Medical career pathway in Australia

[dentmedguy]

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Hi guys,

I understand that Australian medical students or doctors need to work in rural areas during their studies or interships. May I ask to what extent, in terms of frequency, period length etc, they need to go to these rural areas before they can obtain full practising licence in Australia?

A bit detailed explanation would be highly appreciated. Thanks in advance.

 

[pitman]

There are a number of different rural requirements. None are required as part of getting licensing per se.

First, there is a federally mandated student requirement, for domestic students who get their tuition heavily subsidized by the government. It's known as the "25-50" rule: 25% of those students must spend 50% of their clinical years rural.

Then, schools themselves typically have a rural component to their training, as part of their accrediation by the Australiam Medical Council. Typical length of time is 6-8 weeks (one term). Those who are already rural (as above) wouldn't need to do this.

After graduation, Junior House Officers (aka RMOs - the year after internship) are often sent rural for a term. They are used to help relieve rural generalists, and sometimes to backfill other shortages (e.g., emergency departments in regional centres). In Queensland, the possibility of being sent rural is in the contract, so while not everyone goes, you may be required to go. Based on the sizes of the prerequisite 2-day course they have here, I'd estimate that 10-15% of all Qld JHOs go. Duration is 4-10 weeks.

There are also rural requirements on the order of several years to those Australian grads who had a bonded rural scholarship in med school, but I don't know the details of how that works any longer.

Hope this helps.

 

[dentmedguy]

Pitman thanks for your explanation. Please correct me if I'm wrong.

The "25-50" rule is only applicable to CSP students.

For both local full fee paying and international students, they will be sent to rural areas during their 4-year studies for 6-10 weeks in every term.

There is no rural working during internship period, right?

After internship, 10-15% of them will work in rural areas for 4-10 weeks during their contract. What is the length of period of their whole contract usually?

For the rest of graduates, they are 'lucky' enough that they probably can stay in cities.

Does the junior house officer have full practising licence?

Thanks for your patience and help.

 

[pitman]

The "25-50" rule is only applicable to CSP students.

For both local full fee paying and international students, they will be sent to rural areas during their 4-year studies for 6-10 weeks in every term.

...for a single term, not every term. A term (rotation) is 8 weeks at UQ for example, but 2 of those weeks during the rural term is doing orientation and projects in a regional centre, leaving 6 weeks actually rural.

There is no rural working during internship period, right?

I think there are some exceptions where interns do go; as I recall the intern contract has the same stipulation. In practice though, it's by far chiefly JHOs. The hospitals I know about also wouldn't make you go each year - time served is recognised.

After internship, 10-15% of them will work in rural areas for 4-10 weeks during their contract. What is the length of period of their whole contract usually?

It's a 1-3 year contract for junior docs (in Qld at least), depending on level (for me was 1 year as intern, 1 year as JHO, then 3 years as SHO). Each time it's re-"negotiated" at which time you can elect to go somewhere else (or give notice and go earlier, assuming you have completed internship, unless you're in NSW I believe since your first contract is for two years? - someone correct me if I'm wrong). If at that time you stay put in the same hospital, it's normally rubber-stamped, i.e., you don't have to sweat out whether or not you'll have a job for the next year.

Fr the rest of graduates, they are 'lucky' enough that they probably can stay in cities.

I wouldn't think of it as staying or not staying, since you're put up in Qld Health housing while on secondment to a rural locale. I've lived in Brisbane for 6 years and gone rural as a doc twice (by choice).

Does the junior house officer have full practising licence?

Not sure what you mean here. "Full registration" is conferred after internship, but that doesn't have much practical significance, except it's easier to move inter-state once you're fully registered.

You can't practice independently until you're specialized. However, if you have permanent residency, you can do locum work at hospitals after your JHO year and make significantly (3 to 4 times) more than as a hospital house officer.

By and large, specialty training doesn't start until after the JHO (RMO1) year. The main exception is GP training, but the first year there is in a hospital as a house officer, so assume two years out (or more) doing 5 terms per year, then you can join a specialty college, then 2 to 6+ years specialty training, then you're a consultant/fellow.

Between JHO and specialty, many elect to stay in the hospitals as a Senior House Officer (doing additional terms in whatever fields), or as a Principal House Officer (doing specialized training in a particular field, but as a house officer and not counting as part of a college's specialty training requirements).

 

[redshifteffect]

NSW is complicated...alot of places now have 2 year contracts when you sign up for internship, which is 1 year as an intern and 1 year at the RMO level.

However not all NSW hospitals are like this, and there are still some with only a single year contract.

In terms of specialty training all will require a minimum of internship, you can apply to certain programs while doing internship, Pathology, GP, ED, Psych, IM and possibly a handful of others. Some will even make exemptions for you if you are good enough by calling you an RMO on paper but treating you like a registrar and admiting you to the college. I know a person who did this with Rehab medicine. For GP although you can get in during your internship year, you spend your first year in the program in the hospital as an RMO, followed by 2 years in the community, when you are officially given the title "registrar".

However most like Surgery, Anaesthetics, Radiology etc. require a minimum of 1 year as an RMO before application. Since these ones are so competitive it's pretty hard to jump the queue and get into them straight from internship, but again if you pick the right hospital (not going to be a large one in the metro areas) you can possibly do your RMO year purely in that field, again on paper you are an RMO but you might be in the training program.

The problem is trying to equate the North American system to the Australian one...they are pretty different systems with entirely different sets of rules.

 

[Raigon]

NSW is complicated...alot of places now have 2 year contracts when you sign up for internship, which is 1 year as an intern and 1 year at the RMO level.

However not all NSW hospitals are like this, and there are still some with only a single year contract.

In terms of specialty training all will require a minimum of internship, you can apply to certain programs while doing internship, Pathology, GP, ED, Psych, IM and possibly a handful of others. Some will even make exemptions for you if you are good enough by calling you an RMO on paper but treating you like a registrar and admiting you to the college. I know a person who did this with Rehab medicine. For GP although you can get in during your internship year, you spend your first year in the program in the hospital as an RMO, followed by 2 years in the community, when you are officially given the title "registrar".

However most like Surgery, Anaesthetics, Radiology etc. require a minimum of 1 year as an RMO before application. Since these ones are so competitive it's pretty hard to jump the queue and get into them straight from internship, but again if you pick the right hospital (not going to be a large one in the metro areas) you can possibly do your RMO year purely in that field, again on paper you are an RMO but you might be in the training program.

The problem is trying to equate the North American system to the Australian one...they are pretty different systems with entirely different sets of rules.

What if I did my minimum internship/RMO in Australia, went to America to do residency, but decided to come back to Australia because it's better? Will it put me in a very bad position, having a vacancy period (residency in the US, if I happen to get one AFTER I get into medical school, yes let's not get ahead of myself) after doing that internship?

What's the best way in which I can keep options in Australia available if I choose to go back to the US?

 

[redshifteffect]

What if I did my minimum internship/RMO in Australia, went to America to do residency, but decided to come back to Australia because it's better? Will it put me in a very bad position, having a vacancy period (residency in the US, if I happen to get one AFTER I get into medical school, yes let's not get ahead of myself) after doing that internship?

What's the best way in which I can keep options in Australia available if I choose to go back to the US?

In the next few years it probably will be pretty tough to get back once you've left as your residency will not be Australian and they are already making moves to make it more difficult for overseas trained specialists to practice in Australia. I can't really blame them, because that is the way most countries operate. Having a PR/Citizenship will only help prevent any legal work issues, but ultimately the people doing the hiring (hospitals, private practices etc.) can still choose someone who was trained locally.

I think you'll have to choose one or the other, and just hope for the best. Its going to be increasingly difficult to keep both doors open as more and more Australian graduates start graduating.

 

[Raigon]

In the next few years it probably will be pretty tough to get back once you've left as your residency will not be Australian and they are already making moves to make it more difficult for overseas trained specialists to practice in Australia. I can't really blame them, because that is the way most countries operate. Having a PR/Citizenship will only help prevent any legal work issues, but ultimately the people doing the hiring (hospitals, private practices etc.) can still choose someone who was trained locally.

I think you'll have to choose one or the other, and just hope for the best. Its going to be increasingly difficult to keep both doors open as more and more Australian graduates start graduating.

Damn... that really sucks. =/

So even if I graduate from Australia and have PR/citizenship, if I didn't perform the majority of my training there, I don't have much chance. So much for keeping both doors open.

But somehow, I wasn't surprised. Australia and the US are basically two different worlds and possibly two different worlds apart. They are both excellent places for medical training, but with two entirely different systems. I still prefer to practice medicine in the Us, but after Obama-care cuts the salaries of doctors in half and if the economy keeps crashing even after stimulus after stimulus, I can say for sure, I'll (along with the rest of America) will be screwed.

Guess that's why I wanted to keep both options available. And I heard that Australia has an extremely large national debt, one of the highest in the world. No wonder the tuition fee is so high. Not sure if Australia will be okay for long term.

That leaves Taiwan, but I don't wanna go back. =="

Anywhere else in the world I can go to in the world? And I want snow and large houses.

 

[redshifteffect]

Canada. Easiest way to get there is with US or Australian training, you'll have zero chance of getting into a Canadian program unless you have a Canadian PR/Citizenship.

 

[Raigon]

Canada. Easiest way to get there is with US or Australian training, you'll have zero chance of getting into a Canadian program unless you have a Canadian PR/Citizenship.

Oh I forgot about that place! I visited there once, it's beautiful and the people are relatively friendly.

I have relatives who live in Canada, too so I can ask them about living there and getting permanent residence. The only thing that may be keeping me from going is probably their messed up universal health care; I've got one of my father's old colleagues that lived there with benign tumor and had to wait months before they could arrange for surgery. Sure they have coverage for everyone, but they have to wait in line like everyone else, and the line is LONG. And by the time he had there, it was beyond surgerical measures. Pissed the hell out of him.

Everything else about Canada is nice though - houses, snow, god I miss snow.

 

[marble30]

You won't miss the snow if you have to spend an hour shoveling the driveway just so you can get the car out. 😛