AdvanceMed

Tag: interns

  • 5 Key Take Aways From the New National Medical Training Survey

    5 Key Take Aways From the New National Medical Training Survey

    This week the Medical Board of Australia released the findings of the first-ever national medical training survey (MTS). As someone who has previously championed and developed these types of reports on the New South Wales level, it is truly pleasing to see this report launched. And boy did they release some findings!

    With the results of 59 headline questions reported across several different segments, including interns, prevocational and unaccredited trainees, IMGs and specialty trainees. With the main report running 249 pages, several other reports drilling down to College level, State and Territory level and even an Aboriginal and Torres Strait Islander report.  As well as an online interactive dashboard and a page where you can customize your own reports. There’s truly something for everyone in it. 

    So, what are some of the key findings from this report? Key points from this survey are that greater than 75% of doctors in training are happy with their training and workplace, however, 22% had experienced some form of bullying, harassment or discrimination. Most doctors in training are working safe hours but a concerning amount are still working in excess of 60 hours and even 90 hours per week, with surgery being one particularly bad specialty for this. Contrastingly far too many doctors in training aspire to enter a specialty like surgery than there is the actual capacity or need for. The survey shows that individual doctor career plans are out of alignment with medical workforce planning. Finally, even though we do have information about how medical schools are now performing as part of the medical training pipeline this information is surprisingly absent from the survey.

    Let’s drill a bit further into some of the key initial findings from the survey.

    Table Of Contents

    Overall Impressions Of the Medical Training Survey.

    The Medical Training Survey will be run each year to get feedback from doctors in training in Australia (and in time their supervisors) to (according to the Medical Board of Australia):

    • better understand the quality of medical training in Australia
    • identify how best to improve medical training in Australia, and
    • recognize and deal with potential issues in medical training that could impact on patient safety, including environment and culture, unacceptable behaviours and poor supervision.

    It will take a while to assess the impact of this report. What we will need to see over time is the collection of data and the monitoring of trends to see whether the presence of the survey itself can spur on positive change.

    There is some hope that it might do that.  As similar surveys which have been running in the United Kingdom for some time now have shown improvements on parameters such as the extent to which Foundation doctors felt adequately prepared for their posts by their medical school has improved over time.

    GMC Foundation Results

    Image from the UK medical training survey depicting a sharp rise in “preparedness” from 2012 to 2013 (previous surveys would show this trend as going upwards from a lower level, but the 70% appears to be a natural barrier to further improvement). Source gmc-uk.org

    Overall Most Trainee Doctors Are Happy.

    With all the negative stories associated with the lot of trainee doctors in Australia over the past few years.  It may be tempting to conclude that trainee doctors in Australia are a deeply unhappy lot.  However, that’s simply not the case.

    And whilst, those stories should not be ignored and whilst there is empirical evidence of trainee doctors in Australia being exposed to adverse experiences in the workplace at unacceptable rates.  This experience is thankfully not the experience of the majority.

    In fact, 78% of the survey respondents indicated that they would recommend their current training position to other doctors (agreed or strongly agreed), followed closely by 76% of respondents being comfortable recommending their workplace as a place to train (again agreed or strongly agreed).

    Medical Training Survey snapshot

    International Doctors Are Even Happier According to the Medical Training Survey.

    I get asked a lot by international doctors if hospitals in Australia are good environments for IMGs.

    Here’s a table that shows you that overall IMGs are actually even happier than interns about their training post and workplace.

    82% IMGs would recommend their training post to another doctor, compared to 75% of interns. And 80% of IMGs would recommend their workplace to another doctor, compared to 75% of interns.

    Doctors In Training Are Still Working Too Much.

    The survey shows that the majority of doctors in training are now working under 49 hours per week.  However, 17% are in a risky area of working up to 59 hours a week and there are concerning outliers with 13% reporting working greater than 60 hours per week, including up to 90 hours or beyond.

    What is also interesting is that whilst one might expect that excessive work hours are more of a problem for specialty trainees when one compares the figures between, say interns and specialty trainees the difference is the other way with 16% of interns working over 60 hours a week and only 12% of specialty trainees working over 60 hours per week.

    But if we go a bit more granular and check out a specialty like surgery, we see more of what we expect to see.

    52% of RACS trainees report working greater than 60 hours a week. If you spot a worse group than this on the survey, I’d love to know about it.

    Where Did That Unrostered Overtime Go?

    Also, only 47% of doctors in training report being paid for unrostered over time, which is a deep concern.

    There Are Still Too Many Doctors In Training Being Exposed to Bad Behaviour.

    22% of doctors in training report personal experience of bullying, harassment or discrimination and 27% report witnessing this.  This is on part with other reports conducted around this issue, including one I helped write a few years back.

    Similar to our report findings only 35% of the recipients and 29% of the witnesses reported reporting this behaviour.  Which again is consistent with other studies.  What is most worrying is the level of non-witness report as this is probably the key statistic to be focussing in on here.

    If there is a silver lining to all of this it is that 52% of recipients who reported bullying, harassment or discrimination received a follow up to their report.  Now 52% may not seem all that great.  But this is actually a pretty good baseline result given what we know so far about the skills and capabilities of senior colleagues in handling the difficult issue of bullying, harassment and discrimination.

    Career Aspirations Greatly MisMatch the Reality.

    The MTS also included questions about career planning and intentions. Apparently 16% of Interns were unsure whether they did or did not have a training plan.  In my book that means you don’t have a plan.

    But check out the next table for an example of poor expectations management! 

    According to another medical workforce data set, the Health Workforce Australia, Medical Education and Training Dataset there were 1051 accredited surgical training positions in Australia. Now bear in mind that these 1051 positions aren’t just occupied by an individual doctor for one year but several years in order to complete a training program.

    Contrast this with the fact that 26% of the interns, resident medical officers, senior residents and unaccredited trainees indicated they were most interested in pursuing surgery as a career.  That’s a raw number of 351 of survey respondents alone. If we scaled it up to include those in these cohorts who did not complete the survey then we are probably talking 1500 to 2000, when the true capacity is around 200 to 300 per annum.

    If we look at the other end of the spectrum we then see a specialty such as psychiatry which traditionally struggles to attract trainee doctors sitting at only 4% when in fact it has capacity for and needs more trainees than surgery.  By the way, psychiatry also ranks in the top 5 professions for salary in Australia, along with Surgery.  Just saying.

    I was disappointed to see that this particular question was not asked of international medical graduates.  This would be important information to have.

    We Are Not Connecting the Dots (Yet) Between Medical School and Doctors In Training.

    So the last key finding is really a non-finding. I was surprised to see with all the effort that went into making this survey right a failure to ask a really obvious question about the transition from medical school to being a doctor-in-training. 

    As we have alluded to in the United Kingdom survey this has been a key and consistent question in their national report.  And it is an important one as we need to ensure that various parts of the medical training continuum are connecting with each other.

    What is even more surprising is that this question does get asked in Australia. It is asked as part of a survey led by the Australian Medical Council but with the participation of the Medical Board of Australia in a separate survey called the Preparedness for Internship Survey. This survey showed that 74% of respondents (interns) felt their medical school training had been sufficient.

    I believe it’s a mistake not to include this question in the national training survey as it helps us to connect some important dots with other questions.  Hopefully, over time, the Medical Board will find a way of combining the results of both surveys.

    I would encourage you to go and have a look at the survey yourself. Play around with it and see what you find.

    In this post, I haven’t even touched on things like the differences between various States and Territories or touched on very much issues around specialty training or other specific groups.

    I would love to get your feedback on the type of follow up post you would like to see to this one.

    Question. What is the Medical Training Survey (MTS)?

    Answer. The Medical Training Survey is a national, profession-wide survey of all doctors in training in Australia. It is conducted in a confidential way to get national, comparative, profession-wide data. With the aim of strengthening medical training in Australia.

    The survey is designed to be quick to complete and done on all manner of online devices and has the support of key stakeholders, such as doctors in training groups, employers, educators, the AMA and regulatory bodies.

    Question. How does The Medical Training Survey happen?

    Answer. The Medical Training Survey is open during August and September of each year, which coincides with the medical registration renewal period for most doctors in Australia.

    The survey is run independently by research agency EY Sweeney.  The survey is confidential, and data is gathered from online entry. Only aggregated data is ever reported, with the minimum threshold being ten (10) data points on any item and group to report back.

    Question. Who can do the survey?

    Answer. All doctors in training in Australia can do the survey. This includes interns, hospital medical officers, resident medical officers, non-accredited trainees, postgraduate trainees, principal house officers, registrars, specialist trainees and international medical graduates. Career medical officers who intend to undertake further postgraduate training in medicine can also participate.

  • Yes. Medical Interns Get Paid In Australia – Medical Intern Pay

    Yes. Medical Interns Get Paid In Australia – Medical Intern Pay

    A question we get asked reasonably frequently is about medical intern pay and specifically whether medical interns get paid in Australia. Often this comes from doctors working in other countries. We think the main confusion occurs around the concept of an intern in a medical setting and an intern in a corporate setting.

    In relation to the question of whether medical interns get paid in Australia. The answer is an unequivocal yes. Medical Interns are paid a salary of between $68,000 AUD and $79,000 AUD base salary per annum for full-time work, depending on which State or Territory of Australia they are in. The majority of interns are employed on a full-time basis and they can often earn a little be more due to working shifts and overtime.

    So the question then arises as to why medical interns are paid and other interns are not? As well as whether there are other situations where a doctor might be employed in a non-paid capacity. Feel free to read on further where we answer these questions and discuss the topic of medical intern pay.

    Medical Intern Pay

    Why Are Medical Interns Paid and Other Interns in the Corporate Sector Normally Not paid?

    According to the online etymology dictionary, the word intern comes from the French word “interner“, meaning send to the interior or confine, which itself derives from the Latin word “internus“, meaning within or internal.

    the French word “interne” means ‘assistant doctor’ and the word means one working under supervision as part of professional training”

    So it seems that the concept of the medical intern or doctor intern came first. This, in turn, stems from the concept of an apprenticeship, which arose in the middle ages under the guild system. Agricultural methods and technology had become more advanced, requiring fewer workers in the fields. So people started leaving the farm to take up trades in their early to mid-teens.

    Apprentices would pay a guild master to teach them the trade. Apprentices typically lived with the master for a decade, if not longer, and couldn’t marry or earn wages during the apprenticeship. At the end of the apprenticeship, the apprentice became a member of the guild and a “journeyman”, which meant he could earn his own wages.

    Medical Interns Were Probably Not Paid At Some Point.

    Therefore it’s also likely at some point even medical interns were unpaid. The apprenticeship model in medicine evolved into the concept of a medical internship year probably sometime in the early 1900s. And intern doctors became doctors who were recent graduates of medical schools who were unlicensed but able to work under supervision strictly in hospitals.

    So at some point, medical intern pay was introduced for these doctors. You generally needed to complete your intern year to be able to go out on your own and start a practice. But many doctors stayed on longer and these trainees were often housed by the hospitals. This is where the term resident comes from.

    For some time now. Since the end of the second world war, at least we have had medical intern pay. This is a reasonable proposition as they have already undertaken a large degree of unpaid higher education (generally more than any other profession) to get to this point and they now contribute significantly to the operation of many hospitals.

    According to Taylor Research group, corporate intern programs originated in the United States in the 1960s as both businesses and government agencies saw the merit of providing short term opportunities for prospective future employers to gain some work experience in their summer breaks. However, it has only been in the late 1990s that government and corporate internships have become common in college campuses in the United States and also only in the last couple of decades have they started to become more common in other countries.

    Because these internships are generally shorter and limited in time and focused around providing current students with a work experience opportunity most internships have been offered on a voluntary basis. This is not to say that no corporate internship provides payment or other benefits. In some cases, there may be allowances for things like travel or accommodation or other expenses. And of course, the premise of an internship in the corporate sector is that one receives free on the job training.

    Are there situations where you might not get paid for working as a doctor in Australia?

    There should really be no situation where a doctor performs work in Australia and is not paid for this. Certainly, all true medical internship positions are paid under an Award based system. Which is a set of rules that are commonly applied to a group of employees across a certain industry sector and by which the employer must abide.

    Sometimes the concept of a clinical placement or clinical observership can be confused with a medical internship. These are actually quite different things.

    A clinical placement in medicine in Australia normally occurs as part of the formal requirement for workplace-based experience in a medical school program. Students are assigned to placements under supervision in hospitals, general practices, and other settings.

    A clinical observership is a period of time where a doctor observes another doctor or clinical team in a non-active capacity. The most common reason for this is to permit doctors from other countries to familiarise themselves with the Australian health care system and gain exposure to patients. Most such placements last around 4 to 8 weeks.

    How do I find a Clinical Observership?

    If you are an international medical graduate a clinical observership is not only a great opportunity to gain exposure to the medical system in Australia but it may provide you with an opportunity to make connections with potential future employers. So it’s not surprising then that clinical observerships are highly sought after.

    Most clinical observerships tend to be arranged through personal connections. For example, you may know a senior clinician in a hospital who is able to arrange a clinical observership for you. Some hospitals may offer formal observership programs such as Northern Health in Melbourne, in which case the criteria for gaining an observership is quite high.

    Be aware that the hospital may be using observerships to test out potential employees. So it’s probably best to have some grounding in what sort of things employers look for in medical officers before embarking on an observership.

    Where is the best place for medical Intern pay in Australia?

    In order to work out where the best place to work as a medical intern in Australia is we would need to take a number of factors into consideration including remuneration, career opportunities, work conditions, the desirability of location and cost of living.

    If we are to look just at remuneration then Western Australia is definitely the best place to work in Australia as an intern as the wages for interns in Western Australia are the best in the country.

    Coupled with this Western Australia has some very nice places to live and has recently become a far better prospect for the cost of living, in particular renting and buying a house, since the decline in the mining boom that grossly affected housing prices there.

    Where is the worst place to work for medical Intern pay in Australia?

    If we were to use the same factors that make Western Australia the best place to work in Australia then New South Wales, in particular, Sydney would be easily the worst place to work as a medical intern in Australia. The pay rates for interns in NSW are the worst in the country and it doesn’t get better as you progress as a trainee. And, of course, Sydney is the most expensive city to live in in Australia.

    But it’s not all bad. New South Wales has a lot of training opportunities and Interns in NSW are offered a 2-year contract, whereas Interns in other parts of the country are only given one year. This makes a great difference as it can take the pressure off in your first year because you are not worried about impressing your employer to get another job the following year.

    Related Questions

    Exactly how much can medical interns make from shift-work and overtime?

    Whilst the base salary of an intern in Australia is somewhere between $68,000 and $79,000 AUD it is possible to do considerably better than this. Most interns are required to do a level of overtime and what is called shift work (work outside the normal hours) both of which are paid at a higher level than normal work. For example, most overtime (work in excess of 40 hours) is paid at double time in Australia.

    So you can see that that base salary can improve quite significantly. But of course, it also means you are working longer hours, which may not necessarily be a good thing.

    How much does a Resident Medical Officer earn?

    A Resident Medical Officer is someone who is at least a year more senior than an Intern. In their first year, a Resident Medical Officer will earn considerably more money than an Intern. For example in NSW interns earn a base salary of around $66,000 AUD and first-year residents earn a base salary of around $77,000 AUD.

    Do corporate Interns ever get paid?

    Corporate internships are sometimes paid. Using non-paid employees to do the work of employed workers can get employers into trouble with regulator authorities, particularly in countries like Australia. So generally corporate internships that are of longer duration do tend to get paid.

    Is there somewhere I can find out more information about pay rates for doctors in Australia?

    Interestingly there is no one place to find out about doctor pay rates across the country. We have written a blog post that summarizes the pay rates for interns across Australia here and we hope to have the time to summarize the rest for you. Check back regularly.

  • #TipsForNewDocs | Tips For New Doctors in 2019

    #TipsForNewDocs | Tips For New Doctors in 2019

    This month around Australia the new medical graduates join the health care system as Interns. #tipsfornewdocs is an initiative to extend a welcome from #olddocs to the system

    Welcome to all those new Interns who have started in the Australian health care system this January.

    In the spirit of welcoming you and being helpful we would like you to have a helpful term changeover checklist on us (courtesy of our community manager Rachel.

    #tipsfornewdocs
    Click To Download

    #TipsForNewDocs

    The hashtag #tipsfornewdocs is credited to the PRINT Conference. They have been running awesome Pre-Internship preparation conferences in Sydney, Melbourne and Brisbane for several years now.

    Its an initiative to connect #newdocs with #olddocs and welcome them to the system and profession.  As you can see from our collection of favourite tips. Its now an international phenomenon.