THE law of unforeseen consequences might have led to four NSW universities coming to an informal agreement with their state health minister not to increase enrolments of international medicine students.
Michael Spence, vice-chancellor of the University of Sydney, told the HES that shortfalls in government subsidies in covering the cost of domestic students had led to universities increasing their international student enrolments. That, in turn, was placing undue pressure on the public health system to supply more medical internships.
“Three separate reports have shown Sydney University loses $40,000 per domestic medical student. That means universities have been covering the shortfall by enrolling more students into (low-cost, high-volume areas such as) business and enrolling more international medical students, which puts even more pressure on the availability of clinical places,” Dr Spence told the HES.
“The current system is a shemozzle and it can only get worse with the possibility international students might not be able to get internships.
“NSW universities have, since 2012, agreed to keep international enrolments at their current levels.”
But a NSW Health spokesman denied the existence of any agreement, adding that international medical enrolments had continued to increase, as had domestic enrolments.
“The total number of international full-fee paying medical students enrolled at NSW universities increased from 847 in 2012 to 871 in 2013,” he said.
He said that by 2018, the Medical Training Review Panel estimated that international medical graduates were expected to have increased by 80 per cent since 2008.
The spokesman said the Health Department continued to honour its Council of Australian Governments commitment to provide all NSW medical graduates with internships.
Despite this, a Sydney University spokeswoman confirmed the agreement.
“It was not a formal or documented agreement and there are no reporting requirements. However, Sydney Medical School has reduced its intake of international students in 2013 and 2014,” she said.
Dr Spence’s assertion came as Sydney University’s Workplace Research Centre released a comprehensive report on the increasingly complex issue of finding sufficient clinical training places as enrolments in allied health courses boom under the demand-driven system.
The report found the number of enrolments in health-related disciplines had doubled over the past decade, with demand for clinical placements growing at a similar rate.
“In 2012, there were approximately 34.5 million clinical placement hours — up 8 per cent on the year before,” the report said, noting Sydney University alone had the equivalent of 6000 full-time students enrolled in health degrees and who completed 2.5 million placement hours.
Dr Spence said the vast bulk of placements nationally were in the public system. The NSW Health Department, frustrated by the growing burden and cost of supplying placements, had attempted, unsuccessfully, to invoice various universities for those places.
“To describe the situation as money laundering is too colourful,” Dr Spence said. “But there definitely have been attempts at cost shifting between the commonwealth and the states, with state health departments looking to charge the federal Education Department, via universities, what can be quite significant fees for placements.”
Dr Spence said there was no cohesive system for allocating clinical places, with most offered on a “grace and favour” basis between individual local health areas and universities.
However, he said, unless a more rational system was devised, some universities might have to offer some of their health courses without relevant clinical training. “Our report points out that students are not just a cost to the system, but also a benefit,” he said, adding that negotiations with the private health system to supply places were ongoing and “sensitive”.
Source: The Australian