Dear Ming Yong,

Thank you very much for your commitment to spend the last six years in our wonderful country and contributing so much to the employment of fully-fledged Australian citizens. In particular we thank you for the $300,000 you have paid, without which (we’re sure you can appreciate) government ministers’ superannuation funds would undoubtedly suffer and Mr Carr’s beloved wife would have been unable to travel on so many exciting overseas trips.

While we sympathise with your plight, we would like to point out the very, very small print on your student visa application, which clearly states:

“The Australian Government, wholly and without reservation, retains the right, after receipt of extortionate student fees, to discriminate against the applicant by imposing further costs upon him/her for the continuation of his/her training while attending to sick Australian citizens.

Any cost associated with high-skill based learning in this wonderful country will be borne, solely and without legal recourse or whingeing, by the applicant.

Should the applicant decide, at any point, to discontinue training in this wonderful country, and flee to another, more reasonably priced country in which to complete their degree, the applicant acknowledges that, if at any point he/she decides to return in a professional capacity to this wonderful country, he/she will have to pay further extortionate fees to bring his/her degree in line with Australian standards.

Until such time as the applicant’s already high skill levels are raised to a satisfactory standard to meet our ridiculously strict requirements, the applicant agrees that he/she will happily enter the transport industry and drive taxis to accommodate Australian citizens.”

Yours truly,
Department of Health

CC: Department of Education, Department of Immigration, Hon. Bob Carr

Thank you for studying in Australia. I take it the reason you wanted to become a Doctor was to the help sick people in your home country. Yes, we do have a shortage of Doctors in Australia. That is due to the fact that the Medical Board likes to keep the shortage so they can keep their fees as high as possible.

I assumed that when overseas students are finished their studies that they would return to their country & help their own sick countrymen. I know that the doctor to patient ratio in China is much higher than it is in Australia.

Studying in Australia isn't supposed to be used as some sort of defacto immigration scheme.

Let me see. We are stealing doctors from places like Bangaladesh and
Nigeria to work in our country areas, because the Libs cut doctor
training years ago and we now pay the price.

Why can't some of these students spend time working in the country?

Why make foreign interns PAY?

Because they are part of an immigration system that $gives to the rich via bigger markets but subtracts from the average citizen via externalisation of costs, via gridlock in everything from social services and stability to INFRASTRUCTURE costs.

Immigrants come to Australia and xcause huge demands for more infrastructure which Australian taxpayers have PAID for.

Better that immigrants pay $300,000 per person to make Australia fairer and friendlier for all to USE. In the meantime while Governments learn this LESSON in TRUTH, those immigrants long-term more capable of paying FOR that infrastructure do so by particularly paying for their internships. Internships that not only involve free work but most importantly involve raising the living standards of those doctors in most cases from abject poverty in their failed homelands to wealth and prestige in Australia.

Its not too much to ask when the alternative is that these doctors will help turn Australia into a failed infrastructure-poor-nation JUST like the one they came from.

If Australian taxpayers or their "billy lids" (kids) want to raise their living standards they must pay $300,000 HECS. Migrants are getting that privilege FREE staight off the plane or leaky boat. Make them pay their HECS.

The only ones with QUI BONO are politicians and wealthy marketeers who are increasingly in the form of foreign investors.

This is CHEATING on EVERY Australian citizen and ALL our current politicians should be repeatedly voted out of power till they realise the ERROR of their ways.

In the long-run freeloading-migrants will be better for this stance because they too are feeling the frustration of lack of infrastructure.

But can they own up to their own guilt in the problem and begin to PAY their share willingly and with PRIDE in a better nation than they left behind.

Australians cannot afford to allow ourselves to be enslaved by scurrilous politicians who only seek to rort them via paying over and over for the infrastructure they paid for years and years ago.

Continuing>

And for what? So those same out of touch fools can strut the world stage in Carr and Rudd luxury while Australians get shot in Greenacre?

If Australians wanted DICTATORS we would have voted for IDI AMIN. Slipping in a vile O'Greineresque dictatorship government model using wrong $footed IMMIGRATION is a crime against the Constitution of this land.

Make the interns pay and teach them it is in THEIR interest not to have their new homeland turn into a dictatorship like the ones they so hastily fled.

jayb:"Studying in Australia isn't supposed to be used as some sort of defacto immigration scheme."

Sorry, but that is just naive. This is exactly what it is, the Howard government set it up so that they could have young middle class immigrants educated to Australian standards immigrate to Australia, and it wouldn't cost us anything. A higher degree from an Australian institution counts a long way towards permanent residency.

...I think it is high time we accepted a few “Quacks”, (unregistered Doctors) in our communities: Example the old days when our favored betting medium was the local SP bookie!

...Doctors are painting themselves into a corner with overpricing their services. Asia beckons, as evidenced in the exodus of patients fleeing Australia to affordable dentists; a trend is evident.

Thank you for coming to study in Australia, Ming. I am glad that you have enjoyed the experience. I am sorry that the government is screwing you over your internship - it is truly disgraceful behavior.

Thank you for SELLING OUT Australia, WATTLE. I am glad that you ARE enjoying the big-noting experience. I am sorry that YOUR dictator government is screwing tax-paying Australians over while you obviously have found a way around that. Related to a coporate director are we? - Yours is truly disgraceful quisling behaviour.

It is in every Australian's interest and the interests of Migrants that migrants pay their (minimum $300,000) infrastructure share. Those like doctors in a position to comfortably pay more should be willing and proud to do so knowing it will allow Australia to maintain standards well above the disgusting national governments they fled.

Bugsy: Sorry, but that is just naive. This is exactly what it is,

I know exactly what it is Bugsy, I did say "supposed to be."

But you are right, "that IS exactly what it is," but it shouldn't be. These students have a responsibility to go home & raise their own countries standards not stay here because they can earn more money. It's greed.

[Most of comment deleted. This person is a spammer, however I have left the name of the company they are spamming from. They claim to specialise in SEO, and if this is how they do it, I wouldn't recommend using them.]
itagmedia.com

*These students have a responsibility to go home & raise their own countries standards not stay here because they can earn more money.*

Hang on, we in country Australia need doctors too, not just you
city slickers. Perhaps students should be offered internships, if
they agree to work for a few years in country areas.

Without the country, you people would have no farming or mining,
you'd frigging starve, so stop being so selfish.

"Ming: Despite being international, all Australian-trained medical graduates understand the Australian people,"

Good luck with that, having been born and lived in Aus. for 45 years I find I understand them less and less every year.

Though in saying that, once you conclude they simply want more for less, then it starts to make sense. Greed, fear and self entitlement are at the top. One only has to look to Governments these people elect for some idea of the hopelessness the future of Australia faces.

...You very nearly "got away with that" Valley Guy!

Thanks, Ming - wish you well in the future.

Valley Guy,

Hard to disagree with your assessment of the prevailing attitude in this country.
I watched a doco recently of Scott Neeson's work in Cambodia, and I was struck by the humility and compassion of the people working there - we could do with a good dose of those much needed virtues in Australia.

I am astonished at the amount of negative responses Ming has received from his very eloquent opinion piece.

I would like to point out a few things to those who are so against the provision of intern places to international students.

1) There is a rural doctor shortage which has resulted in the Australian government 'Importing' thousands of doctors who are not trained in Australia, and hence serve their 2-3 years in the country before (generally) moving straight to metropolitan areas. These Drs are renowned for not being able to 'connect' with or communicate effectively with these rural areas. Obviously, this is a generalisation and I am sure there are some very good doctors who have been trained overseas. This process is also extremely expensive for the Australian government.

2) The international students who come here to Australia to study medicine pay approximately the same amount as students who go to Bond University (our only private University). I don't disagree with these fees, as education is a service that the Australian government EXPORTS. HOWEVER, if these doctors wish to stay on in Australia and practice, this can solve two issues:

It is more economical, and all standards will be met to the Australian public of Australian TRAINED Drs.
Perhaps we do create a 'bonded' scheme where those int'l students must then repay each year of their intern to an area of need... However, I strongly disagree that they should pay for their intern position as they are doing the Australian Health system a favour.

To all those who believe this is a backdoor to become a resident in Australia - GOOD. These are trained, educated, intelligent people who will add culture to a multicultural society. Just because some of them come from 'elected' communist countries (do some reading Valley Guy), or corrupt nations, does not mean they bring those values here.

I open you all with welcome arms if your intentions are to stay in Australia. Forgive those who are ignorant for what service and value you can and will bring to Australia.

Regards,
James

I would just like to point out a few facts to inform this discussion as after reading the comments I'm not quite sure whether people fully understand what's going on

1) International students have already paid that 300,000 dollars, so they're not trying to avoid paying for our HECS or trying to "turn Australia into a failed infrastructure poor nation".

Also, the people that arrive in this country (it sometimes saddens me to say this because it tells you how inequitable education is steadily becoming) are not here for " raising the living standards of those doctors in most cases from abject poverty in their failed homelands to wealth and prestige in Australia." There are here because they recognize the value of Australia's medical training and they have the money to pay for it. I get the feeling that those people that are willing to shell out 300,000 dollars for an education are not in abject poverty nor are they investing money in a medical education mainly for wealth and prestige.

2) I think most international students are not demanding the government offer them jobs, like it is their right. I think that they should have the option, like any other skilled professional whose profession is listed on the skilled migration scheme to be offered the chance to stay in Australia and practice what they have devoted their lives for 5-6 years for. This is especially in the context of the fact that the health authorities did not give the current graduating medical students (as well all of those two years their junior) ANY warning that they would cease offering internships. So by that time, most had already invested 40,000-80,000 in their studies and were unlikely to drop out or to look for alternatives.

3) Suggesting that you pay for your internship is essentially like suggesting you should pay for a job. An internship is not just training, it is a job. It is a job where you work overtime and you work hard. Yes, the training part is important, but the medical profession is unique in that doctors effectively "train" and learn their whole life. Formal training only really ceases after you become a consultant and that usually takes 10-12 years. When we say training, we really mean learning on the job, which I'm sure all would agree you shouldn't have to pay for.
If you're really suggesting that international students pay for their jobs, then I imagine that new labour laws have to be set up, to allow employees across Australia or at least NSW, to pay their employers for their jobs. And you'd probably have to create a new entry in the dictionary just for Australia's special definition for employees in relation to foreign trainee doctors only.

4) Suggesting that you pay for your internship while domestic students should not have to is frankly inequitable and bordering on discrimination. If two people anywhere in the world, apply for the exact same job by the exact same employer (NSW Health, for example), it would never be justified to even offer different salaries based on their nationality. And now we're suggesting that one of them should pay for their job, while the other gets paid to do the same job.

In conclusion, let me ask you this question. You, as part of the Australian public is deciding your future fate for yourself. How would you feel, in the emergency department if the deciding factor that allowed the intern-doctor to put in your cannula and write out your medication, was the amount of money he/she was willing to pay to do that?

greensquare:

...Your altruistic defense of foreign doctors falls flat. There should be a royal commission to investigate the medical industry, and in particular the area of the GP. When two thirds of drug addicts using the drug injecting rooms at Kings Cross are there to inject the prescription pain killer oxycontin, should we not assume that doctors are actually producing their own patients, (as one among many examples)?

...If the GP is simply acting as a traffic policeman, directing patients to specialist services, surely our system of medical professionals is actually oversupplied. We the patient could handle this particular application of the health service ourselves. For what the GP is required for in our communities, his is a task that could be handled as efficiently by lesser trained medical staff at a fraction of the cost to consumers (and generally the tax payer), negating the need for foreign doctor imports altogether.

...The medical industry is a prime example of negative over-regulation that is strangling the life from Australian society.

...Finally, foreign doctors are in this country for their own purposes alone; it is naïve to believe they are here to save Australians from deliberately manufactured doctor shortages! A “cushy” high paid job as a GP is the motivation.

For the work shy, in danger of being made to go to work for a living, give me a call.

My wife has a list of the doctors in our district who will give you a "doctors certificate" to get out of it.

Give her your certificate, with the doctors name obscured, & she can tell you which doctor wrote it. They all use just half a dozen pre written certificates, [like our teachers use on school report cards], they use. Thus it only takes them about 50 seconds to collect another bulk billing fee. Wouldn't want to waste too much time on it now would they.

Ming is probably one of those worth having. I'm sure there are cheaper, & easier ways to get the bit of paper he desires. It is unfortunate he will for ever be scared by this rip off.

While I sympathise with Dr Yong's position, this article completely misses the point.

FACT - the annual fees for international medical students are no different to students studying degrees like commerce/law. Many of them have large debts, and cannot find work in Australia.

FACT - an Australian internship is ONLY good for Australia. It won't help someone find a job overseas. Opening up a lot of internships now means we then have to create a whole lot of residency positions next year.

FACT - forcing health departments to open up internship positions will not only create jobs where none are needed. Why should any government department fund positions that they don't require? Should the DPP start hiring an excess of lawyers as there is a job shortage among law graduates?

FACT - an internship is a vital training role. Opening up more positions outside of hospitals will result in substandard training of all doctors. Personally I'd prefer to have doctors who can do their job rather than cutting waiting times by a few minutes.

FACT - the doctors being imported are already fully qualified. The newly graduating medical students do NOT have the training to fill these positions. The shortfall will decrease each year as the number of medical students increases.

FACT - this issue has been well known as early as 2005, before most current international students enrolled. There has never been a guarantee of a job for international OR domestic fee paying students. If the universities lied and said it wouldn't be a problem, then this is an issue between them and their students. The government should not be forced to pick up their slack.

Diver Dan, I'm very happy you've said all of that... I'm actually doing a thesis on the topic of pretty much everything you have just brought up.

The first thing I can say is: You're absolutely incorrect about all of those massive, unsubstantiated assumptions. It seems you're on a bit of a vendetta against GPs and the doctors within Australia.

May I first refer you to an article written by Barbara Starfield (Starfield, B., et al., The effects of specialist supply on populations' health: assessing the evidence. Health Aff (Millwood), 2005. Suppl Web Exclusives: p. W5-97-W5-107.) I will summarise the main findings of this review of primary care below:
- Primary care (i.e. GPs) is THE most important tier of a nation’s health system;
- It's the field of medicine that directs itself to the total needs of a patient and their family, and has an emphasis on the integration of health services whilst trying to limit any fragmentation of care
- Secondary Care (i.e. specialists) is extensively (36x) more expensive than primary care - as well as not having the same population-level beneficial effects on health outcomes
- Hence - it is more efficient, and has a better outcome for patients to have their treatment with a GP (obviously there is a point in time when specialist care is needed for some cases)
- Hospitalisation rates inversely associated with access to primary care and the number of primary healthcare providers
"It is not just the supply of GPs or primary care clinicians that is associated with improved health outcomes. In the US, having a primary care physician rather than a specialist physician as the regular source of care is associated with better five-year mortality (after controlling for independent variables)" (Quote JWP)
If we have less highly-trained GPs out there - these health outcomes will NOT be the same. (I can give you 100 articles to read to back up what I am saying)
(1/2)

I'd love to know what your "Cushy" job is Diver Dan - I can assure you, MOST GPs are certainly not in a CUSHY job. After undergoing 5 years of medical school, 2 years of intern and residency, a further 4 years of General Practice Training and then having a life which is surrounded by your patients is by definition not a CUSHY job

P450 - FACT: There is a RURAL DOCTOR SHORTAGE. Have you not heard? There ARE positions to fill. It is NOT all about ED waiting times.
FACT: The issue is actually between the state and federal governments as they ALLOWED for the increase in medical student numbers - hence, their responsibility to increase training roles in THEIR Health System.
FACT: The shortfall will decrease ONLY if we create more training positions... how does this not make sense to you? The imported doctors are not favourable as they are not AUSTRALIAN trained.
(2/2)

...Well northstar, you will obviously pass with flying colours when you submit your thesis which backs-up AMA propaganda ensuring the system will never work for the sick in our communities; especially those without the means to pay “bribes” to pass through the doors of a doctors’ surgery.

...I am a bit “over” my observations of watching the under-resourced chronically ill in our communities (which includes children of single mothers), manipulated by the medical fraternity into parting with money they “don’t have” to qualify for medical treatment.

...We live in a world of “rich and poor”. Who do your wonderful medical fraternity, the ones whom your thesis will be inclusive of, cater to? Let us be honest, primary health care in Australia is designed by market forces, to wring-out dollars from a captive audience, primarily first and foremost as the objective. It is private enterprise at its worst!

...The shortage of doctors can be easily fixed by reducing doctor quality not increasing it. This may be easily achieved by eliminating the power of the AMA to manipulate at will, Government policy.

Dear Diver Dan,

I have read all of your comments and you are categorically wrong in absolutely everything that you say.

Probably time to go back to watching children's television programs, they might be a little easier to understand.

nodiverdan/northstar:

..."The uncomfortable truth": Come to grips with it!

Northstar, it’s time to listen to the facts rather than the AMA’s mistruths.

(1) There is a rural doctor shortage, but it is NOT a shortage of interns or RMO's. It's a shortage of GP's, emergency specialists, obstetricians etc. Sending junior doctors to rural locations and expecting them to perform procedures such as lumbar punctures, ascitic taps etc will be detrimental for patient's health. That is why experienced and highly trained international doctors have to be imported.

The shortage developed because in the past because not enough medical students were being trained. This has been rectified with large numbers of positions being opened in 2005-09. As these students graduate and become fully qualified as doctors (ie become GPs or specialists) over the next decade then the shortage will disappear. But that takes time, and is wrong to allow interns/RMOs to practice unsupervised in complex environments.

(2) You're confusing a university degree with a job. Sure the government allowed an increase in the number of places, but at NO POINT did they guarantee that international medical students or domestic full fee paying students would have jobs. What has happened now is no different to what has happened to students who have degrees in commerce and law. An Australian medical degree is recognised worldwide, and there is no reason international students cannot practice in the other 192 countries serving the rest of the 99.68% of the world’s population in places which will have a genuine shortage in 10-20 years time.

(3) We have addressed the shortfall. The number of domestic students coming through the ranks of their universities will be sufficient to meet demand. As I said, it will take some time for them to become fully qualified, but we will not be having the same problems in a decade from now...

Unless we open up more intern spots for sympathetic reasons – creating an excess of substandard doctors...

If we are to train foreign Doctors in Australia, at considerable expense to the Foreign students, then surely the "product" we seem to be selling, ought to include obligatory intern-ship, without which, all of the previous training becomes worthless, and or, leaves some very highly trained people, with few other choices, than to pilot a taxi cab, in a crowded city.
There remains a huge unmet need in the bush for trained, or in training, and therefore supervised medicos!
Why, we even had a discussion not all that long ago, about approving Doctors' assistants?
Former and very highly trained and extremely competent army medics, who often have better trauma management skills than many doctors, on the basis of vastly superior practical experience?
For which, but particularly in medicine, there's simply no substitute!
I live in the bush and have been waiting over thirty years for elective surgery, to fix a hernia.
Supervised interns, could take on the simple stuff or open and shut surgery! [And the obvious pun was intended.]
If only politicians weren't always completely quarantined from the end point consequences, of their often obdurate obtuse decisions?
Then surely, we would have adequate, "coal face", staffing levels, in our public hospitals!
Rail lines would be properly maintained and trains would now be very fast and run on time.
Decentralisation would have occurred many years ago, and there would not now be gridlocked cities, with infrastructure no longer able to keep up with ever escalating demand.
I mean, as an example, infrastructure that's simply deferred to meet politically motivated budget demands, costs AT LEAST DOUBLE, just a single decade later!
And properly planned rapid rail roll-outs, would quite literally pay for themselves, if only govts retained critical resumed rezoned land, which as later residential land sales, would refund in full, all the requisite outlays!
Similarly, Interns, training as specialist rural GP's, would allow more people to consider returning to the bush, relieving some of the crush in crowded, overpopulated, overpriced, gridlocked cites.
Common sense is arguably the rarest of all commodities, but particularly, it seems, in politics?
Rhrosty.

Rhrosty,
You have written that without an internship a medical degree is useless. This is completely false. The medical degree makes someone a doctor. For Australian students the law means it is then necessary to do a one year internship to demonstrate they are safe to practice medicine And also to act as cheap labour for the public hospital system.
I went to medical school with many international medical graduates who then directly after completing their degrees returned home to work.
We have sold these students a well respected medical degree at an internationally competitive price. The internship is nothing to do with them, that is strictly for Australian students.
Of course I also went to medical school with many other international students from developing countries who's medical degrees were paid for by ordinary Australian taxpayers for the purpose of helping these countries. Most of these students completed their degrees then suddenly decided they did not want to go home and stayed here, without ever paying back their the AUSTRALIAN TAXPAYERS.

This whole situation is just about foreign people trying to take advantage of Australia. We should be educating Australians as doctors, end of story.

There have been recent allegations that hospitals reserve available internships for foreign students to shore up the number of fee paying students for universities they are associated with. If so, such preference discriminates against Australian medical students.