I've been in full swing at Adelaide for at least 5 weeks now. I've split my time between research and the palliative care service, and tomorrow I am starting on the medicine service.

The most valuable aspect thus far has been that I have gained a much greater appreciation for another health care system. Australians both publicly and privately fund health care. Everyone has access through the public system, but those who earn a certain income have tax incentives to obtain private insurance. General internists act as specialists, caring for more complex patients with general practictioners doing all of the preventative management. In addition, the palliative care physicians use their hospice unit as an acute care unit. The palliative care physicians admit people to manage their symptoms, with the expectation that they will be discharged home with better functional status.

At a time when we as Americans are initiating changes to our health system, it has been good to learn about and experience care delivery here. For me, this rotation has served as a real-time immersion in comparative health systems. Though there may be starker contrasts between the United States and resource poor nations, anyone interested in health policy in the United States would benefit from coming to Australia. Australia tackles similar problems, including health inequities between minority and majority populations, battles between state and federal control of health policy, and the balance between tertiary and primary care.

Brooke Cunningham, an Internal Medicine Resident at Duke, trained at Flinders Medical Center in Adelaide during her senior year.