We need IMGs, but their countries do too

Rapid solutions to the GP crisis are paramount, but can we ethically encourage immigration to fill the gap?

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As a national GP deficit looms, overseas-trained doctors are more essential than ever – but the ethics must be carefully considered and it isn’t the ultimate solution, says GPRA President Dr Karyn Matterson.

Following the release of the Kruk report – an interim report from an independent review commissioned by the national cabinet into regulations around health practitioners – at the end of April, there has been chatter from all sides about the problems it’s solving, and those it’s not.

In a release published last week GPRA encouraged speedy implementation of the recommendations highlighting the need for immediate actions such as fast-tracking IMGs from countries with similar regulatory systems – suggestions made by senior public servant Robyn Kruk in the report – to remove barriers for IMGs already in the system.

Accordingly, health ministers from across the country met last week and agreed to roll out core recommendations from the Kruk report related to improving Australia’s pull for IMGs. These will be rolled out by the Health Workforce Taskforce in collaboration with Ms Kruk.

But the report left some wanting.

“While the Kruk Interim Report address the ‘in-house’ difficulties in our IMG system, our wish is that the federal government elevate the conversation to include ethical attraction and support once migrant doctors arrive in Australia,” said Dr Matterson.

GPRA registrar liaison Dr Muhammad Raza expressed concern over the cost of training and lack of support IMGs face, and recommended reducing costs, upping support and broadening training pathways to encourage immigration of medical graduates – a move he said would benefit the health of all Australians.

But Dr Matterson brought attention to the ethical considerations medical leaders face in the recruitment of IMGs, particularly “medical brain drain”.

This refers to the self-determined emigration – often from developing countries – of healthcare professionals in search of better standard of living, quality of life, better salaries and/or stability, which potentially saps the source countries of doctors.

“What has been referred to as the ‘medical brain drain’ is in fact a delicate balancing act of allowing migrant doctors freedom of movement and the autonomy to choose their own destiny to the highest extent possible whilst not disadvantaging their source country,” Dr Matterson told The Medical Republic.

Possible solutions may include public health funding from Australia to the migrant doctor’s source country or establishing exchange programs where doctors are encouraged to return to their source countries to provide care, Dr Matterson said to TMR.

She cited Dr Ajay Rane as one example of a doctor chosen by their country of origin to be educated in Australia then returning home to train and share their skills.

“We do need to be cautious in determining elements of the ‘train and sustain’ models and who they are applied to, as many of our migrant doctors come from NZ, UK, Ireland or even parts of India which are not considered developing areas but still may be doctor resource poor,” she said.

Once in Australia, ethical recruitment is also important in fostering trust among IMG candidates emphasised Dr Matterson.

She suggested designating accredited recruitment agencies to ensure ethical negotiation and registration of employment contracts as well as calling for, at minimum, parity of supervision for local and overseas medical graduates, ideally including additional support in integrating into Australian communities for IMGs.

“Paramount to self-determination are peak bodies such as GPRA and GPSA to support migrant doctors. In this current climate, the independence of doctors and the value of their lived experience, training and education is critical to ensuring that our professionalism does not become one homogenous, monotone voiceless group lacking diversity, curiosity and innovation,” she said.

GPRA also called for a shake-up of the speciality training system, for Australian medical graduates (AMGs) and IMGs alike.

“GPRA would call for a supplement to support base rate parity between GP registrars and non-GP registrars to ensure that GP registrars – both AMG and IMGs – attain the equity desired within the medical workforce landscape. Both this and portability of benefits are essential to create a sustainable GP specialty training continuum,” she said.

Dr Matterson said the focus should really be reducing our reliance on a migrant workforce, in line with clause 3.6 of the WHO Code.

“Australia’s recruitment and retention strategies would go a large way to be solved by recognising the value of the speciality of general practice and implementing base rate parity policy to ensure that doctors in GP training receive the same base rate as their counterparts in other non-GP specialty training programs,” she said. “This can be done immediately and would represent a tangible, positive step forward in improving attraction to the specialty of GP.”