The

BIGIss

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Guide2013

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ABOUT THIS GUIDEWELCOME

The Australian Medical Students’ Association (AMSA) is the peak representative body for medical students in Australia. AMSA exists to connect, inform and represent our members. An important part of the work we do, is to advocate on a range of issues that affect us as medical students and future health professionals. We represent the interests of Australian medical students to relevant government departments, non-government organisations, media outlets, universities and the public.

The issues that affect medical students change over time, making it difficult for all medical students to stay up-to-date with the current issues. This guide is designed to help familiarise students with our biggest advocacy priorities for 2013, and to provide some information about how to find out more and get involved yourself.

As a federal election year, 2013 is a great opportunity for AMSA to lobby political parties on the issues important to all Australian medical

students. This Big Issues Guide 2013 provides an introduction to the issues affecting medical students and AMSA’s corresponding stances. For more information on these and other issues, or to have your say, contact your local AMSA representative or visit www.amsa.org.au. It is important to let us know what you think so that we are in the best position to represent the views of Australian medical students to the decision makers.

HAVE YOU GOT AN ISSUE?If there is a particular issue you think is important for AMSA to address, you can pass this information on via your AMSA representative. Often AMSA is already aware of important issues and are already working behind the scenes so talking to your AMSA representative is a good way to find out more information. When the issue is new to AMSA, your AMSA representative will pass on the information to the AMSA Executive and the rest of AMSA Council to see what we can do.

AMSA ADVOCACY WINS!AMSA advocacy can be very powerful and sometimes we have a really big advocacy win. In 2011 AMSA’s advocacy was a major contributor to the abolition of Student Learning Entitlement, which limited students to receive only seven years of Commonwealth-supported funding for their tertiary education. This meant students who studied for more than sevens years in a Commonwealth-supported place faced the possibility of having to complete their degree as a full-fee paying student or of not being able to complete their degree due to the governments ban on Domestic undergraduate full-fee paying places.

In 2012, many Australian-trained medical students were not offered an internship, and AMSA’s advocacy helped pushed State and Federal governments to invest more money into funding of internship positions. The power of AMSA’s advocacy comes from linking strong local engagement with a strong national platform: making our impact on the big issues.

ISSUE

1EFFECTIVE

WORKFORCE MEDICAL PLANNING

THE BRIEFThe number of medical graduates in Australia has rapidly doubled, from 1, 633 in 2006 to approximately 3,400 in 2012. Health Workforce Australia’s Health 2025 report series indicates that health systems must retain Australian-trained graduates in order to ensure a sustainable health workforce by 2025.

Many communities, especially those in rural and remote areas, continue to experience difficulty accessing medical care.

In 2012 there was immense difficulty placing Australian-trained medical graduates in internship positions. An Australian-trained medical graduate must complete an internship year in order to continue training in Australia and serve our in-need communities.

It is expected that pressures on pre-vocational and vocational training capacity will continue to increase. Health Workforce Australia modelling projects a shortage of over 400 vocational training positions by 2016.

Currently there is a lack of nationally coordinated workforce planning to facilitate medical graduates’ progression to internship and further training. Decisive State and Commonwealth Government action is needed to ensure that the medical training system has capacity to develop the workforce needed to fulfil Australia’s population health needs.

AMSA WILL:• Continue to advocate strongly for funding

to provide all graduates of Australian medical schools guaranteed internship places

• Continue to raise awareness of this issue and encourage creative discussions and solutions to help address the problem

• Engage MedSocs and universities to provide greater information and support for students who may miss out on an internship

SOLUTIONS• The Commonwealth must collaborate

with State Governments to guarantee all Australian-trained medical graduates, including international student graduates, access to an appropriately accredited, quality internship

• The Commonwealth must expand the training capacity within private and community sectors, in metropolitan and regional locations, ensuring all new positions are accredited to ensure appropriate quality standards are maintained

ISSUE

MAINTAINING QUALITY IN MEDICAL

EDUCATION

THE BRIEFThe number of medical students in Australia has increased by over 100% in the past decade. Meanwhile, the number of medical schools has also increased from 10 to 20. These significant increases in medical student numbers have put immense pressure on the medical education system, which is now at the limits of its capacity to provide quality teaching, supervision, patient contact, infrastructure and assessment.

While there have been recent investments in clinical training, including through the establishment of Health Workforce Australia, significant resourcing pressure continues to threaten the quality of medical education in Australia.

Our health systems face serious challenges in providing ongoing training opportunities for Australian-trained medical graduates. Despite this, a number of Universities have recently submitted proposals for new medical schools.In this environment, increases in medical student numbers, whether associated with new or existing medical schools, would seriously threaten the quality of education provided to medical trainees and, given the current shortage of pre-vocational and vocational training positions, would not necessarily translate to an increased medical workforce.

AMSA WILL: • Continue to highlight the importance of

high quality clinical teaching, teaching resources, physical facilities and rigorous assessment throughout medical training and to advocate for increased funding to provide these resources

SOLUTIONS• The Commonwealth must centrally regulate

the total number of medical students at Australian medical schools, including International and Domestic full-fee students, aligning numbers of places with clinical training capacity and a nationally coordinated workforce planning process

• There should be no further increase in the number of medical students, whether associated with new or existing medical schools, until such time that evidence is available of sufficient clinical training capacity and quality training positions

• The Commonwealth must not approve the establishment of any new medical school until the capacity of the medical training system has expanded to accommodate those who have already commenced training

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ISSUE

3INTERNATIONAL

STUDENTS

THE BRIEFApproximately 15% of our members are international students. There are a number of issues that international students face when studying medicine in Australia, and AMSA believes that it is important to address these issues wherever possible.

Issues such as wellbeing, mental health, financial wellbeing, and social circumstances are all impacted upon when a student moves from their home country to Australia for their studies. The high demands and lengthy process means that medical courses can place additional pressures on international students studying medicine in Australia.

Visa restrictions mean it is often difficult for medical students and their spouses to work while studying as well.

Additionally, international students are given lower priority for Australian internships, and hence could potentially miss out on jobs once they graduate.

AMSA WILL:• Work with other organisations to provide

better information and support to international students

• Utilise the AMSA International Students’ Network to better connect international medical students studying in Australia

• Continue to advocate for better support of international students

• Advocate for improved access to Australian internships for international students

ISSUE

FUNDING OF MEDICAL

PROGRAMS

THE BRIEFCurrently medical education in Australia is significantly underfunded. In December 2011 the Final Report of the Lomax-Smith Higher Education Base Funding Review highlighted the chronic underfunding of medical education, both in terms of resourcing and international comparators, with combined student and Government funding of $28,622 per student in 2011 sitting well below the Medical Deans estimated cost of over $51,000 per student. To address this, the report has called for an increase in Government funding and for student contributions to be elevated to 40% of course fees, which together could result in a significant increase in course fees for medical students.

The introduction of postgraduate-level ‘MD’ medical courses allows Australian medical schools to circumvent the ban on domestic full-fee places, which currently applies only to undergraduate-level degrees. The University of Melbourne first offered a postgraduate-level medical degree in 2011 and many universities plan to introduce MD courses in the near future. The maximum FEE-HELP loan available to Australian medical students is $112 134; in 2012 the University of Melbourne MD program cost $53 056 per year, with an estimated $228 678 for the four year course.

Universities have recently called for greater flexibility to set course fees, specifically targeting medical courses. Any further deregulation of student course fees is likely

to lead to major increases in course fees and student debt. High student contributions and graduate debt act as a barrier to equity of access to medical programs.

AMSA WILL:• Continue to lobby for equal access to

medical schools for all Australian students

• Continue to lobby for increased financial support for all medical students

• Advocate for the Government to provide sufficient funding to resource medical education

SOLUTIONS• Commonwealth funding of medical

programs must be increased to more closely match the actual costs of medical education.

• The Commonwealth must introduce a ban on all domestic full-fee medical places in public universities, at both undergraduate and graduate level

• The Commonwealth must not allow any further increases to medical course fees by any mechanism other than indexation, including through fee deregulation or by directly raising the upper limit of Commonwealth-supported student contributions

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ISSUE

5STUDENT

FINANCIAL SUPPORT

THE BRIEFAMSA recognises that tuition and living costs are a substantial barrier to access tertiary education. Currently, many medical students who experience significant financial hardship do not have access to government student income support programs.

Current eligibility criteria for student income support are based on demonstration of independence through age or having met a threshold of earnings as a result of working fulltime (an average of 30 hours per week) over 18 months; or having worked 15 hours per week for a period of two years.

High course contact hours required in medical degrees and often limited flexibility for deferment of studies prevent medical students below the age of 22 years from qualifying for income support. Medical studies often involve significant travel to attend various urban and rural clinical placements, which often results in additional living expenses and is a further barrier to maintaining employment.

AMSA WILL:• Continue to advocate for better financial

support of medical students

• Continue to raise awareness of this issue and encourage creative discussions and solutions to help address the problem

SOLUTIONS• The Commonwealth must increase

student income support to, at an absolute minimum, meet the costs of living as indicated by the Henderson Poverty Line

• The Commonwealth must provide an income threshold for independence that is not dependent on working a specified number of hours per week or months per year, which are prohibitive to students in hour-intensive courses and courses with limited flexibility for deferral.

• Commonwealth student income support policies must ensure that financial, social and geographic factors do not act as a barrier to higher education for appropriately qualified students.

ISSUE

RURALWORKFORCE

SCHEMES

THE BRIEFLong-term improvements to Australia’s rural doctor shortage requires the enhancement of policies and programs that focus on the recruitment, retention and support of medical students who wish to practice in rural areas.

Governments have implemented various bonding schemes to increase the number of clinicians practicing in rural areas. The Bonded Medical Places Scheme (BMPS) is intended to provide more doctors to areas experiencing doctor shortages and is offered as a specific stream of entry to medicine. Students accepting a place in medical programs through the BMPS commit to working in a district of workforce shortage for a period of time, generally equal to the length of their medical degree, minus any applicable scaling for rurality. Medical Rural Bonded Scholarships (MRBS) provide financial support during medical school, in return for six years compulsory return of service in regional, rural and remote areas.

The requirement to commit in advance to extended return of service obligation years and heavy-handed consequences for withdrawal prior to fulfillment of these obligations drive negative perceptions of rural practice.

Therefore these schemes are likely to be counter-productive to increasing long-term rural workforce supply. Evidence suggests that recruiting students with a rural background and providing students with early, positive

exposure to rural practice are effective strategies to increase the likelihood medical students will work in rural areas upon graduation.

However, the lack of opportunities for graduates to continue pre-vocational and especially vocational training in rural areas remains a major barrier to attracting and retaining doctors in rural areas.

AMSA WILL: • Continue to seek abolition of the Bonded

Medical Places Scheme and Medical Rural Bonded Scholarships program, or to alternatively alter its operation.

SOLUTIONS• The Commonwealth must phase out the

Bonded Medical Places Scheme and Medical Rural Bonded Scholarships programs, on the basis of their likely lack of long-term effectiveness on rural workforce shortages.

• The Commonwealth must enforce the goal, articulated in its Rural Clinical Training and Support policies, for medical schools to recruit a minimum of 25% of medical students with a rural background.

• The Commonwealth must increase financial support for programs that provide students with early, positive exposure to rural practice.

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ISSUE

7INDIGENOUS

HEALTH

THE BRIEFThe long‐standing inequity in health status between Aboriginal and Torres Strait Islander Australians and non‐Indigenous Australians is unacceptable. Achieving equal representation in medical education is an important milestone in the goal to realise broader social equity between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians.

Beyond this, Aboriginal and Torres Strait Islander doctors play an important role in improving the health of Aboriginal and Torres Strait Islander Australians.

There is a need for greater investment in recruitment and retention programs to increase the number of Aboriginal and Torres Strait Islander people graduating from medicine.

It is critically important to increase investment in ensuring Aboriginal and Torres Strait Islander students to ensure they gain the necessary qualifications to be eligible for medical training.

AMSA WILL:• Continue to advocate for improvements in

Indigenous health, with particular emphasis on supporting Australia’s Indigenous medical students

• Work towards improving Indigenous health curricula whilst at university and improving placement availability with

Aboriginal Community Controlled Health Organisations

SOLUTIONS• The Commonwealth must set and fund a

national target for Aboriginal and Torres Strait Islander medical graduates that accounts for all necessary recruitment and retention strategies required, as outlined in the Australian Indigenous Doctors’ Association’s (AIDA) document, Healthy Futures Best Practice Standard

• The Commonwealth must collaborate with Universities to provide Aboriginal and Torres Strait Islander medical students with the financial, academic, social and collegiate support they require to complete their medical studies and further training.

ISSUE

GLOBALHEALTH

THE BRIEFAMSA members are generally very aware of their responsibilities as global citizens. Rising levels of support for events like the AMSA Global Health Conference (GHC) and the work of the AMSA Global Health Committee, demonstrate that Australian medical students are engaging in the global issues regarding the socioeconomic forces and inequities that shape worldwide health.

These issues are numerous and include violent conflict, infectious disease, food crises, climate change and so on. By offering conference opportunities we give students the chance to discuss and learn about such issues. The AMSA Global Health Committee links together like-minded medical student groups across Australia that collaborate toeducate their peers, write policy, run projects and raise funds as well as medical resources to address issues in global health.

Climate Change, in particular global warming, has been regarded by experts as the “biggest global health threat of the 21st century”. The profound effect climate change is having on the health of the global human population is widely acknowledged. Climate change will severely harm the health of individuals and communities through extreme weather events, natural disasters, floods and resulting diarrhoeal disease, degradation of arable land, nutritional impacts, mass migration, violent conflict and widened areas of diseases such as malaria and dengue fever.

Refugees and Asylum Seekers may have been exposed to a range of conditions that predispose them to poorer health, including time spent in refugee camps or detention facilities; history of persecution and armed conflict; and the threat of, or actual physical violence. Exposure to these conditions puts refugees and asylum seekers at an elevated risk of mental and physical illness.

It is imperative that the Commonwealth Government honour its obligations under the Declaration of Human Rights and recognise national and international law when making decisions regarding policy that impact on refugee and asylum seeker health.

AMSA WILL:• Continue to advocate for improvements in

refugee and asylum seeker health.

• Continue to increase awareness about health discrepancies worldwide.

• Continue to advocate for Federal and State governments to be proactive in responding to the threat of climate change, and to mitigate harm wherever possible.

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ISSUE

9STUDENT

WELLBEING

THE BRIEFMedical school can be an exciting and rewarding journey, however thereare many challenges associated with such a demanding and high-pressure environment. Medicine brings unique mental, social, emotional and financial challenges, and often students who are learning to take care of others forget to take care of themselves.

The wellbeing of medical students is becoming an increasingly recognised issue with studies showing that medical students experience rates of stress and depression above the general population.

In recent years, AMSA has been working hard the create awareness and improve medical student wellbeing through a number of initiatives.

INITIATIVES:• Wellbeing Policy enacted by the AMSA

Council in March 2010

• Publication of the Keeping your Grass Greener: the wellbeing guide for medical students: www.amsa.org.au/keepingyourgrassgreener

• The AMSA Get-A-GP Campaign

• Establishment of the Wellbeing Network

• Healthy Body Healthy Mind Campaign

• Wellbeing workshops at AMSA National Convention

• Wellbeing promotion through AMSAtv and publications

GET INVOLVED IN THE BIG ISSUESContact your local AMSA representative

Visit the AMSA web site: www.amsa.org.au

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