6 December 2017

Why the College wants to stem OTDs


The RACGP is pointing to a growing glut of GPs in big cities to back its call for an immediate stop to visas for overseas-trained doctors to work in areas of need.  

In a new submission to government, the College says it is “vital for the continuity and stability” of Australia’s medical workforce to remove GPs immediately from the list of skilled occupations for immigrants.  

It says the number of overseas-trained GPs practising in major cities has jumped by 150% since 2000-01, far exceeding 20% growth in the number of Australian-trained GPs.  

Moreover, overseas-trained doctors (OTDs) now account for 49% of FSE GPs in the major metropolitan areas. 

The bulge in metro areas reflects the large numbers who make their way to the cities after fulfilling their obligations to work in rural and remote parts of the country, the College says. 

Under the skilled migration policy, Australia takes about 500 to 600 OTDs each year to serve up to 10 years in areas of workforce shortage before they can practice without restrictions.  

“Medical workforce issues in Australia are no longer a matter of supply, rather a matter of maldistribution,” the RACGP submission says.  

“Together with removing general practitioners (from the skilled occupations list) alternative measures and pathways for Australian-trained doctors to fill workforce gaps need to be developed.” 

But leading rural doctors say an abrupt cut in the supply of overseas-trained GPs would be yet another health policy blunder. 

“We don’t endorse the immediate cessation of visas for international medical graduates,” Dr Adam Coltzau, President of the Rural Doctors Association of Australia, said. 

“We have improved a lot in terms of our selection and training (of rural doctors) and the growth of rural clinical schools, but these things have a delayed effect, and there is still a lot of work to do. 

Dr Coltzau, a Queensland GP, noted that the recently appointed National Rural Health Commissioner Paul Worley had yet to begin work on developing a national rural generalist training pathway to address the workforce imbalance.  

The RACGP’s submission makes no mention of the rural generalist model championed by ACRRM to produce multi-skilled doctors to meet a broad range of medical needs in rural communities.  

But it notes “significant growth” in Australian-trained GPs in rural and remote areas in the years  ACRRM has promoted the approach defined in the Cairns Consensus statement. 

“This is specifically the case for very remote areas, where the growth of Australian-trained GPs has exceeded that of overseas-trained GPs,” it says. 

Indeed, Department of Health figures show GPs trained in Australia or New Zealand rose to a FSE of 88 in “very remote” areas in 2016-17, up from 42 a decade earlier, while OTDs grew to 44 from 32.  

But the same set of statistics shows reliance on overseas-trained doctors remains heavy across the board.  

In outer regional areas, for example, locally trained GPs accounted for a FSE of 817, up from 665 in 2006-07, while OTDs accounted for 1196, more than double the rate of 570 recorded 10 years earlier.

“Importing doctors from overseas was never a comprehensive workforce solution for rural and remote Australia,” former RDAA leader Dr Paul Mara said.  

“It can be argued (the policy) simply delayed the implementation of policies that work to get the right doctor with the right skills into the right towns under a model that meets the needs of communities.” 

Doctor-immigration policy should reflect general immigration policies and “not act as a vehicle to get politicians and others off the hook for lazy policy”, he said.