Much to the chagrin of the medical colleges, the health ministers have moved ahead with a fast-tracked registration program for overseas-trained specialist doctors.
More detail on AHPRA’s fast-track registration is finally here, just under one week before its official launch – but the RACGP reckons the regulator still hasn’t given enough information.
Under the controversial new pathway, GPs who have already fellowed in Ireland, New Zealand or the United Kingdom will be able to go straight to the Medical Board of Australia for registration and bypass the college assessment process.
According to an advance copy of the new specialist registration standard, these doctors will automatically be granted specialist GP status – i.e. vocationally registered – by AHPRA.
Anyone with that status is eligible to bill vocationally registered GP rebates.
Specifically, Irish doctors need to have gained membership of the Irish College of General Practitioners from 2009 onward, as well as a Certificate of Satisfactory Completion of Specialist Training.
New Zealand doctors need to have fellowship of the Royal New Zealand College of General Practitioners from 2012 onward.
UK doctors need to have membership of the Royal College of General Practitioners from 2007 and a Certificate of Completion of Training.
International medical graduates who have not fellowed in their country of origin or who have fellowed in any specialty besides general practice still need to go through Australian medical college assessments.
This will change slightly in the future, with the fast-track pathway set to open to selected anaesthetics, psychiatry and obstetrics and gynaecology fellows from December.
Once the specialist doctors are registered, they will have six months of compulsory supervision from an Australian-registered specialist, as well as mandatory cultural safety training.
There are also transition arrangements in place for doctors who are currently on a college-based specialist pathway who are eligible for the expedited pathway.
AHPRA also confirmed that a national medical board committee made up of doctors and community members would make all registration decisions about individuals on the expedited pathway.
This was the extent of the new information, with the program to open on Monday 21 October.
“Our concern is that it’s been so rushed and we don’t have any detail about how [individuals] will be assessed and how these doctors will be supported and supervised,” RACGP president Dr Nicole Higgins told The Medical Republic.
While the UK, Ireland and New Zealand are culturally similar to Australia, she said, there are major differences to the healthcare systems.
“These doctors may have had very different medical education because of where they trained,” said Dr Higgins.
“Our systems of Medicare and the PBS are very different, and then also our context in rural and regional Australia is also quite different.
“We want to make sure that these doctors and their families are supported when they come into the country, but also make sure that they’re safe for our patients and they’ve got the right skills for the community.”
Because CPD requirements have been uncoupled from college membership, there is no mandatory reason for these doctors to join Australian specialist medical colleges.
Because they have specialist status, they also won’t necessarily be incentivised to join a college in order to get access to higher rebates.
Dr Higgins said that the college had found that around one in five doctors coming in from substantially comparable countries still needed extra support and supervision around communication, knowledge and professionalism.
“We still don’t know the mechanisms or how AHPRA is going to catch these doctors and provide that extra support,” she said.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Dr Higgins said, have also been at pains to point out that UK-trained obstetricians are not trained in colposcopy or instrumental forceps delivery, which doesn’t make sense for an Australian context.
The RACGP isn’t the only aggrieved party in this: both the anaesthetics college and the Council of Presidents of Medical Colleges have called for an immediate pause on the rollout of the pathway.
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Speaking today, CPMC chair Associate Professor Sanjay Jeganathan said the expedited pathway would not address Australia’s workforce maldistribution or how to retain doctors in the long term.
“Bringing in overseas doctors faster won’t solve our problems if we don’t send them where they’re needed most,” he said.
“We need a plan that fills the gaps in our healthcare system and ensures rural Australians don’t have to make long journeys for basic specialist care.
“We also need to know exactly how this plan will work to ensure it’s safe and effective.”
Instead of a fast-track pathway, Professor Jeganathan suggested stronger incentives for overseas-trained doctors to work in areas of shortage, tailored approaches for each specialty and clearer information on how AHPRA will select and supervise doctors.
Ultimately, he said, bringing in more doctors faster will not solve Australia’s biggest problems.
