Ké Mochel had actually planned to start her internship1 immediately after the summer. But she had bad luck with the draw and was allocated April 2023 as her starting date. “I was in tears when I read that”, she says. “I can be a bit stressed out at times, so I was really at the end of my tether. Who wants to wait more than a year and a half? Travelling is not really an option and I am not interested in doing another master.”

“A Medicine study is already quite long, and after your internships, you’re still not done, “Ké says. Training to become a medical specialist takes at least another four years. “It might be weird to think about it now, but what if you want to start having children or buy a house in a few years’ time?” In the end, she was able to cut down on her waiting time by swapping with another student. She can now start in June 2022. She intends to spend this year doing her master’s research before her internships as well as working for a couple of months.

This article is based on interviews with fourteen medical students, access to correspondence between students and the programme, and official documents about the drawing of lots for internships.

Swap deals

Niek Stege was not so lucky. He had made a complicated swap deal with several students, but a fellow student dropped out at the last minute. He can only start in April 2023. “What the heck, I thought. It really is a bitter pill to swallow that you can only start a year and a half later.” He, too, points out that extra delays with such a long study as Medicine are problematic: “You have to adjust your plans and ambitions, because now you can’t develop yourself further or study at the pace you want. I was also a little older when I started, so I’ll be 25 soon and then all of a sudden, I won’t earn much for two years. Because you can’t work that much next to your internships.”

A lot of bartering is going on because of the extended waiting times. On social media, students even offer money for a more suitable starting date. “Substantial offers are being made”, Niek adds. EM even spoke to a student who is prepared to pay 2,000 euros to be able to start this year. Niek says: “I understand the idea, but I am not going to take part in it out of principle. It creates an unfair situation if students who can afford it can ‘buy’ a better starting date.” Whether students have actually paid for an earlier start date is unknown.

The study programme confirms that the waiting times are long and that it is working on coming up with solutions, especially for the students with a waiting time exceeding 50 weeks. The situation is complex. “We will probably not be able to resolve it completely, but we will be able to alleviate some of the pain.” To date, the programme does not want to respond in more detail, as it wants to inform students first.

A temporary measure is to increase the number of places this academic year. In addition, a compensation scheme is in place for students who have to wait longer than 26 weeks. They are entitled to financial reimbursement from the university’s profiling fund, although this is subject to a number of conditions. For example, students must be enrolled.

Missed out on the draw

Lengthy waiting times for internships have long been a problem at many medical study programmes in the Netherlands. But last year this was exacerbated by the corona period. Master’s degree programmes and internships were mostly suspended for two months at the start of the pandemic. Corona caused delays for students who were already doing their internship, along with a postponement of the draw for the previous academic year, and there were fewer gap years taken.

Before the summer, it was already obvious that there would again be longer waiting times this academic year compared to other years. In April, there is always an extra draw for those students who are following a nominal route. The idea behind this is that they can start their internships as soon as possible to avoid any delay in their studies. However, almost 100 students were told that they had missed out on the draw and as a consequence were unable to start their internships this year. They were not assigned a starting date at all. That had never happened before. They were allowed to participate in the draw again in August, but were not given priority.

Lawyers

One of the students excluded in April is Steven Merkens. He had failed a subject in his bachelor’s study just after the start of the corona crisis. Thanks to the so-called ‘zachte knip’ (soft cut) – a concessionary measure for students whose studies were postponed due to corona, he was able to combine that subject with his master’s research last year so that he could start his internship this academic year. “That soft cut measure was a good thing because it prevented me from postponing my studies. But then all of a sudden, I was not selected in the draw. He describes what followed as ‘a real rollercoaster’.

“After we were not selected, we were told by the study programme that we could not start until the academic year of 2022-2023”, Steven explains. “That would mean I would still be delayed by a year after all and would have no idea where I stood for months on end. I had a big row with the study programme.” This led to a lot of frustration, so much so that he even spoke to lawyers to see if legal action could be taken against the study programme. In the end, he left it as it was ‘because everything is pretty much a done deal’.

“I really feel like I’ve been taken for a ride”, he says. ” That kind of news has a big impact on your life. You start making all sorts of plans and you can’t just change them like that – a rental contract, work arrangements.” Because he was expecting a major study delay, he moved to Amsterdam to live with his girlfriend and work full-time as a doctor’s assistant at a general practice. He sees it as a stroke of luck after having such bad luck. “I really feel that I am contributing something here. But if you had told me this a year ago, I wouldn’t have believed it. Of course, I would have preferred to do my internships now.” As it turns out, he will be starting them next summer.

Bad luck five times in a row

Anna den Broeder was also told that she had not been selected in the draw. She recognises Steven’s frustration. You can specify your preferred starting date at the draw and if you are not selected, you are automatically entered into the draw for the next starting date, she goes on to explain. There are five starting dates per academic year. “My preferred starting date was September 2021, but I was told that I had not been selected at all. So, I had bad luck five times in a row.”

The same thing happened to her flatmate Laura, and together they decided to write a letter to the faculty board, which was signed by dozens of fellow students. “It was very unclear what being eliminated actually meant for us. That led to a lot of frustration for us and our fellow students”, Anna recalls.

Lucky

Illustraties EM magazine illustrator
Image credit: Pauline Wiersema

In response to their letter, the study programme organised an extra information meeting. This cleared up a lot of confusion, but it did not lead to a solution for the students who had been eliminated. The housemates decided to leave it at that. “It was too stressful for us to keep on going”, Anna states.

A temporary solution was found in the end for some of the unsuccessful applicants. The study programme has increased the number of places for internships this academic year. Instead of 72 students, 84 students can enrol every 10 weeks this year. Anna was able to take advantage of this. She got lucky in the August draw and can start in February 2022. She emphasises that although she is very pleased about this, she also sees that long-term solutions are needed. Her flatmate Laura can only start a year later and is therefore going to do an extra master’s degree.

Vijf maanden extra wachttijd door corona

The national advocacy organisation De Geneeskundestudent (The Medical Student) had already warned of substantial delays last year. “These have not yet been caught up and may even have gotten worse”, is the conclusion of the current president Femke van de Zuidwind.

“Waiting times have always been around, but they have skyrocketed since corona”, Van de Zuidwind notes. “We can see that in most study programmes it has led to an additional five months’ waiting time for internships. There are also lengthy waiting times at other UMCs, but Rotterdam is an extreme example. Students have raised this issue several times already. It is disappointing to hear the same old answers again this year.”

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Medical master students encountering major delays in their studies

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Support programme

Van de Zuidwind points out that government funding is available to address delays in medical studies. In the National Education Programme (the emergency support package to counteract the consequences of corona in education), a sum of eight million euros has been reserved for study programmes in dentistry and medicine. That eight million is specifically earmarked for dealing with shortages of work experience placements and internships.

The University of Amsterdam has comparable waiting times, says Van de Zuidwind. She sees that the study programme there has already come up with solutions. “For example, students are given the opportunity to keep their level of knowledge up to date and gain experience in nursing roles.” She also sees creative solutions at Radboud University, where she herself is studying. “There, for example, an extramural care internship has been started, which students can do before starting their other internships.” But what is needed above all, she stresses, is research into bottlenecks and more capacity to resolve the problems in the long term.

Going to Terneuzen every day

The fact that solutions are a lot more complex than creating a few extra places is also apparent to Juliette Mattijsen and Sietske van Till. They were on the Student Council of Erasmus MC last year and had a closer look at the issue. “It is nice for students if they do not have to wait, but the quality of the education has to be good as well. You cannot put too many students in one department, because that does not necessarily improve the quality”, Sietske contends.

Another problem is the proximity of other university hospitals. Leiden in particular is close by, so both UMCs try to place interns at the same hospitals. “There is even some overlap with the VU Amsterdam and Nijmegen. Do we really want students to travel to Terneuzen every day?”

Solutions

“There are departments that have less scope to supervise interns than others. So, we adjust the capacity accordingly”, explains Juliette, who is almost done with her internships. This applies to the ophthalmology, dermatology, and ear, nose and throat departments, for instance. This is also one of the solutions that the Student Council proposed last year. “These internships are very short-term and specialised. It may not be absolutely necessary to do them. Most of what I learned there I will only put into practice when I become an ophthalmologist; some of it I could also have learnt from a GP. Instead, you could choose one of the three specialities, as is the case in Maastricht, or a longer internship in social medicine 2.”

Another idea put forward by the Student Council is to have a more flexible approach to elective internships and social medicine. Juliette comments: “You may not need all the experience from internships to work at the Municipal Health Service.” Moreover, a four-day week instead of a five-day week for interns could provide extra capacity. “Plus, you create a more relaxed atmosphere that way because burn-outs are a big problem among medical students. Or students would have time to study or work alongside their internships.”

They emphasise that long-term solutions are a must. Sietske says: “It also makes sense that with corona, fires are mainly being put out. Extra places were made available last year and that will be the case again this year as well. But this means that the study programme is actually relying on reserve capacity. It is difficult for some departments to supervise so many interns. And despite the extra capacity, there are still students who have to wait two years. Nevertheless, they do trust that the study programme will come up with a plan: “I have the feeling that the study programme is working on it and is looking for solutions because the risk now is that these delays will continue for years.”

  1. A large part of the three-year Medicine master consists of internships (‘coschappen’ in Dutch), also called the foundation programme or clinical rotation. During their master’s medical students work at different hospital departments, to be trained in different fields of medicine. ↩︎
  2. The core task of social medicine is prevention.  Doctors work as company doctors or for insurance agencies, for example, or at the GGD Municipal Health Service ↩︎