RACGP moves to axe IMG rural moratorium

Facing a workforce crisis, the college has released a set of proposed actions to keep Australia attractive for overseas docs.

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The requirement for international medical graduates to work remotely for up to a decade could become a thing of the past, at least for some, after the latest review into regulatory settings on overseas trained doctors.

In a submission to public servant Robyn Kruk’s Independent Review of Overseas Health Practitioner Regulatory Settings, the RACGP made several suggestions aimed at simplifying the registration and transition process for IMGs.

Some are more controversial than others.

On the more radical end is the proposal to remove geographic practice restrictions for IMGs who have already done fellowship training, an option which the college points out was missing from Ms Kruk’s interim report.

The suggested class exemption to the 10-year moratorium would allow doctors in metropolitan areas to apply for a provider number concurrently with taking college assessments.

This would represent further change to the 19AB exemption/distribution priority area (DPA) system that has long forced internationally trained doctors to work in rural areas for up to a decade.

Until about a year ago, the system worked to push incoming doctors out into the most remote parts of Australia.

“These are doctors who’ve already qualified as GPs [to our standards], and at the moment one of the biggest barriers for those doctors coming into Australia is being told where they have to go,” RACGP president Dr Nicole Higgins told The Medical Republic.

International graduates who need to do some form of Australian-based training program would continue to be subject to workforce requirements.

A change to the way DPA areas were calculated by the Labor government meant that it effectively expanded the program to large regional centres and even some underserved areas of major cities.

The result was an almost immediate drain of doctors from small rural towns.

ACRRM and the Rural Doctor’s Association of Australia have criticised the policy change in the past.

While ACRRM doesn’t necessarily support forcing internationally trained doctors into the regions, it has said the policy change resulted in “perverse” consequences.

Another potentially radical suggestion from the RACGP in its submission to the Kruk report was to offer all internationally trained doctors permanent residency in Australia from the outset.

Among other things, this would make them eligible to enter the Australian General Practice Training program.

The college said this will provide IMGs with “high-quality training in general practice increasing their likelihood of passing RACGP exams and becoming specialist GPs”.

The potentially more palatable RACGP suggestions include simplifying comparability assessments by removing the mandate for RACGP applicants to write 10 clinical case analyses and demonstrate that they have 50 hours of Australian-standard CPD under their belt.

It also moved to axe the requirement that IMGs write a reflective essay upon starting work in Australia.

“It’s important that we ensure that they’re safe to work and they’ve got a supervision and support, but we just lay so many hurdles in front of [overseas trained doctors],” Dr Higgins said.

“And we need to think about what’s going to make a difference and what’s not … making sure that the assessments that we do are practical.”

Both the RACGP and ACRRM rejected the interim report’s proposal to move the responsibility for conducting comparability assessments – i.e. working out whether a given doctor will require additional training to meet Australian standards – from the colleges to the Australian Medical Council.

“This [review] is being driven by workforce [concerns] … the states are pushing to ensure that they maintain workforce, because what’s happened is that some of the hospitals have lost accreditation throughout Australia,” Dr Higgins said.

“This has impacted on their ability to deliver services and we don’t want general practice caught up in that discussion.

“We want to make sure that we still can control our own workforce, and make sure that the doctors and the patients are safe.”

Dr Higgins pointed out that Dr Jayant Patel, who was eventually tried for the unlawful killing of three patients at the Bundaberg Base Hospital, had entered the Australian system at a time when specialist colleges were not conducting comparability assessments.

Unlike the rural college, however, the RACGP did not touch on its role as a provider of the pre-employment structured clinical interview (PESCI) exam in its submission.

The final report from the Kruk review is expected to drop in the coming months.