Game of musical chairs

One July morning, final year students around the state woke up with a start. From 8am, we were hyper-attentive to any sound from our devices – waiting, waiting, waiting for an email. Internship offers were coming out.

Why were we so stressed? In NSW, only domestic graduates of NSW-based universities are guaranteed their internship. The remaining jobs are distributed down the priority list, and all our international full-fee paying peers can do is wait nervously. When this job is the only way to get your medical registration, it means everything. Last year’s internship recruitment process left 17 graduates unplaced, five from NSW. With two new NSW medical schools announced in the past few years, the discrepancy in available internships will only get bigger. Even the students with guaranteed places were nervous. Between the news stories of training centre deaccreditations and the harrowing experiences of unaccredited registrars, we were worried about where we could end up. Last year, the highest overall grade achieved in the AMA (NSW) Hospital Health Check was a “B”. Three hospitals failed in the domains of Wellbeing and Overtime. The time to act is now.

If you are fortunate enough get a job, even in a well-rated network, the road ahead is still uncertain. A week after internship offers were released, the Surgical Education & Training results came out. On a neurosurgical placement at an esteemed hospital, one of my unaccredited registrars made it onto the program – the other one didn’t. My heart sank with him – PGY6, multiple attempts and no certainty for another year. He was a fantastic teacher, a good well-rounded clinician and undoubtedly skilled. This is the reality for the majority: in 2017, there were 889 applications for only 255 SET spots. This issue is not limited to surgery – modelling from 2014 data predicts that this gap will increase to 1000 doctors without a specialty training position by 2030. The increasing numbers of junior doctors are not matched by an increase in training positions, or consultant positions, despite obvious workforce needs reflected in extensive overtime expectations. The day after the SET results, my registrar was back in theatres, meticulously guiding me as I did my first ever vertical mattress suture on a real human being. Kind and encouraging despite circumstances – these are the doctors who are trying their best in a flawed system.

After I received my offer, a friend asked me how I was going to celebrate. I told her I was already off to attempt a rehab referral for one of our patients. “I’m so excited,” I wrote. “I’m working!” Next year, on the 20th of January, over 1000 of us will begin work as junior doctors in hospitals across the State. However, not all of my peers will be able to join us. Of the ones that do, getting to the end of our training looks to be a long, challenging road. I’m not willing to accept the status quo – a system that allows more students than ever to obtain a medical degree yet constructs barriers to their ability to substantially contribute to Australian healthcare as specialists; a system where doctors are burning out over the workload, yet not enough jobs are created for qualified people to share the burden.

This is my voice – let us hear yours. Lead by example: call out bullying and harassment, fill out the Hospital Health Check survey next year, and protect our trainees. Join AMA (NSW) as we rally for change. Let’s make this journey better for
all of us.