The Rounds, August 2013, Volume 8

I have developed a love for documentaries over the last six months after having downloaded ABC iView and SBS on demand. Once again, I find myself drawing inspiration from one of these documentaries for yet another article. This time there are no cute animals, no breathtaking landscapes and certainly no soothing voice over from David Attenborough.

JABBED is an Australian made documentary that examines the history of vaccination and reemergence of preventable conditions as parents across the world are skipping their children’s shots to avoid vaccine reactions.

Australia has a robust childhood vaccination program. Whenever I see a child in the emergency department, one of the questions I always ask is “Are your child’s vaccinations up to date?” In my personal experience, reassuringly the answer is more than often “yes”.

However, it is difficult to ignore the reported reappearance of childhood diseases such as, measles, mumps and whooping cough. The reliance on herd immunity has

resulted in decreasing vaccinations rates and a resurgence of disease even in adult populations.

Interestingly, as I have become more involved with the AMA Queensland, I find myself asking colleagues a similar question “Is your membership up to date?” The response I often hear is, “No. What’s the point in being a member?”

Gone are the days when people would join the AMA just to be a part of their professional organisation. We live in a consumerist society where people want instant bang for their buck. Given that some DiTs pay a small fortune in courses, college memberships and exam fees, it is no surprise that they are hesitant to sign up to any extra expenses.

The AMA is best known for their history and advocacy work. The President, Council and Secretariat relies on a number of colleagues volunteering their personal time to attend meetings and functions to improve working conditions, rights within the workplace and protect the interest of patients. The difficulty with this work is that it takes time to reap rewards and the benefits are often not immediately obvious; there is no tangible benefit that can be delivered into the hands of our members.

To make matter more difficult, the advocacy work AMA conducts is on behalf of the entire medical profession, irrespective of whether doctors are members or not. So why should you pay money to be a member of the AMA, if you get the benefits of their representation for free?

The answer is simple – herd immunity. The more people we have as members of the AMA, the stronger we are as an Association. This is particular true of our DiT population. We represent the largest numbers of doctors but have proportionally the smallest number of members. If we can increase our DiT membership base, the louder our voice, the more power we have to influence policy and affect change. Most importantly, the better the protection we can offer our members.

In the wake of the intern and RMO campaigns, ongoing overtime issues and now the $2000 self-education tax cap, there has never been a more important time to be a part of the AMA.

So I leave with one last question, “Is your membership up to date?”

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J U L 2 0 1 3 V O L U M E 8

DR VANESSA GRAYSON Chair, Council of Doctors in Training

MEMBERSHIP IS LIKE HERD IMMUNITY

THE ROUNDS Residents & Registrars || July 2013 Volume 8

Check and update your details on the newly

refreshed AMA Queensland website!

Visit amaq.com.au

INTRODUCING: THE COMPETITIVE EDGE SERIESIt’s difficult to overstate the seismic shift in employment security that junior doctors in Queensland, and across Australia, are facing in recent times. The fact that 200 junior doctors were left without positions at the end of last year’s Queensland Health RMO Recruitment Campaign is testament to this new environment.

A medical degree is no longer a guarantee of employment, and the current workforce shortage is not providing the relative abundance of employment opportunities it may have in the past. Instead, reduced employment options are increasing the competition.

AMA Queensland is already lobbying at state and national levels to ensure doctors who have slogged their way through six plus years of tertiary education have adequate employment opportunities, training and security. We are also focussed on giving our members the ‘competitive edge’ when it comes to their careers.

“The Competitive Edge” is The Round’s new series that delves into the vast array of courses and workshops available to junior doctors designed to improve your clinical skills, as well as essential non-clinical skills like communication, leadership and teamwork. We begin our series with a look at options to improve your knowledge of anatomy, a subject essential to all specialties.

THE COMPETITIVE EDGE IN: ANATOMY

It has been estimated that the number of teaching hours dedicated to anatomy in medical school has been reduced by up to 80% since the introduction of problem-based, graduate medical programmes. The lack of anatomical teaching in modern post-graduate medicine can assume part of the blame for a poor grounding in anatomy, however there are further qualifications available to counter this.

Several post-graduate courses have been developed around Australia and New Zealand to assist junior doctors in filling the gaps in their anatomical knowledge. Here are four options available to remedy your anatomy deficiencies, to make you better clinicians, and give you the competitive edge.

POSTGRADUATE DIPLOMA IN SURGICAL ANATOMYUNIVERSITY OF OTAGO

Modality: Combined distance/on campusBased: Dunedin, New ZealandDuration: 1 year, four weeks of residential learningCost: $32,500* (NZD)Website: surgicalanatomy.otago.ac.nz

In brief: One of the more established postgraduate anatomy courses, this programme consists of four taught papers, both distance learning and two separate two-week periods of cadaver dissection, and intensive campus-based instruction.

* Estimated costs from publicly available material. Students are advised to seek more information from the individual

provider.

GRADUATE DIPLOMA IN APPLIED ANATOMY BY DISSECTIONUNIVERSITY OF NEW ENGLAND

Modality: Majority off-campusBased: Armidale, New South WalesDuration: 1 year, 15 days of residential learningCost: $21,064* Website: une.edu.au/courses/2012/courses/GDAAD

In brief: Run by the eclectic and enigmatic Professor Fiona Stewart, this post-graduate qualification from UNE combines distance learning with an intensive 15 day residential stay incorporating full-body dissection.

POSTGRADUATE SURGICAL ANATOMY TRAINING COURSEUNIVERSITY OF QUEENSLAND

Modality: On-campusBased: Brisbane, QueenslandDuration: 23 weeksCost: $5,500* Website: uq.edu.au/sbms/postgraduate-surgical-anatomy-training

In brief: The UQ PSATC began in 2012 and provides topographical anatomy training with practical sessions on prosected specimens. The course runs Wednesday evenings or Saturday mornings and is RACS accredited.

SURGICAL ORTHOPAEDIC ANATOMY COURSEQUEENSLAND UNIVERSITY OF TECHNOLOGY

Modality: On-campusBased: Brisbane, QueenslandDuration: 12 weeksCost: $4,500* Website: qut.edu.au/study/short-courses-and-professional-development/short-courses/surgical-orthopaedic-anatomy

In brief: This is an anatomy course for the orthopaedically inclined. Three points towards your application for the orthopaedic training program will be awarded. Weekly anatomical demonstrations with prosected specimens, as well as demonstrations of surgical approaches.

A medical degree is no longer a guarantee of employment... reduced employment options are increasing the competition.


Among students, junior doctors, the Colleges, the AMA and even the government, there has been discussion whether the rank of P3’s and P4’s should be switched; that is international students obtaining a higher priority than domestic interstate students.

Feedback has suggested this type of change would be ‘unconstitutional’ (referring to Section 117 of the Australian Constitution), and would impede the notion that Australia should be ultimately self-sufficient in healthcare provision. The Australian Constitution states: “A subject of the Queen, resident in any State, shall not be subject in any other State to any disability or discrimination which would not be equally applicable to him if he were a subject of the Queen resident in such other State.”

Basically, this means that all Australians should be treated equally in all states. Legalities aside, many people have attempted to discuss this at various levels and no-one, even the Government, seem to agree on the principle. Should Australian healthcare jobs be kept only for resident Australians, or should the priority be on finding the most suitable candidate?

With respect to interns specifically, there are multiple things to consider when discussing how to rank medical students for jobs. Issues such as government funding to medical school programs, university reliance on international students for budget shortfalls, lack of domestic medical graduate movement into rural and regional areas of need, College training positions, and a lack of national federal and state coordination for accurate estimation of internship requirements should all be considered. The confusion surrounding these challenges was painfully apparent following the last year’s intern campaign which led to more than 100 junior doctors becoming suddenly unemployed.

Below is an outline of key points to consider when examining these complex employment processes:

1. Poor financial distribution: international students currently bolster university medical school budgets. This is in part because of the unequal distribution of funds within the university itself (as dictated by the University Senate) and the inadequate funding agreements between the universities and state/federal governments.

2. Situational awareness: most international students know that job prospects are limited. There has been a recent push to help ensure that all medical students are aware of the current employment climate prior to accepting a medical school position.

3. Supply and demand: we know there are not enough doctors. We know we will not have enough doctors being graduated until 20181. Additionally, it is well documented that with only domestic graduates, the goals of healthcare provision fall far from adequate2.

4. Organisational management: each year, Queensland Health attempts to predict the number of interns they will need based on long-term population studies and current demands in hospitals. This, in turn, affects funding allocated to hospitals, as well as medical student intakes for the following years (based on University Medical School projections).

5. Systemic inconsistencies: state ranking systems vary, as well as medical assessments, clinical exposures and exam scoring systems. Although each medical school graduate should meet benchmark criteria for the interns to acceptably meet the Australian Curriculum Framework for Junior Doctors, there are widespread inconsistencies intrastate, let alone interstate, when it comes to medical education and assessment.

Ranking: in all States, a domestic students applying for a job in their state of graduation places them at a higher rank than an international student applying in their state of graduation. Recognition of this fact then shifts the argument from ‘job access’ to ‘job preference.’

Should Australian nationality and residence ensure your preference as a doctor in another state, even if you’re not the most qualified candidate? In answering this difficult question, we must recognise the multifaceted problems with internship allocation, university funding and the current and future healthcare needs of the Australian people.

International graduates from domestic medical schools are a vital part of the current and future healthcare system. With an increase in medical graduates Australia is slowly travelling towards becoming self-sufficient with provision of doctors. Until then, competition for internships will continue to intensify as domestic and domestically-trained international students look for placement. Job access is being restricted through a lack of government funding and job preferences are diminished by inadequate and inconsistent ranking systems.

Should we be treating international students with an Australian medical degree differently because they are not Australian by nationality? There is no straight-forward answer and many issues have to be resolved before this situation can be addressed adequately and equitably.

1 http://www.hwa.gov.au/sites/uploads/health-workforce-2025-volume-1.pdf; http://www.hwa.gov.au/sites/uploads/health-workforce-2025-volume-2.pdf

2 http: //www.publ ish.csiro.au/?act=view_f i le&f i le_id=AH10897.pdf; http://www.ahwo.gov.au/documents/N H W T / T h e % 2 0 h e a l t h % 2 0 w o r k f o r c e % 2 0 i n % 2 0A u s t r a l i a % 2 0 a n d % 2 0 f a c t o r s % 2 0 i n f l u e n c i n g % 2 0current%20shortages.pdf;

DR JONATHAN DA SILVA Chair, International Subcommittee

PRIORITISING INTERNATIONAL STUDENTS


FACEBOOKLike AMA Queensland on Facebook! ‘Like’ our page, drop us a line on our wall and check out latest photos.

CONTACT AMA QUEENSLANDFor further information about AMA Queensland or any of the issues covered in this edition of The Rounds, please contact us us on the below details:

TWITTERJoin the conversation and follow AMA Queensland on Twitter.

Andrew Turner

Manager, Workplace Relations AMA Queensland

Email: [email protected]

Dr Vanessa Grayson

Chair, Council of Doctors in Training

Email: [email protected]

www.facebook.com/amaqueensland

@amaq-president

PO Box 123, Red Hill, QLD 4059 P: 07 3872 2222F: 07 3856 4727 E: [email protected]

www.amaq.com.au

theroundsYOUR CDT - HOW TO CONTACT US:

GET THE COMPETITIVE EDGE:LET’S TALK ABOUT RESEARCHWant to know how to publish research, or even how to commence? Need tips on presenting research at conferences?

Then come along to AMA Queensland’s competitive edge seminar that will arm you with information on completing, publishing, and presenting research. Our experienced presenters will cover topics including choosing your research area, submissions and revisions, ethics approval, and more.

PRESENTERS AND TOPICS INCLUDE: How to get started and types of research

Dr Don McLeod

Translating an idea into a research topic Prof Leonie Callaway

Standing out from the crowd: Presenting your project A/Prof Victoria Brazil

What not to do – Common pitfalls A/Prof Mark Smithers

Where: The Emporium Hotel, 1000 Ann Street, Fortitude Valley

When: Friday 6 September from 6.30pm

RSVP: RSVPs are essential go to: www.surveymonkey.com/s/amaqresearch or Phone (07) 3872 2222 or email [email protected]

Cost: FREE Beer, wine, soft drinks and canapés available throughout the evening.

COMING EVENT!


Contact Angie Collinson on 0407 972 143 for more information or to RSVP28TH OF AUGUST 5:30PM AT ALCHEMY RESTAURANT

Proudly sponsored by:

CELEBRATING JUNIOR DOCTORS WITH DR KARL

KRUSZELNICKIAlso featuring inaugural the AMA Queensland doctor in training awards! Nominations open in mid August. For more information about the event or the awards, please contact Holly Bretherton at [email protected]

Friday 25 October, from 6:30pm

Victoria Park Golf Complex

SAVE THE DATE

Documents

The Rounds, August 2013, Volume 8