised roster would ensure fair distribution of all shift types. It would take a culture shift but the whole point of more doctors is reduced workload to a manageable level - why not start at the bottom and allow change to filter through as those doctors progress.

No, what you're proposing is creating more junior doctor spots by increasing those allocated to "service-type" shifts. This does not equate to good training, and potentially, could prove dangerous.

 

[Matt]

In addition to the question in the first post, how would you compare dentistry with medicine? What are the pros and cons of each? and are they actually similar?

To be honest dentistry trumps medicine in a whole lot of ways.

It's a better lifestyle, the pay is better, the training time is less, and the job security is looking like it's going to be a lot better.

The only advantage medicine has for someone like me is academic interest. It's a shame I don't have any interest in dentistry because in a lot of ways its a much better career path. All I really want out of medicine is the enjoyment I get out of learning and the practical application to complement that learning. There's a lot of crap that comes with medicine that I don't particularly want. All the drama surrounding the med student tsunami is nothing short of depressing. It's not what I signed up for and the last thing I want to deal with when I graduate is more competition. The competition involved with getting into medicine was painful enough.

Medical school looks very much to be a big, easy calm before the storm postgraduation is shaping up to be. At the moment though, medical school is everything I wanted it to be and I couldn't be happier about that.

 

[moody89]

well put Matt, I couldnt agree more.

 

[joey_zhao]

a question

I agree that it is most likely all grads will obtain intern places (except maybe international students)

thats interesting coz im from oversea and i'd like to do medicine or phamarcy sooner or later. i just wonder what causes this? why international students won't get an intern place? ill definitely apply for permanent residency after study. thax

 

[Mana]

Due mainly to the shortage in the number of training places and the increase in student numbers.

Why is this so? The government pledged to provide training positions for all australian commonwealth supported medical graduates. As of now, this includes basically all Australian graduates from here on in (except for Bond university graduates).

As is the case, international medical student graduates are last priority in selection for internship at hospitals australia wide. This is a bit of a pain (as my mentor would be living with me had this not been the case) but unfortunately it's how it's being done at the moment.

 

[chinaski]

Why is this so? The government pledged to provide training positions for all australian commonwealth supported medical graduates. As of now, this includes basically all Australian graduates from here on in (except for Bond university graduates).

You're correct about internationals potentially falling to the bottom of the heap. Just to clarify, though - the government has only pledged (as far as I know) to provide internships to all HECS Australian grads. They have not (and could not) pledge to provide training positions to all and sundry. Worth drawing the distinction between the two - because they are very different scenarios!

FWIW, I would discourage anyone from medicine if they have the attitude of, "Well, I'm interested in medicine, but I am also interested in dentistry, accounting, law, investment banking and a whole lot of other possibilities... but medicine seems the natural thing for me to do because other people say so/I have the marks to get in/everyone else seems to be doing it/I don't really know what it's all about, but it sounds good/etc". In a nutshell, if you can imagine yourself doing something other than medicine and being happy as a clam, you should think long and hard about taking the easier path and avoiding medicine altogether. This goes doubly now that the tsunami is upon us. To succeed in the developing climate, you will really need dedication and drive (and even despite that, you still mightn't get what you want). It will be harder to get ahead if you are ambivalent about the career you have chosen, or if you regret having chosen it in the first place.

 

[Mana]

Oh yes, sorry, I stand corrected. Getting into a training program is, i have heard, harder to get in from PGY2 than getting into med school is from year 12...

 

[Hayden]

You're correct about internationals potentially falling to the bottom of the heap. Just to clarify, though - the government has only pledged (as far as I know) to provide internships to all HECS Australian grads. They have not (and could not) pledge to provide training positions to all and sundry. Worth drawing the distinction between the two - because they are very different scenarios!

FWIW, I would discourage anyone from medicine if they have the attitude of, "Well, I'm interested in medicine, but I am also interested in dentistry, accounting, law, investment banking and a whole lot of other possibilities... but medicine seems the natural thing for me to do because other people say so/I have the marks to get in/everyone else seems to be doing it/I don't really know what it's all about, but it sounds good/etc". In a nutshell, if you can imagine yourself doing something other than medicine and being happy as a clam, you should think long and hard about taking the easier path and avoiding medicine altogether. This goes doubly now that the tsunami is upon us. To succeed in the developing climate, you will really need dedication and drive (and even despite that, you still mightn't get what you want). It will be harder to get ahead if you are ambivalent about the career you have chosen, or if you regret having chosen it in the first place.

Or you could avoid all training route problems and become a rural GP

 

[chinaski]

Or you could avoid all training route problems and become a rural GP

That still depends on you getting onto the GP training program. I think, within time, even that will be difficult.

 

[Hayden]

Sorry that was a little personal joke... we've had a program where they are really pushing the benefits of rural general practice...

 

[chinaski]

Sorry that was a little personal joke... we've had a program where they are really pushing the benefits of rural general practice...

You are not alone. There's plenty of rural GP propaganda going around (you don't want to get me started on that!).

 

[theangelofdarkness]

I'm still fairly unhappy with the planning that has supposedly been done thus far. I want guarantees, dammit! And I don't want to be severely disadvantaged if I fail.

 

[Jono]

I'm still fairly unhappy

I know medicine is meant to be special but when it comes down to it: is there any other profession where you are guaranteed a job after graduating? Monash university pumps out more journalism students every year than there are spots and nobody seems to complain. There's an old joke that there are more people studying law than practising it. In the real world not everyone gets a job. You should be happy with a guaranteed intern position.

 

[chinaski]

I'm still fairly unhappy with the planning that has supposedly been done thus far. I want guarantees, dammit! And I don't want to be severely disadvantaged if I fail.

Whilst I sympathise with your frustration, I also think that in realistic terms, expecting good guarantees is a far-fetched notion. The last thing we want is the government rushing in to secure politically advantageous "guarantees", which are appealing to the eye (and media), but flimsy in substance and unappealing/damaging to junior doctors. I am afraid there is no easy way out of the mess that the government has made. It's simple maths: too many indians, not enough Chiefs. Inevitably, some people will miss out as the bottleneck narrows.