Choosing Australia

Post #6 of 'The Two-Year Application Process'.

Understandably, people around me were, at the very least, confused and incredibly sceptical at the most when I made the momentous decision to defer my place to study medicine at UCL, one of the top medical schools in the world, to have a go in applying to medical schools in Australia and potentially start the next era of my life.

Many factors led to this decision, and I drew out networks and flowcharts to rationalise the different paths I could take from this point because I knew this choice was probably the most important I ever had to make so far. I'll try my best to simplify my train of thought in this post; I remember so many ideas and opinions whizzing in my head at the time!

The financial standpoint (medical school) 🏫

Let's start with medical school itself. As a dual British-Australian citizen, I would be classified as a domestic student for admission to Australian medical schools, meaning I would be entitled to the following, which international students cannot receive:

• a Commonwealth Supported Place (CSP) with local tuition fees

• Centrelink payments, such as Youth Allowance and Rent Assistance

• HELP loans, i.e. student loans so that I do not have to pay CSP tuition fees upfront

• reduced healthcare costs through Medicare (bulk-billing and rebates), Health Care Cards and the Pharmaceutical Benefits Scheme (PBS)

• domestic scholarships which can be used to fund medical school.

Let's break down these bullet points.

A Commonwealth Supported Place (CSP) with local tuition fees

A Commonwealth Supported Place (CSP) is a university place where the Australian Government subsidises most of the tuition fees, and the student's tuition fee is called the Student Contribution Amount (SCA). International students are not entitled to a CSP and must pay the full fee for their place without any subsidies from the Australian Government.

Using my program, Griffith University's Bachelor of Medical Science and Doctor of Medicine:

• For the Bachelor of Medical Science, I study three years' worth of courses as a typical degree, accelerated into two years of full-time study. Of course, I still pay for three years' worth of SCAs. The total SCA of the Bachelor of Medical Science under a CSP is ~$27,500. International students in the Bachelor of Medical Science would have to pay a total of ~$109,500 over the two accelerated years. This means domestic students pay 75% less than their international classmates.

• The Doctor of Medicine is a four-year postgraduate program, with the SCA currently ~$13,200 per year. The SCA does increase every year in line with inflation, so I would expect to have ~$56,000 in tuition costs over the four years. International students currently pay $77,500 each year for the Doctor of Medicine, and since international tuition fees also rise every year, I would expect an international student to pay ~$320,000 over the four years. This means domestic students pay 83% less than their international classmates.

• Therefore, for my whole six-year medical program, I would have ~$83,500 in SCAs, whereas an international student would have ~$429,500 in tuition fees. International students would have to pay upfront over 410% more in tuition fees than their domestic peers, which is mind-blowing. If I didn't have Australian citizenship, I would certainly not be able to pay almost half a million dollars for medical school as an international student.

If I stayed at UCL, I would have four years of tuition fees (as the last two years are covered by the NHS Bursary). Since tuition fees for all degrees in the UK are £9,250 per year, I would have £37,000 in tuition fees. This is equivalent to ~$72,150 (using £1 = $1.95), which seems lower than the $83,500 in SCAs here at Griffith, but bear in mind that considering I would be paying six years of tuition fees at Griffith vs. four years at UCL, the extra $11,000 of tuition fees for two whole years of medical school at Griffith is still a lot cheaper than the £9,250 per year of medical school at UCL.

Centrelink payments, such as Youth Allowance and Rent Assistance

As an Australian citizen, I am entitled to student-specific benefits from Centrelink, called Youth Allowance and Rent Assistance (as I am renting independently). This is Australia's alternative to maintenance loans in the UK and does not have to be paid back.

Currently, I receive $797.50 per fortnight in Youth Allowance and Rent Assistance combined, which would add up to ~$32,000 over the two years of the Bachelor of Medical Science, or ~£16,400. Imagine receiving £16K+ from the government as a student for free. In the UK, most students take out maintenance loans and still receive less than that figure over two years to cover their living costs, and they have to pay that back over many years after graduation depending on their income.

The Centrelink payments cover virtually all of my living costs, which means that I don't need to find a job to financially sustain myself. This has taken a huge weight off my shoulders and has allowed me to focus on my medical studies. If I were at UCL, I would certainly have multiple part-time jobs (as the maintenance loan I would get would not be sufficient) to stay afloat and help my mother afford living costs at home, on top of their very rigorous medical degree.

HELP loans, i.e. student loans so that I do not have to pay CSP tuition fees upfront

Higher Education Loan Program (HELP) loans are Australia's version of the UK's student loans. They only give loans for tuition fees (not for living costs, as Centrelink payments can be used to fund those instead), which is different to the UK, as both tuition and maintenance loans can be taken out.

The key difference between British student loans and HELP loans is that HELP loans do not have interest. While they are subject to indexation in line with inflation, it means I should be able to pay off my SCAs in full while I am still in speciality training after graduating from medical school. Combined with the fact that Australian doctors receive significantly higher salaries than their British counterparts in the first few years, it is likely that I can pay off all my student loans in less than 10 years. British doctors, in comparison, often graduate with six-figure debts because they have taken out both tuition and maintenance loans throughout their entire degree. With interest of 4.3%+ added on top and much lower salaries, many British doctors will not be able to pay off their student loans within 40 years before they are waived.

Something else that is unique to Australia is the census date, which is the final date that domestic students can voluntarily pay their tuition fees before they become a HELP loan. This flexibility allows students to reduce their fees while still in university before indexation is applied (one year after a HELP loan is made). For me, it means that I can shave off the total $27,500 in SCAs for the Bachelor of Medical Science to around $20,000, and the rest of my SCA will be put onto a HELP loan for me to repay once I graduate medical school.

Since I would have to take out tuition and maintenance loans for my whole time at UCL, I would have a total of ~£76,000 in student loans, or $148,200. And this figure is assuming that I stay at home for all of medical school at UCL, but this likely would not be the reality and I would move in with fellow students and friends at some point during the six years. In that case, I would be entitled to a higher maintenance loan, but at the same time, this would increase my total student loan debt from £76,000 to over £90,000, or $175,500. Bear in mind these figures do not account for the 4.3%+ interest that gets accrued to them from day one of medical school (so they would be much more in reality). Now compare these figures to the $83,500 in SCAs at Griffith (I would not have any maintenance loans, as Centrelink payments would have covered the vast majority of my living costs). You can see that going to an Australian medical school like Griffith instead of UCL could save me well over $100K in student loans, including interest!

Reduced healthcare costs through Medicare (bulk-billing and rebates), Health Care Cards and the Pharmaceutical Benefits Scheme (PBS)

While the NHS' key strength is providing high-quality healthcare for free at the point of delivery, Medicare and the Pharmaceutical Benefits Scheme (PBS) achieve a similar outcome for me as an Australian citizen. Bulk-billing allows me to go to the GP and get blood tests for free, and I receive rebates for private hospital appointments (e.g. with dermatologists and clinical allergists) so that I do not pay full private fees (unlike private healthcare in the UK).

The PBS is a scheme where Australian citizens with Medicare receive discounted fees for medication compared to a private prescription. A Health Care Card is a concession card for people claiming Centrelink payments, such as Youth Allowance. The two schemes have meant that I have been able to save hundreds of dollars on essential medication, and with NHS prescriptions increasing in price in the UK, the savings I receive here in Australia make my medicines cheaper cumulatively.

Domestic scholarships which can be used to fund medical school

While international students can receive scholarships, medicine is always excluded from the list of eligible degrees, hence international students in medical school have to pay all their tuition fees upfront (which is around $429,000 at Griffith).

As an Australian citizen, however, I was eligible to apply for all scholarships that I met the criteria for, just like onshore Australian students, and I could use them for both tuition fees and living costs. Griffith offered me the Vice-Chancellor's Academic Achievement Scholarship and the Chancellor's Scholarship. I am also eligible to receive funding for various reasons from external Australian institutions, such as the New Colombo Plan (NCP) and the Pinnacle Foundation.

Combining these with the Centrelink payments of Youth Allowance and Rent Assistance, I expect to receive a total of ~$60,000 in financial aid over the two years of the Bachelor of Medical Science, which will not need to be paid back. For the Doctor of Medicine, I could very well receive close to $100,000 in support from Centrelink payments and external scholarships, which could mean a maximum of ~$160,000 in financial aid over the whole six-year medical program at Griffith, or ~£82,000. I would never receive money close to this figure for free as a medical student in London.

(For British students, the only two ways I can think of that would allow you to study medicine debt-free (or close to debt-free, for the pre-clinical years) would be:

• receiving the Crankstart Scholarship and a Thatcher Undergraduate Scholarship from Somerville College at the University of Oxford

• receiving the Cambridge Bursary, Education Premium for Free School Meals, and a Dobson Free Place from St John's College at the University of Cambridge.)

The financial standpoint (employment) 🩺

Medical interns (the Australian equivalent of Foundation Year 1s in the UK) have varying salaries depending on the state they are practising in (New South Wales generally has the lowest salaries, while Queensland has the highest). Using Queensland (as this is where I'm studying medicine), the current base pay for medical interns is $90,141 per year. Since overtime and night shifts can increase that base pay by 20-30%, doctors can often reach $110,000+ one year after graduation, or roughly £56,410. It is definitely possible for medical interns to earn £60K+, rivalling the most prestigious investment banking and finance graduate schemes in London. Compare this to the recently announced national base pay of £36,616 for Foundation Year 1s after years of resident doctor strikes. This is roughly $71,000, and don't get me wrong, this is leaps and bounds better than the £29,000 (~$56,500) that Foundation Year 1s were receiving just at the start of this decade, but when you compare the salaries to the student loans I've established earlier and the relatively less financial support in the UK, the pay scale for British doctors is currently still not progressive enough. The first few years of graduation for them are particularly the hardest, with house prices in the UK much higher than in Australia for smaller plots of land, and a cost-of-living crisis.

For consultants, Australian doctors can earn over three times as much as their British counterparts, with posts on Indeed and Seek frequently displaying salaries of over $500,000-$600,000 per year for the most experienced roles. For context, the highest salary a consultant in the NHS can earn, after 14 years of working as a consultant, is currently £131,964 (~$257,000).

Australian doctors often have more flexible weekly timetables than British doctors, with fewer working hours and more choices on taking overtime and night shifts. This is partly why Australian doctors report much higher job satisfaction and retention, and this is consistent across metropolitan, rural and regional areas. Couple this with better working conditions and more equipped facilities in Australian hospitals compared to the current underfunding from the NHS.

Of course, an aspiring medic should not enter medicine for the money (as other careers can earn very high salaries in a shorter training time than medicine). Still, it is vital to consider financial health after spending many years in medical school, accruing high student loan debts, and seeing where you would be best remunerated for delivering the high-quality patient care expected from a doctor, especially when it comes to financial milestones such as buying a house, paying taxes, raising children, etc. Especially as someone from a low-income, single-parent and first-generation background, I would love to have the financial freedom to provide for myself and those I care about in the future with my dream career and not incessantly worry about making ends meet and affording to pay the bills.

A new adventure with old memories 🌏

I've just talked about a lot of 'adult' stuff with finances and job stability, but those were definitely not the only factors I considered. Above all, I've always wanted to go back to Australia at some point after graduating from medical school. It's where my earliest memories took place and the weather was always better for self-development and health (I usually become chronically and severely ill during winters in the UK, more so than the typical person, due to the colder weather).

While I'll always appreciate London's vibrant culture and stunning landmarks, with buzzing streets and plenty of activities to do with friends and family, I had a gut feeling that it wouldn't be my permanent home. My sister lived in Melbourne all the time while I was in London with my mother and brother. When I visited there at the end of 2022 for her wedding, the first time I stepped on Australian soil since leaving the country in 2010, I immediately felt rooted to the city, as if I never left. All the streets and buildings in the suburbs I used to live in sparked memories I could never recall in detail, and the familiar smells and sounds of Aussie accents made me feel like a four-year-old all over again who didn't have to worry about life. And I wanted to have these experiences again.

Now that I've grown up, I've wanted to have the chance to explore Australia independently with a new lens. I knew this was easier said than done, as I had never lived by myself before, and my living arrangements would be more complicated due to my life-threatening food allergies. My mother was understandably very worried for me regarding how I would fend for myself on the other side of the world, but I felt that this was a risk I had to take. Throughout my life, I've never been an avid risk-taker, always opting for the safest options and not putting myself in danger at all if possible. But that's led me to decline opportunities that I would regret later. Having the opportunity to go to Australia and study medicine without significant financial or administrative concerns as an Australian citizen was not something I was prepared to throw away just to stay in London for another six years. I knew that if I didn't give Australian medical schools a shot, I would regret it while at UCL.

Studying medicine in Australia would provide me with a whole new landscape to make a fresh start at this turning point in my life. With new people to meet, places to see and experiences to try, I thought I would develop so much more as a person by making the big move to Down Under than staying in my comfort zone in London. Even though I would be a domestic student on paper, my international perspective would give me the best of both worlds, and that dynamic with others would be invaluable for my personal growth. In addition, I would be much closer to Asia, so visiting countries like Japan, South Korea and Thailand would be significantly quicker and cheaper, and it would allow me to stay more in touch with my East Asian heritage.

But even if I didn't get into an Australian medical school, I had nothing to lose as I would still have a deferred place at UCL. Taking a gap year, even though I was the oldest student in my school, would give me a well-deserved break of education after 13 consecutive years of hard work and self-discipline. I would have more time to pursue interests that I've always wanted to explore but couldn't do so due to academics, and I could also work to raise money so that I would be able to afford some of my living costs and not take out hefty maintenance loans that would accrue interest all throughout medical school. Applying to Australian medical schools would simply be an extra task to do, but receiving an offer would change the course of my life.

Interestingly, if I were a dual British-Australian citizen residing in Australia and wanted to go to the UK to study medicine, I wouldn't be classified as a Home student as the British Government requires students to have lived in the UK for three years before starting university to be eligible for Home status, meaning I would be subject to international fees despite having British citizenship (and international tuition fees for medicine are incredibly high). So I'm very glad that Australia recognises me as a domestic student despite me not having lived in the country for 14 years, and I receive the same privileges as Australians who have been onshore all their life.

Coming to work in Australia ✈️

I always knew that if I studied medicine, I would love to go back to Australia as a doctor, temporarily or permanently. But doing so as a medical graduate from the UK would be very hard, indeed.

I remember reading this article not long before I sent my medical applications to Australia:

https://www.theguardian.com/society/2023/sep/11/medical-students-plan-to-quit-nhs

A third of medical students in the UK plan to leave the NHS within two years of graduating, and of these students, 43% stated Australia as their top destination to emigrate. It highlighted how competitive the process would be; I would be battling so many other British doctors to enter the country.

You might think that with my Australian citizenship, I would be prioritised over these British doctors who have never been to Australia in their lives. But you would be wrong. Because citizenship does not matter in this situation. What matters is that I graduated from a medical school outside Australia, and therefore I would be classified as an international medical graduate (IMG). I would be seen in the same way as an American, Korean or Italian.

IMGs are the last priority for jobs in Australia, as hospitals will always prefer someone who's been trained in the country and knows well the operation of the Australian healthcare system. IMGs cannot be medical interns as they have no places left after giving them to Australian-trained doctors first (Australia has an ongoing internship crisis), and the IMGs with the highest chances of getting into Australia will have already acquired several years of experience, near the end of speciality training and becoming a consultant. This would mean that if I graduated from UCL, I would have to wait until the mid-2030s at the earliest to have a decent chance of working in Australia. Compare that to now, when I'm already in Australia studying medicine. I could not afford to wait 10-15+ years to enter this country, because by that point, would I still even want to move? I would have already established a support network and roots tied down in the UK (by potentially finding a partner and raising a family, for example), so going to Australia would become even more complicated.

As a UK graduate, I would be eligible to apply for registration in Australia through AHPRA's Competent Authority Pathway, a scheme that prioritises IMGs from the UK, USA, Ireland, Canada and New Zealand. But there is a catch-22 regarding this pathway. From Mana, a well-known user at Med Schools Online (the Australian equivalent of The Student Room, tailored to medicine and dentistry):

The Competent Pathway is a pathway whereby overseas medical doctors (from the UK, Canada, USA, NZ, or Ireland) can apply to have their medical degree recognised in Australia. To qualify for this, you need three things:

1. A medical degree that is recognised (and later verified) by the Australian Medical Council (from the above-stated countries)

2. An offer of employment as a doctor in the Australian medical system (as a resident).

3. To apply and be accepted for provisional registration with the Medical Board of Australia.

Sounds easy enough right?

WRONG — this is actually quite a Catch-22. Why?

There are loads of junior doctors applying for residency around Australia. In some states there are very few places for resident positions (PGY2) owing to the fact that they are given 2-year contracts (such as in NSW, for example) — this means that most of the resident positions are already taken by people interning at that particular hospital network. However, there are states that don't pre-allocate their PGY2 offers. In this case, the interns will have to apply for a residency. However, in this case, most hospitals would be likely to hire from their own pool of staff (except in rare cases, such as the intern from the previous year being dangerous or incompetent). This saves them from having to retrain and re-acquaint themselves with the hospital system as well as knowing that they are competent to practice as a resident because, hey, they just proved their competence last year right there.

Other positions are likely to be filled by other Australian junior doctors (of which there is no shortage owing to the increasing number of interns graduating every year).

Finally, there is that student who is applying through the Competent Pathway. To do so, they need to have 1, then they need to secure a job — that is, they need to be hired in preference to someone who just finished their internship in Australia. However, they are faced with the problem that they are now much less competitive for the job because they haven't got provisional registration with the Medical Board of Australia.

So the hospital has a choice of hiring an Australian intern who has practiced in an Australian hospital in the last year or to hire that person applying through the competent pathway who doesn't even have registration yet (and they can't until they get the position). Of course, the hospital will hire the Australian — and the competent pathway applicant can then kiss goodbye to their ability to apply for registration.

Hence, it's a catch-22 — only in very rare cases would one nowadays get admitted through the competent pathway. Don't expect to get in with this pathway — you won't.

When I read Mana's posts on the forum, I was taken aback. I thought that being from the UK, whose healthcare system Australia modelled theirs, would give me a competitive advantage because there would be less adjustment I would have to do to work in Australia. But knowing that Australia would always prefer its home-grown doctors and only take in those out of the country with enough experience to prove their competence under a different healthcare system is comparable to those of Australian doctors under the system they want to work in as IMGs, the obstacles I would have to clear to work in Australia after medical school seemed to become even longer, more numerous, and more difficult.

(There is also a law for IMGs called the '10-year moratorium' that I would have to go through if I studied at UCL, which is elaborated here: https://www.health.gov.au/topics/doctors-and-specialists/what-we-do/19ab/moratorium)

If I wanted to reap the privileges of being a dual British-Australian citizen, then I had to get into the Australian system as soon as possible, and that would mean going to an Australian medical school and earning an Australian medical degree. That way, I would have top priority for medical internships in Australia (especially in Queensland as a Griffith graduate), and I wouldn't have to prove my competence because all medical schools in Australia are standardised in training and teaching quality, so hospitals would be confident I had the necessary knowledge and skills to be a successful medical intern and resident doctor. I would be able to work anywhere I wanted (assuming I have an unbonded medical place) without rules such as the 10-year moratorium and return-of-service obligations, and I would have established a support network throughout medical school, with Australian friends, my family (who would have all moved to Australia at some point during medical school), and fellow doctors and healthcare staff in hospital and clinic placements.

Overall

I didn't know all this information when I decided to defer my place at UCL and pursue medicine in Australia. But I knew the gist of things, and I had a gut instinct that making the move was the right thing for me in the long term. And now that I'm happily settled in Australia and studying medicine at Griffith, I can confidently say I don't regret anything, and I'm thriving a lot more here than I ever would at UCL.

I knew that medicine was the most competitive degree in Australia, especially at the undergraduate level, but I was determined to spend all of 2023 trying to submit the strongest application possible. In the next post of the series, I will go through the first part of applying to Australia, including sitting the UCAT again and sending my applications to various Australian states.