In the absence of Dr Zhivago-style conscription, more doctors won’t solve the more pressing workforce issue of distribution.
Representatives of the Australian Medical Council and the Department of Health and Aged care entered the “lion’s den” at this weekend’s AMA24 conference to discuss the contentious fast-tracked registration pathway for overseas-trained doctors.
Last December, an independent review of Australia’s regulation of internationally trained doctors, known as the Kruk report, was endorsed by the national cabinet.
Among its 28 recommendations was a push to introduce or expand expedited pathways to registration for professions of acknowledged shortage.
The Medical Board has proposed a pathway – the announcement of which took the colleges by surprise – that would see medical graduates with “substantially equivalent” overseas qualifications fast-tracked for specialist registration through the AMC, rather than through a medical college.
Speaking at AMA24, chair of the AMC advisory committee for the implementation of the new pathway Dr Susan O’Dwyer said the pathway was awaiting finalisation by the Medical Board and will then seek approval by health ministers.
If approved, the pathway would be available to specialists in four areas identified as most in need: general practice, anesthesia, obstetrics and gynecology and psychiatry.
But all hope for the colleges is not lost.
Dr O’Dwyer said that the AMC was encouraging colleges to consider expedited pathways of their own, which could run in parallel to allow registration and fellowship to be pursued concurrently.
The fast-track pathway will require doctors to have a CPD home, which will potentially prompt some to join specialist colleges.
If implemented, there will be three pathways to specialist registration: the current fellowship pathway through the colleges, the relevant qualification pathway – this is the current comparability pathway – and the new expedited pathway.
Delegates were unconvinced.
“AHPRA running a brand-new expedited specialist pathway, unfortunately, doesn’t fill me with a whole lot of confidence given that the standard pathway, frankly, is a disaster,” said Dr Ian Kamerman, chair of Council of Rural Doctors and AMA federal council member.
“AHPRA’s processes are extremely slow.
“At some stages, I’d say they don’t treat the doctors that are paying for the services as customers, they look down upon them, that’s my experience as a supervisor and then employer of these [overseas trained] doctors.
“How can we have confidence that AHPRA is going to be able to do this when it’s got such difficulty at the moment looking at the existing processes for bringing doctors into Australian registration from overseas?”
Dr O’Dwyer responded by saying that this process is particularly simplified.
“Some of the issue with the standard pathway is progressing from general registration to specialist registration,” she said.
“And the other thing is, we’re going to have a single committee in Australia that will deal with all [the expedited applications].”
After thanking the speakers, particularly the bureaucrats among them, for their bravery in “walking into a lions den”, one delegate questioned the link between getting more doctors into the country and getting them to the right places.
“Any of you who’ve been to the UK recently know that the NHS is about to fall over, what is our moral obligation in stealing their doctors under these circumstances?” they said.
Without returning to the days of Dr Zhivago, with allocated working zones based on post codes or birthdays, more doctors wouldn’t solve the problem, said another delegate.
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RANZCOG vice president Dr Nisha Khot questioned why we expected IMGs – with limited support systems and a sparse cultural understanding of Australia – to provide the bulk of the rural and regional care.
“We put [IMGs] in places where they’re really vulnerable – little places, regional places, rural places – and we say to them, ‘you have a 10-year moratorium’,” she said.
“That, to me, seems unfair right from the start.
“We are all Australians here, we all have a responsibility towards every other Australian who needs health care.
“Whether we do that by date of birth, or surname, or whatever it is that we do, but to me it seems extremely unfair that IMGs are expected to bear the burden of looking after people in rural and regional Australia for 10 years.”
Without college oversight, it may also be harder to ensure positive culture, added Dr Khot.
“Things like bullying, discrimination and harassment – in the ladder of colleges, our college sits pretty high as being a problem place for trainees,” she said.
DoHAC health workforce senior medical advisor Associate Professor Susan Wearne, an IMG herself, said this emphasised the need for a national workforce strategy.
Divisional director at of mental health services at Northern Health and past president of the college of psychiatrists Dr Vinay Lakra said we were on the wrong path to solving the workforce problem.
“We will never have enough doctors as long as we keep our focus on numbers and how the work is done and billing,” he told the delegation.
Recommendation 13 of the Kruk report, which threatened to remove the comparability assessment of qualifications entirely from the colleges to the AMC if timelines weren’t met, also caused contention.
Delegate Professor John Wilson said the attempt to “rattle the cages of the colleges” wouldn’t serve the community.
“The problems that the colleges have had in honoring the progress of IMG accreditation can’t be [performed] any better by a single national committee … particularly when the evaluators and the people doing the assessments are all sitting in this room here and are all pro bono,” he said.
Dr O’Dwyer reiterated that the single national committee would only cover the fast-tracked pathway, while the majority of IMGs will still go through the existing pathways.
She was unsure how many overseas-trained doctors would take up the fast-track pathway.
The pathway is expected to be implemented by October for general practice, with the other three specialties joining before December.
