Fewer Australian National University medical graduates are doing their internships in the ACT hospital system.

In 2024, 96 medical interns joined Canberra Health Services. The ACT was the only jurisdiction to fill all available medical intern positions, a spokesperson said: “A great outcome given the number of positions across Australia currently outstrips the number of domestic medical graduates.”

But according to the Australian Medical Association ACT, CHS had the lowest intake from the ANU in a decade: 51 students, or 53 per cent. A decade ago, in 2014, 84 per cent of interns came from the ANU; last year, 62 per cent.

CHS attributes this to increased competition for ANU medical graduates compared to previous years, with more interstate internships available. “The issue of a shortage of interns is currently the subject of discussion nationally.”

The Canberra Liberals, however, are concerned.

“According to the AMA, previously the vast majority of ANU graduates stayed in Canberra for their internship – a natural fit after spending two years in the hospital system during their degree,” Canberra Liberals MLA Leanne Castley, Shadow Minister for Health, said.

“Keeping ANU medical graduates in the local hospital system and local health workforce is fundamental to easing pressure on the ACT hospital and healthcare system.

“Clearly, whatever Canberra Health Services is offering graduates is not enough to keep them from going elsewhere for their internships.”

In fact, the CHS spokesperson said, three-quarters of last year’s 98 ANU medical graduates originally came from interstate, “so it is encouraging to see so many choosing to remain in the ACT for their internship”.

An AMA ACT survey showed that ANU graduates chose to do their internship at CHS because they always intended to stay in Canberra, they would have a guaranteed job and the application process was straightforward, or because they would be exposed to CHS during their degree.

“ANU graduates may be from the ACT, interstate or overseas, and they may elect to undertake their internship in another jurisdiction for a variety of reasons, including returning home after study, lifestyle, family reasons or professional opportunities,” a CHS spokesperson said. “For example, we have seen a larger number of students who had their studies interrupted by COVID-19 over the last few years have been more likely to leave the ACT for their home state or country to begin their practice.

“We are working with the ANU on ways to increase our number of local graduates, however we will always need to supplement local graduates with new team members from other jurisdictions.”

To attract medical graduates, CHS provides a $5500 relocation allowance, a “generous” fortnightly education allowance, access to study and conference leave, and salary packaging with full fringe benefits tax concessions, a spokesperson said.

Likewise, the 2023-24 ACT Budget invested more than $8 million in improved conditions and support for Junior Medical Officers. “This includes providing longer contracts to improve job security for graduating doctors, creating additional positions for these extended contracts, and increasing pastoral care, training, and development coordination. CHS has also invested in a Director of Clinical Training and a Chief Medical Wellbeing Officer to support and enhance the development, supervision, and wellbeing of medical officers, including junior doctors, across the organisation.”

The AMA ACT welcomed both the longer contracts and the increased funding, for which they had advocated for some time, AMA ACT president Professor Walter Abhayaratna said last year. He believes, however, that students “needed to see an advantage from doing their internship in Canberra for getting into their preferred speciality program”.

But Canberra Health Services’ allegedly poor workplace reputation might deter interns.

“Unfortunately, CHS has historically suffered from cultural problems and received bad press for it, which impacts future interns’ perspectives,” one graduate told the AMA ACT. Others said they received an “overly negative” impression from a recruitment seminar, where they were warned their internship would be “the hardest year of their life” and they might not be granted leave.

“It is also concerning that a number of graduates surveyed by the AMA said they were influenced by CHS’ bad reputation for workplace culture,” Ms Castley said. “At the same time, some of the graduates choosing to stay in Canberra and do their internships with CHS said they had always intended to stay in Canberra. This suggests the ANU may also have to look at how many medical students originally from Canberra want to do their internships here, and whether having a greater mix of local students would result in more doctors staying in the ACT.”

Likewise, according to the 2023 Medical Training survey, ACT interns were the least likely to recommend their workplace as a place to train (73 per cent – eight percentage points below the highest, Victoria and Queensland, at 81 per cent), or to recommend their current training position to other doctors (77 per cent – five per cent below SA and Victoria, at 82 per cent).

However, 84 per cent of ACT interns thought their quality of clinical supervision was excellent / good. Nevertheless, the ACT ranked lowest for satisfaction with teaching sessions, at 78 per cent. (The highest were Victoria and WA, at 84 per cent.)

These figures were an improvement over those in the previous survey, the AMA ACT noted.

“The results of the most recent Medical Training Survey show that CHS’ work to improve the environment for junior doctors is having a positive impact,” a CHS spokesperson said. “CHS will continue to listen to students, trainees, and junior doctors to ensure these improvements are sustained and built on.”

The cohort of interns also comprises 22 graduates from other Australian medical schools (23 per cent), including UNSW, the University of Queensland, and Monash University. “These are large and reputable medical schools from major metropolitan centres around the country, which is encouraging to see,” a CHS spokesperson said.

But the AMA ACT has observed that CHS is recruiting more overseas graduates to fill positions: 23 from overseas medical schools (24 per cent). Two decades ago, the need for international medical graduates to fill vacancies prompted the establishment of the ANU medical school, Professor Abhayaratna remarked.

“There have also been ongoing issues with training accreditation for trainee doctors at the Canberra Hospital which in some cases has caused junior doctors to move interstate,” Ms Castley said.

Professor Abhayaratna was concerned that ANU medical students received limited exposure to CHS during their degree because an average of 15 ANU medical students would be on clinical placement in Sydney at any given time.