House debates

Monday, 18 October 2010

Private Members’ Business

Overseas Trained Doctors

6:29 pm

Photo of Bruce ScottBruce Scott (Maranoa, National Party) Share this | Hansard source

The reason I have brought this issue to the attention of the House is that it has been causing great distress for a number of doctors in my electorate of Maranoa and I know across many parts of Australia, particularly in Queensland. My LNP colleague the member for Leichhardt, Warren Entsch, who is seconder of this motion will talk further about the particular case in Cairns in his electorate. But, for now, I will talk generally about the need to ensure that we provide our international medical graduates with the support they need to serve our rural communities. There is much concern that the current process to assess the competency of overseas trained doctors is discriminatory and that the process to approve registration for these doctors lacks transparency. Five years ago, the Australian Competition and Consumer Commission published a report into its review of Australia’s specialist medical colleges. The purpose of this review was to investigate whether Australia’s colleges were upholding the principles of transparency, accountability and stakeholder participation, and whether there was evidence of restrictive trade practices. The report of the ACCC mentions that the authority had received complaints about medical colleges and the perceived lack of transparency in their assessment processes. The report made recommendations to improve transparency and the provision of more information on how competency assessment decisions are made. Many of Australia’s colleges have moved to improve their practices. It has now been five years since that report was published and I think it is timely to conduct a parliamentary inquiry into the assessment practices of Australia’s medical colleges so that we can see what has been improved and what needs further improvement, particularly in relation to transparency.

Another complaint that has been brought to my attention is the inappropriate use of the pre-employment structured clinical interview, the PESCI, in assessing the competency of overseas trained doctors. Recent decisions made by COAG mean that the goalposts have changed and doctors who want to practice in Australia are asked to undertake the PESCI. However, there are complaints that the PESCI was never intended to be a pass or fail test of competency per se but, instead, was simply meant to be used to identify weaknesses and lack of knowledge in some areas and to identify areas needing improvement. However, there have been reports that some doctors are finding that they are passing their college clinical exams but failing the PESCI, which is administered by the Medical Board of Australia and a relatively new organisation, the Australian Health Practitioner Regulation Agency—AHPRA, which came into effect in July of this year.

For many doctors the goalposts have suddenly and dramatically changed. A recent example was the Queensland doctor from Lowood in the Lockyer Valley who was deregistered after failing his PESCI. He had been practising for six years and from the email I received over the weekend from one of his patients he is well-liked and well-respected. The decision is going to court so let us hope some common sense prevails. I also read in the Courier Mail last month of the New Zealand born nurse who has been refused her nursing registration because she must prove that she can speak English competently, despite being born in New Zealand and undertaking her diploma in nursing at a Gold Coast college. In this case, it seems that the bureaucracy has just gone mad and unfortunately it is impacting the supply of much-needed doctors and nurses, particularly in rural and regional communities.

I acknowledge that there is a lot of fear in some areas, particularly in Queensland, that has arisen from the tragic situation in relation to the Dr Jayant Patel bungle. We must find the balance between ensuring our registration processes and competency assessments are rigorous and ensuring our medical fraternity can provide the necessary support for competent overseas trained doctors to stay in Australia, and in particular work in our rural and regional areas. It should not be a case of one rotten apple ruining the whole barrel of apples. Another issue with the current problem of assessing overseas trained doctors is that the current visa process is not flexible enough to allow doctors to stay in the country while they appeal decisions that they believe are wrong. One such example includes an ophthalmologist on the Gold Coast who was originally given just 28 days after his registration was revoked to leave the country. Thankfully, he was granted a reprieve and his visa has been temporarily extended. But his future treating his patients on the Gold Coast is still very much in limbo.

I acknowledge that there has been a significant increase in the number of medical students currently being trained so that in the future we can meet the demand of Australia’s health needs, but it will be another decade at least before the supply will match demand. Until then, international medical graduates are vital in filling gaps. Even when we are turning out more doctors from our own universities, how many of these new graduates will want to move out of the cities and live and work in rural and remote Australia? Many constituents in my electorate of Maranoa rely on overseas trained doctors to provide medical treatment. Many of them are fully embraced by the community and they have become important members of the community. Like many Australian trained doctors in regional and rural areas, they work long hours and go above and beyond to help their patients. They are certainly treasured and we need more of them.

Sadly, however, in some communities in my electorate they cannot even get a doctor. Recently the Aramac community learned the sad news that their hospital would be downgraded to a primary healthcare centre after the community was unable, through Queensland Health, to secure a permanent doctor. When the people of Aramac learned the news, they were getting ready to celebrate the hospital’s centenary. The health minister for Queensland expects that the people of Aramac will now travel to Barcaldine, which is some 70 kilometres away, for their health needs. Yet, just three days after the minister announced the downgrading of the hospital to a primary healthcare unit—without consultation with the community, might I add—the road from Aramac to Barcaldine was cut off by flooding, which is the third time it has happened this year.

Unfortunately, issues like this are endemic in rural Australia. We do need more doctors in rural and regional communities. We need more support for our rural and regional hospitals. That is why I am calling for this inquiry. There needs to be a fairer go for doctors trained overseas so that we can get them to come out into rural and regional areas of Australia and practise where we know we have a massive and critical shortage. I know many Australian doctors. I understand why they train at university and obtain their degree. They are not encouraged to go out into rural areas of Australia. I understand that. I do not know why they do not like our rural communities but I understand that for so many reasons it is becoming difficult to attract Australian trained doctors to our rural communities.

I invite the Minister for Health and Ageing to give us the opportunity to conduct a parliamentary inquiry, as this motion calls for. The health needs of our communities right across Australia are an important issue. I have mentioned the Gold Coast, I have mentioned the Lockyer Valley and I have mentioned Cairns. I have also mentioned the lack of a hospital in the very remote community of Aramac in my electorate. Can I just say to the Prime Minister that if she is really serious about regional issues, as she said she was when she was sworn in and spoke about the need to focus this government on regional issues: here is an issue of regional and rural health. I call on the minister to give us this inquiry. I also say to the health minister that if she came to Aramac she would be made most welcome. I will make sure that I am there to welcome her. I think we can do a lot with this hospital. I think that if we are able to get a multipurpose health service that would fit Aramac it will be a model that we can use in other parts of Australia. Currently the multipurpose health service criteria mean you have to have a full-time doctor. Let us try to find a way to get a model to fit this community, because one size does not fit all.

I look forward to the minister’s response and I look forward to other contributions. This is an important issue. It is about the health of rural and regional Australia. It is about overseas trained doctors, who are a vital part of our health needs in Australia. I look forward to the support of this parliament.


Steven Knowles
Posted on 10 Feb 2012 10:13 pm

As a Queensland resident and Managing Partner of YOU Global, a global recruitment company with an interest in sourcing human medical resources globally for supply to the Australian medical sector, there are several issues which I feel need a good look at by the politicians who have the power to make some changes:

1. If Australia has an appetite for overseas quality medical specialists due to a shortage in homegrown supply, even if to combat brain drain, why on earth do we have a scenario whereby an overseas specialist must pay around AUD 8,000 to the relevant medical College, even before the specialist will be assessed? This is crazy. Australia should be doing all in its power to attract such talent. Telling an interested specialist "first pay AUD 8,000 and only THEN shall we confirm whether you can work in Austraila" is discouraging to say the least.

I do understand that the Colleges are privately run institutions which have financial bottom lines to consider, but the answer to the Colleges' bottom lines, and the shortage of specialists in Australia, is not to impose an application fee on the specialists we desperately need. The public purse should be funding the costs incurred by the Colleges. Or perhaps the incoming specialist be obliged to pay back the cost but only once gainfully employed within Australia. There are a range of solutions, but charging a non refundable assessment fee of such a large amount is not the answer. That cost is just the start - the Candidate then has to fund airfares for face-to-face interviews, accommodation, lost opportunity in terms of time away from work, visas, and a whole range of ancillary expenses.

Quite different if Australia has other options, but my understanding is that we desperately need the resources.

2. Australia has charged the Australian Medical Council (AMC) with the task of preliminary assessment of International Medical Graduates (IMGs) via the AMC's Computer Adaptive Test (CAT) Multiple Choice Questionnaire (MCQ). If an IMG passes the MCQ, this effectively gives the IMG license to apply for Medical Board registration, and then apply for a visa into Australia.

The reality is, Australia has LOTS of IMGs who have been down this path, passed the MCQ, have obtained Australian residency, but cannot get a job, even in regional areas, despite Australia screaming out for doctors.

Australia has in a way encouraged IMGs to jump through the many hoops which it throws up, to incur the many expenses, and at the end of the race, the IMG can't get a job. It's almost a case of misleading & deceptive conduct.

I've given plenty of thought as to why this ludicrous situation exists. It seems to be about the rules and regulations surrounding employment of an IMG. Despite the AMC stating, by virtue of an MCQ being passed, that an IMG is considered technically proficient to practice medicine within Australia, albeit on a supervised basis, the onus on the employer is so extensive that employers steer clear of limited-registration IMGs. I have a situation right now whereby a Queesnland practice, in an Area of Need mind you, cannot employ an IMG because it lacks sufficient resources to meet the supervisory requirements laid down by AHPRA.

There are surely more effective ways to put these IMGs to good use, give them the jobs that they want, without bottlenecking the process by imposing impossible requirements on the employer.

3. Here's another example of a system which is marred by head-scratching outcomes.

We had an Australian-resident IMG who had taken the trouble of not only passing the AMC MCQ, but under advice had gone to the extent of passing the Clinical Examination as well. The was BEFORE finding a job, presumably because he thought that going that extra mile would improve his prospects.

We had a vacancy, within a Queensland Area of Need, for which the IMG was considered suitable by the prospective employer. However, because the IMG had passed the Clinical Examination, he had inadvertently struck out his ability to be granted limited registration via AHPRA. Therefore he could not be employed. No explanation from AHPRA, that's just the way it is. In other words, an Area of Need in regional Queensland goes without because the doctor has overachieved in his attempts to secure employment.

By passing the Clinical Examination, this doctor had unknowingly restricted himself to being employed initially only by hospitals on a 12-month rotational basis. He had decreased his prospects of employment by gaining further education. How does that make Australia look on the world map?

4. Quite simply, there are way too many fingers in the pie, none with the authority to solve problems, for the Australian health system to effectively and efficiently take in IMGs to solve the undersupply of medical professionals.

Let's see, who has a say in the overall process? There's the AMC (which at times I can't even get through to), ACRRM (charged with undertaking PESCIs), the various Colleges some with both national and State committees, the Medical Board, AHPRA, State health departments, federal health authorities (Medicare and the issue of provider numbers), and the Department of Immigration. I've probably missed some.

Sure, Austraila needs to protect itself from rogue doctors, but surely we're missing out on quality talent because of the Mt Everest-scale challenges we put up for doctors to consider coming to Australia to work. Australia places the onus on the IMG to navigate his or her way through this complex (and expensive!) landscape. These guys are medical specialists, and most IMGs work much longer hours in their home country than the working hours we're accustomed to in Australia, even by your average Australian doctor's standards. Only the most tenacious IMG will have the energy to make it all the way through, and therefore much-needed medical talent never makes it to Australia.

If Austraila has an inability to come up with a system which substantially reduces the red tape and bureaucracy, which reduces costs and timeframes, then let Australia suffer its own inadequacies. Don't impose these shortcomings onto the talent which Austraila needs. As an easy first step towards solving the problem, Australia needs a single point of contact for an IMG. The IMGs should not have to interact with the AMC, employers, ACRMM (for PESCI), medical Colleges, AHPRA, the Department of Immigration, Medicare, and maybe others, when he or she may not have even stepped foot in the country. We need to promote seamless integration.

5. The costs of the whole process is prohibitive enough, but another thing. Free cross-platform video conferencing, such as Skype, is omnipresent in the world today, and has been for some years.

Why does Australia make IMGs run off to a costly video conferencing centre, in order to access expensive and proprietary video conferencing equipment, just for a 90-minute PESCI? Not only does the IMG incur cost in the home country, but we make the IMG pay for the rent of the video conferencing facility at the Australian end. This is plainly unnecessary, and is testament to the lack of high level smart project management that has gone into creation of the current mess represented by the process of an IMG securing employment in Australia.

Steven Knowles
BCom (Bkg & Fin), JP(Qual), F Fin
Managing Partner
YOU Global