Flinders Medical Centre, etc.

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I thought it may be helpful to give my very simplistic view of orthopaedic health care in Australia from my limited experience thus far at Flinders Medical Centre.

Orthopedics in Australia

Intern=intern
Registrar=resident
Fellow=fellow
Consultant=attending


Australian undergraduate and medical school is a lot like the US. 4 years undergraduate, 4 years medical school. They are given placement for their intern year which is a guaranteed spot, and this is at one hospital. After that year, they become an RMO. And they can either be on a medicine track, or a surgical track. This is when things get tricky. After a couple year, then they apply for orthopedics, which is extremely competitive. If they do not get a spot, they then have to do another year and apply again (this is when they are a service registrar). They can apply up to three times. If they have a spot, they then have 5 more years of training. This is in a specific "state", ie Victoria, New South Wales, a South Adelaide, and they do 6 month long rotations at different hospitals in different cities. If they don't get a spot after 3 years, they have to choose another career.

Also, the residents have a series of mandatory courses and tests which I don't exactly understand but are expensive and have a long waiting list reportedly.

Furthermore, there are a lot of international doctors who want to practice in Australia. Probably because the money is decent and there is a good work/life balance. In order to do so, they have to pass the Australian exams (which only has about a 30% pass rate) and do "two years under supervision" where mainly they work as a fellow. If they pass all of that, they then can apply for jobs.

Healthcare in Australia

Here they have a public and a private system. In the public system, all health care is covered. It is set up similar to our county hospital. However, if you pay for insurance, you can be treated in the private system. There are separate private hospitals and patients are treated quicker and more likely by a consultant as opposed to a registrar. Registrars have very little experience in the private sector. Some consultants are strictly private, but many will have both public and private hospitals. Flinders has both a private and a public hospital which are next to each other, as well a a pediatric wing. I am working in the private hospital.

Flinders

On the Flinders campus, there is a university, medical school, and the medical center. Flinders hospital handles all of the trauma in the south, and royal Adelaide handles the trauma in the north. Other exceptions is that flinders doesn't do complex pelvic trauma, and the royal adelaide doesn't do Peds trauma. There is also a women's and children's hospital in the north of the city.
There is not much around the campus. A couple restaurants and fast food places in walking distance. Most have cars. Fortunately, there is an easy and frequent bus schedule so I've been using that with no problem.

Flinders trauma service has a very laid back atmosphere. The theaters (operating rooms) start at 8. There is one orthopedic room, and two emergency theaters, so when lots of trauma comes in, they can run two rooms. Morning conference starts at 8, and all of the interns, residents, fellows, consultants, the anesthesiologist of the day and the charge OR nurse all attend. We start by going over the case list of the day. It is SO HELPFUL to have the ancillary staff there. Then we go over the nonoperative admissions and other floor patients. We then break into two teams and perform ward rounds on all the patients, led by the interns. They had a no bullshit very experience nurse practitioner as well who is a huge help. After ward rounds, everyone breaks off to theater or clinic.

I am surprised at just how nice everyone is. Consultants go by their first names, residents have a lot of autonomy, and if they make mistakes they are addressed but as long as there wasn't gross mismanagement or negligence, no one is angry or in trouble.

I know there are work hour restrictions for registrars, though I don't know what they are. I can say it seems like they work much fewer hours, but they are very bright and have a very solid handle on Orthopaedic knowledge.

Other interesting things: they take everything to theatre. The ED is very very hesitant to give sedation to allow for reductions in the Ed. So most things which would be handled in the ED in the states is taken to the OR, including distal radius fx, ankle fx, Etc.
Although much is different, it's comical to me how much is the same. Battles between plastics and ortho about who is taking hand call, residents bitching about incompetent ED staff, rivalries between nearby hospitals, inappropriate transfers, ORs being shut down early, occasionally ridiculous turn over times. Feels like home.

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