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[sean80439]

Exciting news - I was reading it earlier. We still need a bunch of clarifications; for example if the removed return of service obligation being required for 2019 still. It's definitely removed for 2020 but the language makes it unclear if 2019 is also included. The 'CMI' spots are gone, and there are two pathways, one for private hospitals, which is where the 100 spots are going to be funded and additional funding for primary care in rural areas. What does this mean for Queensland Health hospitals? They rely a ton of CMI interns. Will private hospitals just rotate interns through QH hospitals instead of keeping them at their own institutions? To be honest it really doesn't matter for us as interns next year since after intern year there are JHO spots everywhere.

 

[Domperidone]

Casting the doom and gloom prophecies aside, Australia looks to be by far the best option for IMGs moving forward. This year there were a surplus of CMI internships, meaning 100% of Aussie-trained IMGs who wanted an internship received one. Next year the program is being renamed to the Junior Doctor Training Program, and soon to have spots expanded from 100 to 115 in 2020. They are also removing the return of service obligations in the contract.

It's finally a great step towards a proper direction - the CMI correctly re-upholstered (still the same rural/private only system), but that took years to get to this step. A lot of effort by AMSA by the way, not the schools.

However, while ROS is kinda removed, they're still channeling you into a rural program. Which is amazing for Australia and addresses the issue of maldistribution at a really critical time. Great if it's suitable for those who are flexible or leaning towards rural. But not if you're only accepting it out of desperation. It's a necessity, but something that should be considered prior to going off-shore.
Department of Health - FStronger Rural Health – Training – improving access to training in rural areas and the private sector through junior doctor training

Private hospitals have many merits... but it is a dead end for progression. You have to leave after 2-3 years and start over somewhere else. They just aren't as experienced as public hospital. That said, a job is a job. Training is training. And it's not terrible.

It's not about doom and gloom it's about understanding the fine print before spending 300k. I'm not ragging on Australia for the sake of ragging. It's much like signing a consent form for any procedure, you have to go through risks and benefits, and cover all possible complications.

If there are things premeds need to know before going off-shore, that's part of it.
Some people still get disappointed by what reality is.

It's okay to be positive, but it's okay to be cautious and worried too. It's okay to acknowledge explore that worry that people - particularly some premeds have, rather than ignoring it. Much like.. asking a patient who is anxious about discharge and exploring what the barriers are, or the opposite, someone self discharging.

For students who know they don't want rural - it's incentive to work a bit harder, to have that glowing CV, LORs etc. Or for premeds, think a little harder or work a little harder. I've gone to classes with genuinely bitter students who felt rural or private was a **** deal, felt they were treated as second class citizens because they were not entitled to tertiary like domestics - it's not fun being them I'm sure. It's not fun to be around. It's horrible to teach students with bad attitude. I'm not keen to have this type in Australia (where I'm around), I'll be frank.

From a community standpoint, it is a win-win if they're netting grads wanting rural medicine, who would have otherwise been forced overseas.

Whether it will resolve further post-grad bottlenecks (in hospital based specialties in surgery and medicine), who knows. I guess we'll find out in 7 years.

It'll be interesting to see what selection criteria will be.
It was pretty stringent for CMI (even though it was very fair).

 

[sean80439]

It seems weird to be bitter about having to do ONE year at a private hospital. It's intern year, just suck it up. There are JHO spots everywhere at least in Queensland.

 

[Domperidone]

It seems weird to be bitter about having to do ONE year at a private hospital. It's intern year, just suck it up. There are JHO spots everywhere at least in Queensland.

Sigh. IKR?
Self-entitlement?
I don't know where these people come from and it doesn't seem to matter whether trad or non-trad. That said, the older ones >30 yo handled things better.

To be fair, some of it is built up for them over years of grumbling anxiety, disappointment and discontent. I mean..how some students are treated on rotations in Australia isn't great. Some hospitals will put 4-5 students on a team, how anyone learns anything, I've no idea.

It also really depends.
To network sufficiently for certain pathways, sometimes you have to put in the 2 years in private before moving on. Like selection into BPT as an example. If the program director doesn't know you, they may not put you on. And Private is not purely private - I'm pretty sure it's still going to be "Greenslopes" or Ramsay health. With remote/rural rotations, of variable support, teaching and hours. Depending on what you want. For example, ED private is a bit of a joke - but great if you don't want ED/crit care. ED rural is 'better' but you won't have traumas. Med is more rigorous. Obviously. Also, starting over isn't particularly easy at a new hospital 'competing' with residents 'raised' in the hospitals they join with networks in that hospital. I say competing, but generally it's a friendly environment. You'll notice at well functioning hospitals, many doctors literally stay there forever, from when they were students to consultants. You get comfortable with 'systems' and people. It's hard to appreciate as much as a student. That said, you do adapt to new things eventually and quickly, kinda have to, but it's. it's own challenges in a way.

QLD is a bit different in the sense that intern year isn't merit based for domestics. So hospitals have taken to massive re-shuffling post internship. It didn't used to be this way. It's meant to be 'more' merit based by JHO and up, but many QLD hospitals don't conduct interviews - which is different to the rest of the country. Quality is very variable among interns and residents due to non-merit based, almost-random allocation. Part of the issue is that it takes away incentive to excel as a student, like why care if you have a guarantee & don't have to do anything to get the hospital you want? So, hence the saying domestics have of 4s open doors.

Post match there's typically more spots too. But everyone gets so caught up in the match like it's some competition. I didn't like this way of thinking either. Some felt that Greenslopes CMIs were inferior somehow merely because they make offers last (no idea why) and take the most interns. It's like why FM sometimes attracts a bad rap for having the most spots available - hence it's part of the reason why it's easier to match.

Traditionally, outside of QLD hospitals stay loyal to their interns, make it challenging to be mobile. Not impossible.

 

[sean80439]

QLD has a bit of shuffling usually after intern or JHO years, but typically you'll see people stay on for training wherever they end up until they complete it. Many leave for a year for fellowships so when they come back as consultants it's not just an instant change from Friday to Monday being a Reg to a Consultant.

 

[Domperidone]

QLD has a bit of shuffling usually after intern or JHO years, but typically you'll see people stay on for training wherever they end up until they complete it. Many leave for a year for fellowships so when they come back as consultants it's not just an instant change from Friday to Monday being a Reg to a Consultant.

lol. I meant from year to year. Remember I work in Australia. Sure, many try to stay at a hospital for years - if the hospital rehires them. Greenslopes and country hospitals will keep their interns as house officers. Rural ones are desperate to.

Tertiary QLD not so much the past few yrs. Mixed bag of interns that they did not select. Tables turn a bit by JHO yr. You have to prove your worth to be rehired or they take someone with more glowing LORs from country for jho year. It's good if you're an international trying to go tertiary from rural and worked hard. You replace the domestic not rehired.

Sorry to digress sidefx

 

[pitman]

I personally like how Australia's hospital-based training really is a market of ideas based on varying needs/desired outcomes, like the principle behind decentralized federalism -- some states select by merit, others essentially by random ballot; some states embrace int'l grads, others put up barriers due to state shortage of positions; some are better for regional/rural training of proceduralists...all with a federal/state 'safety net' of CMI, which for political reasons wasn't ever going to be cut.

This is great news for int'l students who were worried, and for Australia.

 

[sean80439]

Based on the new initiative, they seem more interested in training international doctors from intern level and up instead of bringing in already trained doctors and granting visas for them. Definitely the whole grow your own mentality. It's great for graduates of Australian medical schools.

I definitely had that whole waves of emotion thing going on from being certain they were going to renew it, to being unsure based on hospital recruitment teams saying they weren't sure, to reading the budget and not seeing CMI and panicking, to finally getting the confirmation from AMSA that it was renewed in a better capacity. And then today meeting with some medical workforce people, I am definitely reassured that getting a job shouldn't pose an issue as long as I do what I am supposed to.

 

[Domperidone]

Doesn't change the fact that there is oversaturation in cities in the medical, surgical and other subspecialties, even arguably metro FM. Domestic Australian numbers go up each year. Great for rural maldistribution, if sufficient numbers of international students continue or simply stay rural. This is again, not what every premed has in mind prior to going off shore. For any premed your first line option is applying at home first.

 

[sean80439]

Doesn't change the fact that there is oversaturation in cities in the medical, surgical and other subspecialties, even arguably metro FM. Domestic Australian numbers go up each year. Great for rural maldistribution, if sufficient numbers of international students continue or simply stay rural. This is again, not what every premed has in mind prior to going off shore. For any premed your first line option is applying at home first.

They capped Queensland med school intake starting in 2015 based on projected training spots and need. Other states, no clue.

 

[pitman]

The MTRP hasn't shown any meaningful annual increase in grads or students nationwide, nor a trend of an increase, since 2014. Which is why all that's been necessary for *internship and RMO* placements has been the status quo since then (states not losing accredited spots, CMI not being cancelled). I.e., any shunt towards rural Australia should be seen as helping to relieve current (fairly constant) strains in student and junior doc training. And all the scaremongering about intl'l student internship placement odds has been just that for several years now.

 

[labqi]

How are these spots distributed? Are the equal for each state?

 

[Domperidone]

They capped Queensland med school intake starting in 2015 based on projected training spots and need. Other states, no clue.

it's on mdanz. increasing. lol projected spots and need. not really. they number state internships based on CSP projected grad numbers once they reach 3rd yr. or year before final year. it's meant to meet CSP numbers exactly but a 'small" repeat or fail each yr. it used to be that there were far more state internships than grads. now we also have private domestics at bond with no job guarantee. or interstate domestics overflow from SA. if they have capped more aggressively great, only took a few years of asking. I'm serious. This has been asked for by students for years.

How are these spots distributed? Are the equal for each state?

Nope. it's likely old cmi repackaged. heavily in qld rural and private sector. minus 12 in WA and 4 in Sydney North Shore. a couple in Alice Springs as a mixed package with qld rural and private.

Many interstate internationals work under CMI in QLD rural and private now.

Hospitals have to volunteer or express interest to take grads in this program.

Sorry for any typo's on mobile.

 

[sean80439]

it's on mdanz. increasing. lol projected spots and need. not really. they number state internships based on CSP projected grad numbers once they reach 3rd yr. or year before final year. it's meant to meet CSP numbers exactly but a 'small" repeat or fail each yr. it used to be that there were far more state internships than grads. now we also have private domestics at bond with no job guarantee. or interstate domestics overflow from SA. if they have capped more aggressively great, only few years of asking.

also would be nice to not have 4-5 students (or in some cases more) to a ward round. not that all hospitals and teams do, but it's not uncommon. they get aggro sometimes - I don't blame them but I can't handle this and try look after interns.

Nope. it's likely old cmi repackaged. heavily in qld rural and private sector. minus 12 in WA and 4 in Sydney North Shore. a couple in Alice Springs as a mixed package with qld rural and private.

Many interstate internationals work under CMI in QLD rural and private now.

Hospitals have to volunteer or express interest to take grads in this program.

Sorry for any typo's on mobile.

Well, I am repeating back what the medical workforce recruitment teams were telling me, so, I'm not sure why they wouldn't know the details.

 

[Domperidone]

Well, I am repeating back what the medical workforce recruitment teams were telling me, so, I'm not sure why they wouldn't know the details.

I'm repeating back QHealth...
Nadir was reached 2015. There was not meant to be any spaces left for full fee paying in state positions (but again - fluctuations each year with repeating, failing or drop outs, it's a low number at 5-10% but we're talking 700+ CSP grads alone).