Red tape strangling IMG rural supply

A system with too many moving parts is preventing overseas practitioners from alleviating the rural GP shortage.

---

Being able to cut through the red tape that restricts the flow of IMGs into general practice is essential if overseas trained doctors are to enter the rural and remote workforce, one IMG practitioner told a session at last weekend’s GP22 conference.

“If you look at how many medical graduates go into general practice every year as Australian medical graduates, it’s about 1100 or so, while close to 900 IMGs go into general practice every year,” said Dr Alam Yoosuff, a rural generalist GP working in the Finley region of Murrumbidgee local health district.

Dr Yoosuff was speaking on a panel discussing the challenges facing rural health in the next 30 years.

“As much as Australian medical graduates are important in the health system for primary care, the IMGs are equally important,” said Dr Yoosuff, who came to Australia as an IMG in 2006.

“And given that they form that component of the whole workforce, it’s quite questionable whether enough thought has gone into the policy framework and process for recruiting them, onboarding them, and supporting them.

According to Dr Yoosuff, 33% of all Australian doctors got their degree overseas, and 53% of all RACGP members are IMGs. In rural and remote settings, 65% of primary care is provided by health professionals whose first degree is from an overseas country.

Dr Yoosuf said it was important to connect IMGs with high-quality supervisors so they can see the benefits of being able to practise in a rural or remote setting.

But slashing the red tape that currently prevents IMGs from starting to practise in Australia also needs to be prioritised.

“If you look at the IMG recruitment process, you need to do the English exam, then the part one and part two, then you need to find an employer, and then there’s the PESCI process,” he said. “So many parts are controlled by so many different people.

“The locus of control of getting IMGs to be employed in this country, particularly in rural and remote medicine, needs to go to somebody who can keep track of all these spheres, then we will have a much better process.

“As a practice principal, now knowing everything about what it takes to get through this, I can tell you it takes 12 to 14 months to get someone on to a seat. It’s as simple as that. Somebody who doesn’t know how to recruit IMGs would have no way – they would be lost.

The process was cumbersome and a drain on time, energy and finances, he said.

“I think it is time that government, federal and state, and also health workforce agencies, take proactive steps to take that locus of control.”

Due to border closures, IMGs have been unable to join the healthcare system in the past two to three years.

“We’re already nearly 2000 short, and in the next few years – not even the next 30, I’m talking about the next five to 10 years – with the DPA changes, with urgent care centres and urgent care services coming in, we will see rural and remote doctors [relocating] from where they are now to regional centres and ultimately, to call centres,” Dr Yoosuff said.

“Do we have a future focus on how to fix it? I don’t really think so. The need is at the pace of a jet aircraft; we are going at the pace of snail.

“I look at it as the perfect killing the good. Trying to be the most perfect bureaucratic process will actually kill the good.”

Meanwhile, the RACGP said earlier today that a pilot program enabling GP registrars to work in rural and remote communities could be one way in which to boost rural GP numbers.

The government-funded program, launched in August 2022, was designed to place GP registrars in rural and remote locations where there is no on-site supervisor, with registrars supported instead by remote supervisors.

The pilot – which the RACGP said had shown early success – has enabled two registrars to work in locations which would not have been able to host a registrar otherwise, including on Norfolk Island and at an Aboriginal Medical Service in the rural NSW town of Walgett. Each registrar is supported by an offsite supervisor, using phone and videoconferencing to provide teaching and real time assistance when needed.

RACGP senior medical advisor Associate Professor Jill Benson said the pilot was a positive step for both the communities and the registrar’s development.

“We believe that remote supervision is as effective as on-site supervision, and that it is as good for the registrar as it is for the towns,” Professor Benson said. “Remote supervision enables a supported and safe training term in a location that would not normally be available for the registrar, and it provides more opportunities for supervisor engagement than a registrar would normally receive late in their training period.”

The RACGP is planning to roll out the program more widely and identify a further 10 to 20 remote communities that have had difficulty attracting or retaining a GP who could be suitable for remote registrar training.

The pilot will test and refine the RACGP remote supervision guidelines, in the lead-up to the transition to college-led training from 1 February 2023.