13 December 2017

Rural doctors question tough stance on OTDs


Leading rural doctors have slammed the RACGP’s call for an immediate halt to new visas for overseas-trained doctors to work in areas of need, saying it shows the College is out of touch with the challenge of providing healthcare in the bush.

In a new submission to government, the RACGP 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.

Dr Adam Coltzau, the new President of the Rural Doctors Association of Australia, said the proposal was “preposterous” at a time when efforts to build a viable rural medical workforce were still in their infancy.

“International medical graduates have formed the backbone of rural medical workforce for many years,” he said, adding that these doctors who had settled in Australian cities after doing their time in areas of workforce shortage would rightly feel offended by the suggestion that they were unwelcome.

The RACGP submission warns of a growing glut of GPs in big cities as large numbers of overseas-trained doctors make their way to urban centres after meeting their obligations under the so-called 10-year moratorium.

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, it says. Moreover, these doctors now account for 49% of FSE GPs in the major metropolitan areas.

Under the skilled migration policy, Australia accepts about 500 to 650 overseas-trained doctors each year to serve up to 10 years in areas of workforce shortage before they can practice without restrictions.

“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,” the College says.

But despite the swelling numbers of Australian-trained graduates, respected rural doctors say an abrupt cut in the supply of overseas-trained GPs would be yet another health policy blunder.

Dr Ewen McPhee, the RDAA’s immediate past president, said the suggestion was “extremely premature”.

A change in the visa arrangements would affect thousands of overseas-trained doctors classed as “other medical practitioners” who were “keeping the place afloat” in rural and remote Australia.

“This is why we need to be working with (new National Rural Health Commissioner) Paul Worley and creating a national rural generalist pathway to address these issues in a reasonable and professional manner.”

Initiatives such as Queensland’s rural generalist program and ACRRM’s research work had clearly demonstrated the way forward, “but it’s going to take a long time”, he said.

The RACGP’s submission makes no mention of the rural generalist model championed by ACRRM.  It notes “significant growth” in Australian-trained GPs in rural and remote areas during the years ACRRM has promoted the generalist approach defined in the Cairns Consensus statement of 2013.

“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 FSE of 88 in “very remote” areas in 2016-17, up from 42 a decade earlier, while overseas-trained doctors grew to 44 from 32.

But the statistics show 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 overseas-trained doctors 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.

“All doctors who have not yet achieved vocational registration, that is, fellowship of the RACGP or ACRRM, should only be permitted to work in an accredited teaching practice with an experienced and supportive supervisor or under the Remote Vocational Training Scheme,” Dr Mara said.