Alicia commutes five hours to prac every day. It’s either that or drop out of med school

Final-year medical student Alicia Watson drives more than two and a half hours each way - five hours in total - from her parents’ home in the NSW Hunter to Liverpool Hospital, where she’s on an unpaid prac placement.

She leaves before sunrise and when she finally gets home, close to 7pm, she studies for her major exam which is coming up in six weeks.

“That’s pretty much it... I don’t really have time for much else unfortunately,” Watson told nine.com.au.

Other than sleeping in her car in the hospital car park, which she has considered, the gruelling and expensive commute is the only way Watson can survive the final year of her medical degree, which includes months of mandatory unpaid prac at hospitals across her region.

This year she’ll do seven five-week placements with a minimum expectation of 35 hours per week that can often be even longer, depending on the rotation - entirely unpaid.

“People assume that medical students are going to be people that come from money, and therefore don’t need (financial support) but you know, the reason that stereotype exists is because people with money are the only people who can afford to get through medicine,” Watson said.

Across the three years of her degree, Watson was able to rent with friends in western Sydney, working all kinds of jobs from a COVID testing clinic to St John’s Ambulance, and as a technical assistant in an emergency department pilot program.

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She was also a food delivery driver for a while and picked up Christmas casual work in retail and hospitality, but in her final years of study, the added burden of prac meant there was simply not enough hours left in the day for additional paid work and she was faced with moving home to Lochinvar or dropping out entirely.

When she’s tried applying for jobs, she’s been passed up by applicants with more flexible schedules who can work more hours.

She said she’s watched many “non-traditional students” without family support either fail or drop out.

“So many have left the degree or failed academically and had to repeat years... people that were couch-surfing, people who were considering living out of their car, they just weren’t meeting academic requirements not because they couldn’t, they were absolutely more than capable, but because those barriers were there.”

Watson plans to complete her medical internship at her local hospital in Maitland and is passionate about improving healthcare in rural and regional areas, having watched her father be forced to travel to Sydney for treatment for cancer.

She believes expanding the Commonwealth Prac Payment to medical students would help diversify the medical workforce and make it accessible for people who aren’t from wealthy or medical families.

“It’s very hard at the moment for me to encourage people who are from those non-traditional backgrounds to pursue medicine, just because I know how hard it’s going to be,” she said.

Unpaid prac requirements a barrier to rural and low-income students

The federal government recently announced that from the middle of next year, the means-tested Commonwealth Prac Payment, which already applies to teaching, nursing, midwifery and social work, will be expanded into allied health degrees including clinical psychology, physiotherapy, occupational therapy, speech pathology, pharmacy, paramedicine, radiography, rehabilitation therapies, audiology and podiatry.

But medical students are still not included.

The president of the Australian Medical Students Association (AMSA), Seniru Mudannayake, told nine.com.au the students most in need of financial support could become the doctors Australia needs.

“The medical workforce shortage is really most serious in rural, low-income, and First Nations communities and yet this government, in not supporting students from those communities, is keeping medicine accessible only to inner-metropolitan and affluent students, and then sort of complaining when they don’t move into the country,” he said.

“We know that the sort of students who do end up going back to their communities to work are exactly these kind of students who are struggling so much... exactly the students that we’re letting down when we tell them that you have to do two or three years of placement full-time without a cent in prac support.

“I think a lot of students actually had the perception that this was a government for young people, and a lot of us to some extent had actually looked up to the prime minister in the sense that he was someone from a working-class community like many of us, and to see someone from that sort of community be able to achieve so much kind of gave us all the sense that we could too.

“This sort of decision really does feel like a betrayal of those communities.

“We just don’t understand why medicine was excluded, and why this government’s made a choice that Australians from low-income, First Nations, and rural backgrounds don’t deserve as much a chance at being a doctor as their more wealthy peers.”

Australian Medical Association president Dr Danielle McMullen also questioned why medical students are still being excluded from paid prac and has urged the government to reconsider.

“Including medical students would improve community access to healthcare, particularly in underserviced rural and remote communities,” McMullen said.

“Medical students are required to undertake about 2000 hours of unpaid clinical placements. 

“The costs associated with this unpaid placement are a significant barrier to participation among current and potential students from low socio-economic and rural backgrounds.    

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“Evidence also tells us that medical students from rural and regional Australia are more likely to practice in a rural and regional area once qualified.

“Helping these students undertake their placements will mean more doctors in areas that struggle the most with access.”  

Education Minister Jason Clare did not respond directly to questions concerning the relationship between unpaid prac requirements and medical workforce shortages in rural and regional communities.

In a statement, Clare said paid prac was a “game changer providing real cost of living help”.

“This is the first time an Australian government has provided financial support for mandatory placements,” the statement said.

“We’ve started with nursing, midwifery, teaching and social work.

“It’s working. 

“We’re now expanding it to 10 areas for students training to be front line health workers.

“This is the next logical step.

“These are areas where there are big skills shortages and where we expect there will be more shortages in the future. 

“This decision is about getting more people training to be on the front line of our health system and to start and finish their degree.”

Late last Monday night the government also announced it would be funding an additional 50 medical Commonwealth Supported Places (CSP) spread across eight universities across the country beginning in 2028.

A student who studies on a CSP has their tuition subsidised by the government but still does not receive any payment or financial support during their prac placements.

Mudannayake said he was sceptical of announcements for additional placements for medical students.

“Every time the government announces more medical student spots, AMSA looks at that with real cynicism,” he said.

“At the end of the day, if you don’t actually provide the financial supports for students from underrepresented backgrounds to do medicine, those communities will remain underserved.”