Medecins Avec Frontieres: Doctors With Borders and Medical Protectionism in New Zealand
As a New Zealand medical undergraduate, I am constantly reminded of the coming ‘tidal wave’ of Australian medical graduates by both student and professional medical organisations. In short, there are too many Australian doctors being trained, for too few Australian jobs. The situation is nicely summed up by a recent email from the New Zealand Medical Association:
‘In 2000 Australia embarked on a significant increase in the medical student intake with the number of students commencing medical school more than doubling from 1660 in 2000 to 3469 in 2010. Alongside this increase, the demographic of Australian medical students has changed – now, more than 50% of the students commencing medicine are female and 15% come from international backgrounds. As a consequence of these significant increases, there is now a shortfall in the number of intern (PGY1) places for the number of medical students set to graduate from Australian medical schools this year. This year, 3324 Australian-trained medical graduates (2828 domestic and 498 international) have applied for 3091 available internship places. The discrepancy between medical student numbers and internship places is set to widen, with an estimated 3800 students set to graduate in 2015’
The fear is that internship places ‘meant’ for New Zealanders will be ‘stolen’ by our Australian counterparts; those newly graduated doctors who are unable to find an internship position in their own country. Already, measures have been put in place to prevent this from happening. The measures ensure that most Australians will be unable to grab ‘our’ New Zealand internships, as they will be graduating in January; two months too late, as now all NZ internships begin in November. Other interventions are also being considered.
Such measures are typical of the protectionism endemic in any professional workforce. But should healthcare be subject to such protectionism? Jobs go to those most worthy; in this case, the best graduates. The best graduates will likely- at this late stage in their training- become the best doctors. By using these methods do we risk missing out on better interns, interns who are likely to settle in New Zealand and become better doctors? Are we missing out on another strategy to make our health workforce more robust and professional? Do taxpayers deserve the best health workforce that their money can buy, or should we miss out on better interns because those we have trained deserve a secured job? Do NZ medical graduates even deserve a secured job, given the likelihood that they will disappear overseas soon after internship anyway?
Medicine is naturally competitive. Entry is highly sought-after, and some registrar training programmes (training in a specialty, like surgery) are hard to obtain. This is merely another layer of competitiveness; a layer which should encourage better medicine. Competing with Australian universities is an incentive for Otago and Auckland universities to continually improve their medical courses, to ensure their graduates receive the best jobs. Competing with Australian students may better NZ students’ performance, too. Thus, this protectionism could have trickle-down effects; an unwanted ‘complacency’ within the duopoly of medical universities in New Zealand.
Indeed, governments invest heavily in a medical student’s education; judging that a medical graduate has accumulated around $100,000 of debt in their 6 year degree, the taxpayer contributes over $200,000. If medical graduates are being adequately trained in Australia, why must we need to increase student numbers (and therefore public spending) here? The most obvious answer would be that an Australian-heavy workforce won’t reflect the same structure of our community.
Regardless of the fact that Australians aren’t really any different than ourselves, why is it a necessity that our workforce reflects the ‘community structure’? Is this not saying that Australian doctors can never be as good as New Zealand doctors? Or that patients won’t trust them, because they are Australian?
I suggest that halting the increase in student numbers here could be one way to help our friends across the Tasman out; benefitting individuals, as it is individuals who are missing out on jobs. Why are we concerned only about NZ graduates when we are in a position to help Australian graduates out, too?
I realise that an internship is not only a job, but an important part of the doctor’s postgraduate education. I realise that producing heavily indebted graduates who don’t have a guaranteed way to pay off their loan is problematic. But I am unsure whether the granting of a degree must result in the granting of employment. And I question whether the rampant protectionism of New Zealand internships will only bring benefit. For protectionism involves the creation of borders; borders which we can, and should, oppose.