Steve Irons (Swan, Liberal Party) Share this | Link to this | Hansard source

This is the third time I have stood to speak on the report on the registration processes and support for overseas trained doctors and it is a pleasure to continue. The committee received many suggestions for increasing efficiency of the registration process. More efficient sharing of information regarding working visas will reduce the stress and difficulty faced by international medical graduates, improving our ability to attract talent to Australia. The committee recommended that the Medical Board of Australia and the Australian Health Practitioner Regulation Agency provide the Australian government Department of Immigration and Citizenship with direct access to information on its registration database to improve this process. As the committee continued its investigations, the need to improve administrative efficiency and reduce duplication for accreditation and registration became apparent. Unnecessary delays of up to two years were reported to the committee. The Western Australian department of health reported the experience of five- to 24-month delays for international medical graduates in starting work in Western Australia. Clearly the lengthy time frames are frustrating for international medical graduates and their families, as well as for the prospective communities in need of their service. Screening processes need to be robust; however, steps need to be taken to reduce duplication and inefficiencies. Many of these inefficiencies arise from poor communication between key organisations involved in assessment, accreditation and registration. A streamlining of the system and more transparency in the processes will help rectify this situation.

The committee believes that there is a need to establish benchmarks for time frames, with regular reporting on performance against these benchmarks. Succinct and clear data should be published on at least a quarterly basis. This will not only assist international medical graduates and prospective employers to understand the average length of time certain processes will take, but also provide key organisations involved in accreditation and registration with an understanding of how their processes impact on the overall time frames.

As part of increasing administrative efficiency, it is proposed that the Medical Board of Australia, the Australian Medical Council and specialist medical colleges publish data against established benchmarks on their websites and in their annual reports on the average length of time taken for international medical graduates to progress through key milestones of the accreditation and registration processes. AHPRA's annual report in respect of the functions carried out by the MBA must also include a number of other key performance indicators, providing further information to international medical graduates. Furthermore, providing computer based information management systems with up-to-date information regarding the requirements and progress of individual international medical graduates' assessments, accreditation and registration status will enable timely provision of advice. Retraining of administrative staff is also suggested.

A further recommendation goes to where an international medical graduate considers the processes prescribed under the national registration and accreditation system to have placed them at a significant disadvantage compared to their circumstances under the processes of the former state and territory medical boards, proposing that the Medical Board of Australia investigate the circumstances and, if necessary, rectify any registration requirements to reduce disadvantage.

We considered the issue of harassment and bullying, with the report finding that it is implicit upon all medical practitioners to act with a high degree of professionalism not only with their patients but also with their colleagues, irrespective of seniority or any perceived advantage. Individuals have the right to work in a fair, supportive and productive workplace. For these reasons, evidence of allegations of workplace bullying was of great concern. The inquiry received evidence regarding allegations of bullying and workplace harassment. Evidence was also received from individuals asserting that some supervisors have experienced instances of harassment as a result of decisions they have made.

The instances of bullying highlighted in the report are a cause for concern. The committee understands that these issues are not confined to IMGs but also extend to others within the medical profession, with surveys reporting approximately 50 per cent of junior doctors having experienced bullying in the workplace. The committee has made a number of recommendations to deal with bullying and harassment. The tabled report calls for the Australian Medical Council, the Medical Board of Australia and the Australian Health Practitioner Regulation Agency to increase awareness of administrative complaints handling and appeal processes available to international medical graduates by prominently displaying on their websites information on complaints handling policies, appeals processes and associated costs.

IMGs and their families need support which extends beyond clinical and professional orientation to also include social and cultural support to help them as they adjust to living and working in Australia. The committee has heard evidence from a range of stakeholders highlighting the importance of initial support and outlining various orientation programs, the features of which vary significantly in relation to the timing of orientation, the duration of the program and the topics covered in that orientation. Providing a structured and targeted orientation program when they are first exposed to the medical system in Australia should better equip international medical graduates to understand the intricacies of the Australian health system and the medical profession.

The Australian Medical Council reported to the committee that the importance of orientation for international medical graduates has been acknowledged by COAG; however, mandatory participation and orientation is not currently required. A program of orientation to be made available to all international medical graduates and their families to assist them with adjusting to living and working in Australia was a key recommendation by the committee. Health Workforce Australia, in consultation with key stakeholders, should offer this program. Detailed information on immigration, accreditation and registration processes, as well as accommodation options, education options for accompanying family members, health and lifestyle information, access to social welfare benefits and services and information about ongoing support programs for the international medical graduates and their families will greatly improve their transition to Australia. Information on Australia's social, cultural, political and religious diversity and an introduction to the Australian healthcare system, including accreditation and registration processes, were also identified as key recommendations.

The committee views clinical and professional orientation, including cultural awareness education and training, as an important component of the introductory support needed to help IMGs adjust to working within the Australian health system and acquire an understanding of the social mores and customs of Australian culture. In the committee's view, the consequences for IMGs, their patients and the wider community if the IMG is not supported appropriately in this way could be considerable. For this reason, the committee believes that such introductory support should include, but not be limited to, information on immigration, with a comprehensive outline of the steps required to gain full medical registration in their chosen field. Such orientation should also include introductory information on the structure and functioning of the Australian health system. Social orientation to be provided to the IMG should include the provision of basic information such as accommodation options, education options for accompanying family members, health and lifestyle information and access to social welfare.

In conclusion I would say that I believe the committee has produced a really worthwhile report. I hope that it will make a real difference to health care in communities in both rural and city areas. However, in the medium to long term we really do need to look at training more medical doctors, and a good place to start is to establish a Curtin medical school in my electorate of Swan. Thank you.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I would like to congratulate the member for Swan on the fine contribution that he has just made to this debate. I know the member for Hasluck will make a similarly fine contribution to the debate when he speaks to this report, Lost in the labyrinth: report on the inquiry into registration processes and support for overseas trained doctors, from the House of Representatives Standing Committee on Health and Ageing. I would like to congratulate the chair of the committee on the role that he played, and the committee staff. For the committee, this was one of those reports where, when we sat down and started looking at the issues, we were overwhelmed by the complexity of the system and by the fact that so many people involved in the system were experiencing problems, be it the person at the management end, the overseas trained doctor coming to Australia or all the associated health facilities and health workers involved in the system.

This was a system that we found was rife with intimidation. It was a fragmented system. It was a system with a lot of duplication. It was moving towards being a national system but I do not think it had quite come to terms with the fact that it is a national system and there are disparities between the states. This system is about maintaining a high standard, but at the same time we need to ensure that the doctors coming to Australia from overseas are looked after. There are communication problems. There is a partisan system. There are issues around training and cultural awareness, the need for better mentoring, hospital based experience, the appeals process and English language. All these issues came up and were identified as problems along the way. I will touch on some of them in a little bit more detail as I continue my contribution to this debate.

As we all know, Australia has one of the best health systems in the world. If you were to read the reports in the media, you would think that we had a system in crisis. All I can say is that you just need to visit a few other places in the world to really appreciate the strength of our health system, the dedication of those people who work in our health system and why it is a system that overseas trained doctors would like to work in. Unfortunately, the system does not always work the way we would like it to when it comes to welcoming overseas trained doctors—or, as I will refer to them for the duration of this speech, 'internationally trained medical graduates', or IMGs, and I am sure the House will know exactly what I mean.

Key themes that emerged throughout our inquiry were that it was a system that lacked efficiency and accountability, one where the IMGs themselves often had little confidence in the way the system operated. They had been subjected to discrimination and, I must say, some of the stories that the committee heard were heartrending. We heard about doctors who had practised in Australia for in excess of 20 years basically being told that they could no longer practise. They had no warning in a system where the rules constantly changed and was full of really poor communication. This was a system where sometimes competitive practices interfered with and had adverse outcomes in relation to where a person was.

We now have a national scheme, which I think is absolutely brilliant. It replaces state and territory schemes. As I mentioned earlier, the state and territory schemes that it is replacing have had difficulty coming to terms with the fact that it is a national scheme. There are so many duplications and the scheme needs to be more efficient than it is at the moment; it needs to provide better information to all parties involved in the system. The duplication in the system really slows it down, and doctors seeking to come to Australia are prevented from doing so or delayed. Sometimes that delay leads to them locating in another country.

First and foremost in a health system is that we have a health system. The next thing we need to look at is that we look after the patients and the workers in the system. We have to create a system that provides security to all those people who are working in the system. We have to provide support to IMGs who come to Australia from overseas. They need support to integrate into the system and they also need mentoring and cultural awareness. They need to understand the way our complex medical system works. Whilst we saw examples of that taking place in some cases, it was very fragmented and it did not always achieve what it set out to. I wholeheartedly support each and every recommendation in this report. It was a unanimous report and it was one that each and every member of that committee contributed to. We were very mindful of the fact that this would be a blueprint—at least, we hope it is a blueprint—for the way IMGs come to Australia and how they are treated when they get here. It is about setting up independent appeal processes as well as making sure that the assessments that IMGs undertake are proper assessments.

I would like to devote the remainder of my contribution to the work based assessments. We saw two very good examples, one in Launceston and one in the Hunter. I have had a little bit to do with the one in the Hunter. It has been phenomenally successful. The graduates that have gone through it have all been successful. The cost of undertaking that course is minimal when you look at the outcomes that are achieved by the participants.

I recently attended a conference that was held in Newcastle, and the chair of the committee, Steve Georganas, the member for Hindmarsh, attended that conference. It further reinforced that the work based assessment model was the best way to integrate IMGs into our system. It provided a system where IMGs were given the support that they needed right from the day they signed up into the program. There was clinical support. They had a mentor that provided them with support for their family and cultural support. They worked alongside qualified physicians and surgeons. They really learned how the system worked and if they had a problem in some area they were able to work on that. The Hunter-New England program at the time we did the report had 49 successful IMGs progress through it. There is a waiting list to get into this program, just as there is a waiting list to get into other programs.

This was a very important inquiry. It was an inquiry that I see as a way forward for IMGs coming to Australia. As a nation we have to be very mindful of the fact that if we did not have IMGs our medical system would not work. So we have to make sure of the safety within our community but we also have to value and provide the support that IMGs need to function in our health system.

Ken Wyatt (Hasluck, Liberal Party) Share this | Link to this | Hansard source

It is good to have the opportunity of rising to speak on the House of Representatives Standing Committee on Health and Ageing Lost in the labyrinth report, which was an inquiry into the registration processes and the support for overseas trained doctors. This report is interesting because it reflects the complex nature of the accreditation and registration processes and the breadth of issues faced by international medical graduates in their personal and professional lives. Each individual who gave evidence brought a different perspective to some of the challenges that they experienced in this total process—from the time of leaving their country of origin to their arrival in Australia and their appointment to a region somewhere within Australia.

I found the evidence provided by the committee both interesting and vexing. The ongoing challenges were not being considered problematic, and the patterns of access and reasons for failure to me seemed evident, but did not appear to be when we questioned those responsible for the processes when they appeared before us. Whilst things have improved, I hope that this report streamlines the way in which IMGs are recognised for their qualifications, their capabilities and their capacities, and the way in which they meet the registration requirements. I think the Commonwealth government agencies need to better coordinate the service they provide and not assume that all is fine in respect of IMGs, who provide an invaluable service to regional and rural Australia.

The other element that I found interesting was the complexity of the issues facing individuals and the way in which they had to fundamentally go it alone at times in challenging some of the considerations by the professional colleges, and certainly by government agencies, in chasing paperwork and the problematic issues of acquiring additional paperwork from their country and university of origin.

Australia has one of the best health systems in the world, delivering high quality health care to the community. The work of the committee reflects the need to ensure that the status quo is maintained. At no stage did we ever want a reduction in the standard that is provided. In fact, at a hearing in Cairns, three witnesses left the hearing. They made a comment about the committee's inquiry and the details that we were seeking. One of them suggested that we were trying to lower the bar. But at no stage did we ever contemplate that. We have an obligation to ensure that the highest quality of care is provided across this country.

The committee does not support any reduction in the high clinical standards expected of our medical practitioners. Australia is reliant on IMGs to address medical practitioner workforce shortages, particularly in the regional, rural and remote communities, where they make up over 40 per cent of the medical workforce. In some jurisdictions it is slightly higher, but on average it is around that level. IMGs indicated, in both the 22 public hearings and the 216 submissions received by the committee, that in their view they do not always receive the same level of support from the institutions and agencies that they interact with.

The aim of the committee's work was to reduce red tape, duplication and the administrative hurdles faced by IMGs, whilst ensuring that Australian standards continued to be rigorously applied. We heard from those who had difficulties meeting the new mandatory registration standards, particularly the standards pertaining to English language proficiency. One IMG shared a story of how they failed because they were not able to express what an Australian colloquial saying was—which I found very interesting to have included. Another told us about when he was asked 'When an Aboriginal grandma brings a child in for medical treatment what is the first question you should ask the patient?' and he had responded by saying you should ask about the condition of the child. He was chastised for not asking, 'Where is the mother?' On that basis, he did not pass that test. The transcripts, if you get the opportunity of reading them, are well worth looking at. They document some of the challenges experienced by highly credentialed people who through a 10-year period served time in rural and remote Australia.

Let me also say that the response from the Medical Board of Australia, the Australian Health Practitioners Registration Agency and the Australian Medical Council was constructive and positive. In fact, when I met with some of them after we released the report, they were very complimentary about the way the committee had looked at the issues but gave recommended actions that were pragmatic, that they could take responsibility for and implement. We were also ensuring that the supporting documentation, which is often a challenge in terms of presenting it to multiple points of registration and multiple points of examination, became easier with one central depository they could go back to.

We also covered in the report the issue of developing a cohesive and comprehensive system of ongoing support for IMGs and their families, with a particular emphasis on the educational needs of their children along with support and employment prospects for the spouses. The committee recommended that Health Workforce Australia in consultation with key stakeholders develop a nationally consistent and streamlined system of education and training support for international medical placements and for the graduates.

The thing that puzzled me in all of this—it still does to some extent and I hope that we do address it—is that it demonstrated that our workforce planning for our population is not our strength as a nation. If the population projection for the next decade takes us from, say, 22.5 million to 27 million, then why are we not forward planning the number of doctors and allied health professionals that we will need, and making available those places within a university? It makes logical sense. I also do not want to see us plunder other nations for their medical practitioners, because that leaves a deficit in their healthcare systems, and I would rather see us have that as a strength.

The number of medical schools needs to be seriously considered, given the time required for doctors to be trained before they can become general practitioners. We assume that a six-year training degree automatically puts a doctor in situ, where they will practice, but in fact it takes 13 years before they are able to practise on their own. So our time lag is significant. I am aware that Curtin University is seeking to establish a school of medicine to increase the number of doctors for Western Australia and, ultimately, Australia. I hope that in the future they are supported in that endeavour.

The other thing that really struck me was our absolute neglect of rural, remote and regional Australia. Time and time again we heard of the IMG's ageing workforce and some of the challenges in getting people out into regional, rural and remote Australia. We have a requirement for those on 457 visas to spend a period of 10 years in regional Australia; but under some circumstances they can return to a capital city—but they have to be mitigating. It is time that all persuasions of governments at all levels give serious consideration to health services in rural Australia and the models of care that are provided. When we consider what is in this report, I think it should be read by every member of this parliament, because it contains a good synopsis of the challenges we face for the workforce of our health system and, in that sense, will help us to position ourselves to be much more strategic in the training and skilling of people. I would hate to see in 10 years time that we have a lack of numbers to fulfil the needs of Australians.

The other thing that is important in the report is those who contribute to the skilling, to the professionalism and to the quality healthcare system that we enjoy and take for granted. On that basis, I commend the report for broader reading and certainly for support in respect of the recommendations. If they are adopted and taken up, then we will see incredible growth in the number of professionals that service this country. We will see the maintenance of a standard and quality of health care that we take for granted.

Geoff Lyons (Bass, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the report compiled by the House of Representatives Standing Committee on Health and Ageing into registration and support processes for overseas-trained doctors, titled Lost in the Labyrinth. I thank the committee secretariat; the chair of the committee, Steve Georganas; my fellow committee members; and all those who made submissions and attended hearings. I thank them for attending the hearing in Launceston. It was the first time the health and ageing committee has been to Launceston. It was an important inquiry and I hope to see improvements in the processes in the future. As I have said in the House many times before, Australia has one of the best healthcare systems in the world. It delivers consistently high-quality care and we have a qualified, trained and skilled workforce—which is a key component to success in the healthcare system—including an adequate number of medical practitioners. Australia has long been reliant on international medical graduates to address medical practitioner workforce shortages, particularly in regional and rural Australia and remote communities, where they make up 40 per cent of the medical workforce.

In view of the continued reliance on IMGs, the challenge is to establish a system which enables suitably qualified and experienced medical practitioners to work in Australia while also protecting the health and wellbeing of the Australian public. It is important that IMGs undergo thorough screening processes to ensure that they meet the professional standards needed to practice medicine in Australia. We also need to ensure that the process is streamlined and transparent. Over the course of the inquiry the committee received 184 submissions from organisations, government authorities and individuals. We heard of the difficulties faced by individuals trying to go through the processes required to practise in Australia, outlining their personal experiences regarding accreditation and/or registration processes. All medical practitioners, regardless of where they have qualified, must meet certain requirements before they are permitted to practise in Australia, as noted in the submission from the Australian government Department of Health and Ageing. These requirements are designed to ensure minimum standards of quality and safety and, in some cases, will result in practitioners operating under a range of conditions, including under supervision and restrictions on area and/or scope of practice.

Although there is clearly a need for a robust system of accreditation and registration with sufficient checks to ensure public safety, some have argued that the regulatory frameworks to be navigated by IMGs are overly complex and their administration is flawed. There have been inquiries held regarding this subject previously, and there is vast room for improvement and transparency in this area. One submission the committee received labelled the system as resembling spaghetti. We heard from many individual stakeholders who consider their own processes to be straightforward but discovered that once all of these processes and steps were combined the system was far more complex. The challenge is for the various committees to appreciate that the individual steps are logical but together they are spaghetti.

As highlighted in section 1 of the report, for IMGs seeking to practise medicine in Australia, dealing with accreditation and registration is part of a wide process. Many IMGs, particularly those applying from overseas, often need to engage with the Australian government Department of Immigration and Citizenship, the Australian government Department of Health and Ageing, state and territory governments, recruitment agencies and potential employers, and the list goes on. This is a long and complex process.

The MBA's English language skills registration standard was highlighted by many who gave evidence before the committee and caused difficulty for some IMGs seeking registration. The committee recommends that the Medical Board of Australia review whether the current English language skills registration standard is appropriate for international graduates.

Our other key recommendations include establishing a one-stop shop to assist IMGs in navigating the accreditation and registration process; a review of the 10-year moratorium requiring IMGs to work in a district of workforce shortage for up to 10 years to be eligible for a Medicare provider number; an increase in the validity period for English language test results from two years to four years when applying for certain forms of medical registration; and the establishment of a central document repository for IMG paperwork, to reduce the duplication and administration inefficiencies.

The practice of taking IMGs, medical graduates from overseas, has been a wonderful success for Australia. I think the answer to the overseas trained doctors issue is quite complex, but we in Australia cannot do without those overseas graduates. There have been some fantastic overseas graduates and some great contributors to the Australian medical system. I know firsthand about the great contributions to Australia that internationally trained doctors have made in my time as business manager at Launceston General Hospital in just about all of the specialties. I do, however, like the committee, believe that the development of self-sufficiency in producing Australian-trained medical personnel should be the target for Australia. I commend this report to the House.

Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

I too commend every member of the committee that put together this important report. With my interest in this policy area, I have had a number of people around the country ask that the parliament take a more detailed look at the area of overseas trained doctors, international medical graduates, and the pathway—often complex—that they have to traverse in order to become a recognised health practitioner in Australia. The context of this discussion is the recent establishment of AHPRA. We know that they have assumed many of the roles that were traditionally performed by independent state medical boards. In the main, there has been some support for a nationally harmonised process to allow overseas applicants to go through a single national process of registration and ultimately be looked after by the same bodies that look after our domestic graduates.

This is also in the context of a much longer period during which Australia, like a number of developed economies, has been unable to provide itself with, and sufficiently train, domestic graduates to fulfil the needs of our health system. That is primarily because we have an extremely advanced health system that remains dependent on its human workforce despite the increasing use of technology in the health system. Health remains a growth area of government spending that is heavily reliant on highly trained individuals. Australia has not been able to provide for its entire population through lags in the system and also historically through the 1990s workforce modelling that incorrectly indicated that we actually did have enough health workforce being trained. In fact, many experts underestimated the number of, in particular, female graduates who would not move into full-time work. So, while the numbers may have appeared to have been satisfactory to a number of observers, in the early 2000s we were short in nursing, medicine and allied health in particular.

Australia has a long tradition of relying on overseas medical graduates coming into a universal healthcare system that is GP focused. That is why Australia's health system is so utterly dependent on IMGs, particularly in the larger and more sparsely populated states of Queensland, Western Australia and the Northern Territory, where more than half of our medical workforce comes from overseas. Setting those ethical issues aside, there has been a longstanding debate over equivalence versus competency—'equivalence' meaning 'Do you have exactly the same degree?' and 'competence' meaning 'Are you able to demonstrate a level of health or clinical performance similar to an Australian graduate?' Slowly, over time, we have been able to make important shifts towards clear equivalence. We require a demonstration of ability, which is effectively competence, but you do not have to have an identical degree to be able to be recognised in Australia. We have shifted away from demanding that overseas graduates have the Australian qualification, the speciality qualification that is identical or comparable, to a recognition that there a number of universities and certainly countries around the world that have equivalent standards and that, for those practitioners, there should be a more streamlined approach.

If there is one thing that comes out of this report for me, it is that we need to be identifying those overseas providers who can be fast-tracked into Australia because of the recognised degrees and qualifications that they hold —in particular, English speaking—and that they can be brought in with a minimum of fuss and delay. There is obviously a cohort who have potentially high levels of qualification but come from countries where the standard of those degrees is more variable. In those cases, I think it is only right and proper that we are extremely detailed in our evaluation of those qualifications and competencies. I think everyone here would agree that in no way should we shift from a belief that quality of care has to be paramount, that we cannot compromise that for any streamlining of the system.

I think it would be wrong to presume that anything that drove this particular report or any of the views of anyone who contributed to it would have supported such a proposition. But significant groups who shape the health system in this country have contributed generously with their submissions. I appreciate that, as I know that the rest of the parliament does, because it is clear that this is an immensely complex area, that there is no simple solution and that you cannot simply treat everyone in exactly the same way. When an applicant comes into the health system, up until recent years they have predominantly done so via a purely paper based application that needed to be checked in depth. It is really good to see a shift now towards a verbal examination and structured interviews, and I think what will ultimately be most effective is workplace based assessment. That has to be at the highest level. This will allow clinical fellows who are experts in their own fields, and who are performing assessments of people coming from overseas, to give fast feedback to minimise the amount of heartbreak, disappointment, time investment or financial investment that comes with not having early feedback on exactly how that person's application is going, and what their likelihood is of success.

It is also important to recognise that when people come from overseas they come, in many cases, as a family. We still have an issue where some of our highest-need areas are also our most remote. They are the areas where it is hardest to supervise an applicant, and where support for family members is most strained. So it is a real shame that we have people arriving on visas who are, in particular, providing health services to the community but cannot get health care for their own children or enrol their children in the local school. I would like to see these sorts of inequities addressed so that we can at least know that there is the social support there for people who are doing the work in the most remote parts of our country.

We have a number of times raised the anomalies between areas of need, districts of workforce shortages and the payments that are calculated through the Australian government geographic classification of remoteness. All of these, at different times, run counter to each other. In my electorate it causes enormous heartbreak in the remote islands off the coast of Queensland, where it is immensely difficult to get a doctor to practise, and where we rely on exemptions to the DWS to maintain the staffing of our medical centres.

There are inconsistencies as you move around the country, and naturally there will always be lines that have to be drawn on the map, but we are finding that these geographic zones could be better designed. There has been a long campaign run by the Rural Doctors Association of Australia to revisit this five-tier classification system that has been introduced by the current government. We think it is too coarse a classification. It may well work for other purposes, but it does not work for the decisions that practitioners make to move into remote parts of Australia. In many cases, giving someone exactly the same payment whether they are working in Central Australia or in a provincial town is quite inequitable.

It is also concerning that the additional payments that are made to people to move into really remote areas are so small; either we are going to fail to attract people in the first place or we are going to have our remote providers burning out and leaving those areas because the incentive to stay is simply not high enough for them to continue. This will continue to cause problems for remote country towns that need a continued medical service provision. If you take that doctor away the pharmacy then collapses and a range of other providers go broke, and it can rip the heart right out of a country town.

It is very important that we keep those numbers high. It is simply not sufficient to quote numbers across broad regional areas and say that there are more doctors in an inner or an outer regional area. These regions cover areas far greater than most countries on the planet. We need to be more specific, and identify towns that are in the electorates—some even belonging to members sitting here in this chamber—that can lose a doctor and have it be an absolutely harrowing situation for the social capital within that community. Retaining a doctor is everything for a number of those communities, and we need to be finding more innovative partnerships where we can partner up large practices in urban areas—and even hospitals—to provide backup to smaller towns. After all, they have the HR back end. They have the nerve centre of HR skills and administrative capacity to be hiring and finding new providers, but many country towns cannot. It is not enough just to hand them a bucket of money and say, 'Go and find yourself a doctor.' It is extremely difficult for them to do it and to keep doing it every year when they lose someone they have only just recruited.

The messages were quite simple in this report. There will not be any magic bullet, but the shift from paper based assessment to PICSE, structured interviews and work based assessment is agreed on both sides of the chamber. We need to be more imaginative in our assessment so that we can streamline and identify those who are capable and, when they are, ensure that they are identified early and allowed to work in a base hospital or a teaching hospital first so that they understand our system before they are thrown out into the remote areas.

The current moratorium has its challenges but , at this point, as long as we can properly supervise new arrivals to our medical and health system then there are elements of the moratorium that are working effectively . T o remove it would significantly compromise large areas of this country. Once again, to those who put this report together, I commend them and the contribution they have made to rural and workforce health policy.

Deborah O'Neill (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

It gives me great pleasure to speak and address this report and the recommendations that we have put forward after what was for me one of the most interesting periods of learning about our health system that I have undergone. Happily, I have been blessed with good health most of the time and my experience, like most Australians my age, is of a fairly seamless system. But the reality is that we have not, particularly given the $1 billion that was pulled out of health under the former health minister, had a very careful planning of our workforce; neither have we had a very careful education of our doctors to a point that they were able to come into our system in a way that responds to the needs that are evident in the seats that we represent.

So I have to acknowledge from the outset the incredible contribution to the public health of this country of international medical graduates who have been coming to us for so many years and contributed to our local communities in incredibly significant and positive ways. That being said, some high-profile cases recently indicate that perhaps the system was not all in good health and that people who should have been picked up as unsuitable for working in our system were overlooked.

I think I can say that it was definitely a bipartisan, unanimous report in the end. Working with my colleagues we all had a sense of great understanding and acceptance of the good work that had been done but also the fact that currently people who were seeking to coming to Australia to work as international medical graduates to support the service delivery that is so vital to our people were actually, literally caught and lost in a labyrinth.

Considering that in regional, remote and rural communities 40 per cent of the medical workforce comes from the supply of international medical graduates, it will give people listening to this debate some idea of how critical this issue is for us. It was a long inquiry and it was held right across the country. There was incredibly moving testimony by people who had managed their way through the system, got out the other side and were now participating. Similarly, there was incredibly moving in a very unhappy way testimony from people who could not negotiate the system. In that sense I think that the words 'lost in the labyrinth' are something that I want to explore.

Firstly, lost in the sense that there was a very uncertain pathway forward for many of these people, who had in quite a number of cases very lengthy periods of successful service as health professionals, as doctors, in their own countries and who came and met a wall of resistance. It is fair to say that the committee was very mindful that excellence in practice was always at the heart of our concern. But with some of the processes that these formerly highly proficient and recently practising medical professionals had been engaged in, they were suddenly completely lost to our service because they were unable to negotiate the kind of paper warfare that they had to undertake to get through the requirements.

We had the testimony of people who are recruiters themselves, investing a huge amount of time in attracting great people with great recommendations and finding that when those people came to approach the system here there were complete disconnects between information received on application and then information that had to be handled and managed here. It was embarrassing to hear that people had provided accurate registrations of their success and completion of studies and that they had done that over and over and were requested on so many occasions to completely resubmit material.

It spoke somewhat to me of the imbalance of power in this structure. The people who are the gatekeepers of the profession are, with best intentions, determined to maintain excellent standards, but, sadly, in a duty-bound, process-bound system of applying and looking at applications, they ended up creating a structure where people who really should have been able to get in, get their paperwork processed, get through and get practising were actually impeded from doing so. So the sense of being lost in the labyrinth was a loss of capability to our system by people who were messed around through Immigration and through different agencies; a loss of the capacity for their talents and skills to be actually used very, very well here. A couple of the recommendations that relate to the problems that arose related to testing, particularly recommendations 22 and 23 in our report. They spoke about problems that we identified with the way in which people were tested. We had quite a degree of testimony from people who were very experienced, who had been operating for 20 years in their profession in some cases, who had to do the equivalent test of a student who was just completing their undergraduate studies. The mismatch between the testing of current practical capacities and old, known, abstract knowledge was something that we were really concerned about, and we have a number of recommendations regarding that.

I think the member for Hasluck has highlighted one of the other very significant concerns that we came across, which was a failure to have proper workforce planning. That was very evident and had resulted in the situation where we have a period where we have been incredibly overdependent on overseas trained doctors. In the testimony that we took, a number of people pointed out that we are, indeed, a very rich country, an economically developed nation, and it is vital that we have the capacity to meet our own medical practitioner workforce needs. It was indicated that the World Health Organisation global code of practice states that member states should meet their own health human resources needs as much as possible.

Sadly, we have had a period of inadequate supply complicated further by a very uneven geographical distribution of our workforce. Our commitment, as a federal Labor government, to increasing the number of training places for doctors to 'grow our own' is actually beginning to have an impact, but even that was pointed out as having some horns on it in terms of how we get the proper training in place for this large number of graduates who are coming through who are home grown.

I was pleased that in our hearings we went right around the country. I know that the member for Bass indicated that it was the first hearing of that kind held in his electorate. We did glean some extremely helpful evidence when we were in Launceston. We also had the opportunity to visit my electorate on the Central Coast.

As the member for Bowman was just pointing out, the definitions of terms such as 'district of workforce shortage' and 'area of need' became problematic. It was evident to us that these were problematic terms. When faced with the cost of recruitment and then the challenge of how that met with current regulations about where a district workforce shortage occurred and where an area of need was determined according to criteria, we found there was incredible misfit in an area such as mine, which is only 1½ hours north of Sydney. We have had a number of local ageing practitioners, some of them overseas trained, who have now retired. With three or four of them retiring, there was, all of a sudden, a drop in the capacity of local practitioners to respond to growing need, which was not being assisted by current definitions of 'district of workforce shortage' and 'area of need'. That was very, very apparent not just in the remote areas, which we could see when we went to the electorate of the member for Parkes. We saw incredible difficulty there, but it was surprising to me how there were difficulties also in areas such as mine that were quite close to cities. It tells us how fine the line is between the number of people that we are training and the capacity that we have to respond to our local communities. I think that the recommendations we have made in this report—all 45 of them—address some of the systemic problems that became increasingly apparent to us as what was described as 'the spaghetti-like nature' of how one might proceed through this system became more and more apparent.

In closing I thank the members of the committee, the members for Swan, Parkes, Shortland, Bass and Hasluck. It has been very much an experience that I will remember as a very positive one in my first major hearing in this place. I also acknowledge the leadership of the member for Hindmarsh, and in particular the work of the secretariat, who were so determined in making sure that we got excellent evidence on which to draw in making these recommendations. I particularly single out Dr Alison Clegg, Mrs Sharon Bryant and Mr Muzammil Ali, who did incredible work for us.

Mark Coulton (Parkes, National Party) Share this | Link to this | Hansard source

I too would just like to add my brief comments on this report, Lost in the labyrinth. I would like to commence where the member for Robertson finished and acknowledge the work of the Standing Committee on Health and Ageing. I have to say that the work that I do on the health and ageing committee is one of the highlights of my time in this place. I acknowledge the fellow members and also the leadership of the member for Hindmarsh and our deputy chair, because we were focusing on issues that cross the political spectrum. They generally cross the city-country divide and generally are far more complex than would originally be seen from the outside.

Let me say at the outset that I think that, when we are dealing with medical professionals and we are looking at the services to provide to the Australian public, we do have to set a standard. We do need to make sure that we screen people who do not have the technical ability, the cultural ability or the language skills to undertake these jobs. This report is not about opening the doors up to anyone that might want to come and practise medicine in Australia, but what it has done is highlight a number of roadblocks that have blocked people not only in the initial stages but also later. I think it was in Brisbane that there was a doctor who was practicing in the Ipswich area who had been in the country since the mid-eighties and at one stage found himself six days from deportation because of a technicality in the paperwork. He had been here close on 30 years practising and had a loyal group of patients in his practice west of Brisbane and was on the verge of being deported.

If there is one thing that I think I would like to highlight in this report, I think the one thing we should take out of it is to straighten out the kinks and put in a genuine road map for people to come through. That is what we found, whether it was medical practitioners that were coming in as general practitioners or others that were highly specialised surgeons, anaesthetists or cardiologists, a whole range of people who were highly specialised in their own country. They came from English-speaking countries, but because of the process in place—I might say because of the self interest of some of the colleges—they were finding incredible hindrances and roadblocks put in place. That is what we need to overcome. We had people coming into this country who were leaders in their field, but those skills were not being utilised in this process.

So there needs to be a genuine pathway. The information needs to be upfront and easy to follow so that as the applicants go through the process there is a clear pathway for them to get through. We found people that had been sidelined in the process, in things like the language test. There are four parts to the language test and, if you failed one of those, you had to redo the test. The next time you did the retest, if you failed another part that you actually passed the first time, that was considered a fail. So we had some people who had been going for this test many, many times, and I would suspect that many people that were actually born and educated in Australia may have trouble with some of the issues in the written part of the test or the comprehension. But they were being blocked. There was quite a bit of inconvenience and cost. Some of the GPs from country areas who would be called in to undertake some of the testing process were given very little time to prepare and were forced to cover large distances, and every time they did not quite make the bar they were up for considerable cost. The point I highlight is that we need a clear pathway. We need to assist these people through the process. We need to make it open and transparent. We need to make sure we do not lower our standards, that we have people coming in who are suitably qualified to practise medicine in this country, and we need to be of assistance. Not only do the government departments have a role to play in this but the colleges also need to enter into the spirit of cooperation, rather than putting up blocks and looking after their own self-interests. Unfortunately, that came through on several occasions during the hearings we were undertaking.

In closing, I support this report. I believe this will be a valuable tool for governments of the future and the present to sort out this problem. The reality is—and the member for Robertson spoke about our young medical graduates coming through from Australian universities—in a large number of cases it is overseas trained doctors who are training these young students, residents and registrars through the system. They are the ones who are overseeing the training process as our own home-grown people come through. Therefore, we need to ensure that we have everything in place to make that as efficient and as painless as possible. I fully endorse the report.

George Christensen (Dawson, National Party) Share this | Link to this | Hansard source

I want to focus in particular on recommendations 25 and 26 of the Lost in the labyrinth report. These refer respectively to district of workforce shortage and area of need. Recommendation 25 is seeking for the department to publish on its website a comprehensive guide outlining how district of workforce shortage status is determined and how it operates to address the issue of workforce shortages in the medical practitioner industry. It goes on to detail how that should be done. Recommendation 26 recommends that the department consult with the states and territories and their respective health departments to agree on a consistent approach to determining area of need status based on agreed criteria.

Putting that to the side for one moment, I turn to my electorate, in which houses the beautiful Whitsundays. It is an area that people want to come to all the time to holiday, and we want to encourage that more and more. There are four private GP surgeries operating in Proserpine and the Whitsundays, Proserpine being a small town right beside the latter. All of these surgeries are at capacity in terms of their patient numbers. I personally know of GPs operating in their surgeries for 10- to 12-hour days, and they are doing that six or seven days a week. They are burning themselves out. At the same time I have local residents in the Whitsundays telling me about the difficulty of getting in to see a doctor.

It is my strong belief that medical services in that area are in crisis, and that is directly related to a shortage of GPs. I know of at least three centres that have in recent times advertised for Australian GPs to come and work in those clinics—all to no avail. In one instance there was repeated advertising from one clinic for a period of over 18 months. During that time—and again I am mentioning the beautiful Whitsundays—they had one respondent, who was sent some information about the place and then withdrew his application. That just shows you the real dilemma that we have attracting home-grown doctors to regional areas.

The other option available to us is to have foreign doctors coming into our regions in need. As long as they are able to get a Medicare provider number allocated to them, everything should be fine, but this is the problem. We have no capacity to get those people in there because there are no more Medicare provider numbers available. I want to quote a couple of local doctors here. One is Dr Michael McFall from the Cannonvale Medical Centre, whom I am in contact with a fair bit about this issue. I could not believe when the other day he phoned me up and said to me that he had seen 50 patients already that day. This is the kind of pressure that our GPs are under. He wrote a letter to me here last year which we tried to do something about. Unfortunately, because of the system, we were not able to. He writes, 'I am a sole general practitioner with a client base in excess of acceptable levels.' The Mackay division of general practice recommendation for a client load is 1,000 patients per practitioner. His client load is 3,300. His medical centre, he says, is struggling to service this workload. He writes: 'I've been trying unsuccessfully to attract a suitable applicant within Australia for the last 18 months. Therefore, I have been forced to seek interested doctors outside of Australia. However, our region is restricted in allocated placements for overseas trained doctors. Although this medical centre is allowed one overseas trained doctor, this process is taking over nine months to fill this position from the initial contact to actually having the doctor on site. Due to this medical centre's high demand and growth, we could justify and easily accommodate an extra doctor. The problem is the processes do not allow it.'

I go on to 121 Medical Centre, also in Cannonvale, and Dr Yehia El-Baky, who is a great local GP. He highlights the issue more. He writes to me: 'Despite the region's obvious attractions, of which its beauty is just one, it is extremely difficult to attract doctors who have trained in Australia to the Whitsundays region. A new locally trained doctor might volunteer to permanently relocate to the Whitsundays only once or twice a year, and for that reason 121 Medical Centre, like many other medical practices in a rural or remote setting, relies on its ability to recruit overseas trained doctors to provide a stable medical practice capable of opening each day.'

I want to quote at length a local newspaper article on what Dr El-Baky said there. The article is from the Whitsunday Coast Guardian, and it says:

There are certain services you just can’t live without. One of them is health.

A Whitsunday doctor - who sees up to 60 patients each day - says the answer to the severe shortage of GPs in regional areas lies in the hands of the federal government. Principal GP at the 121 Medical Centre in Cannonvale, Dr Yehia El-Baky, says it's no longer "humanly possible" to continue working at the rate he and his colleague have been for the past number of years.

"I am not asking for a new doctor, just a replacement after one of my doctors left," says Dr El-Baky who admits he is considering closing his popular practise two days a week because of mounting pressure.

His practice is actually seven days a week, which I know is something that the government tries to promote to have after-hours medical clinic access. The article goes on:

Dr El-Baky says the answer to the doctor shortage right across the nation lies with the federal government's refusal to relax certain laws that allow overseas practitioners to work in Australia.

I do not want to be partisan and I am not going to be, because I understand that those same principles were in place in the former government as well; I have a problem with the regulations we have in place. The article goes on:

"We can't get Australian doctors … even with the $40,000 incentive to live in regional areas, for some reason they just don't want to come here. But overseas, there are fully qualified doctors—

who are actually here in Australia—

working in service stations, shop fronts, waiting for the okay to come to Australia and practise," he said.

"The government tells us we have about 23,000 people in this region who will need to see a GP, but this is not the actual population. We have 600,000 visitors to the region each year and about 10 per cent of those will need to see a doctor during their visit," he said.

I have been trying to work with Dr El-Bakyto find solutions. In the current system it is very, very difficult. We have actually got a petition that we gathered with all of the local clinics. We amassed almost 1,000 signatures to that petition in a very short time, and that is going through the process of coming before the House, which it will in due course.

I could go on and quote statements of support in trying to solve this issue for the Whitsundays from chemists, from the local ambulance service, from the local hospital—all of whom realise that there is a huge problem here. My issue comes down to this: the current structure for district of workforce shortage and area of need goes around where there is the most need, and I understand that, but we are always going to have smaller areas where there is the most need, and when you have areas where there is need but it is a little bit less they are always going to miss out. So in an area like the Whitsundays, where there may be some doctors meeting some sort of quota, there are going to be doctors there that are going to be burning themselves out because the quota is still going to be over and above what we need it to be, which as I detailed before is one to 1,000. We have doctors there working at ratios of one to 3,300 patients.

The only way currently to get through this is the granting of exemptions under the district of workforce shortage measures, and that is like trying to win lotto. So recommendations 25 and 26 out of this report are critical. They probably are a bit broad, to be honest, but I think that when the government looks at them and responds to them I would urge the government to consider relaxing some of those regulations so that we can get doctors into regional centres like the Whitsundays to take the pressure off existing GPs because, if we do not take that pressure off, they are well and truly going to burn themselves out.

Greg Hunt (Flinders, Liberal Party, Shadow Minister for Climate Action, Environment and Heritage) Share this | Link to this | Hansard source

Thank you very much, Deputy Speaker Mitchell, and may I say you are looking resplendent in a courageous combination of lilac and duck egg blue!

Rob Mitchell (McEwen, Australian Labor Party) Share this | Link to this | Hansard source

Flattery will get you everywhere!

Greg Hunt (Flinders, Liberal Party, Shadow Minister for Climate Action, Environment and Heritage) Share this | Link to this | Hansard source

Let me turn to this report from the Standing Committee on Health and Ageing. It is a report which deals ultimately with the issues faced by rural and regional communities in attracting and retaining medical support for their communities. I want to deal with it in the context of the destruction of Warley Hospital on Phillip Island by the current government after it came to power in 2007 and 2008. I want to deal in particular with the destruction, the proposal in response, the let-down which we have just experienced from the government and the way forward. All of Phillip Island is looking for a way forward on long-term health facilities.

Let us address the destruction. Warley Hospital had been in place for over 80 years. Warley Hospital was founded by the people of Phillip Island who had subscribed to it in the early days and who had supported it along the way. It had received significant support from the Kennett government. It was one of very few remaining community hospitals. It was an heir to the bush-nursing tradition. It was a not-for-profit, community based, bush-nursing facility and yet it was allowed to die by the incoming government.

Warley had its challenges but we made a pledge which guaranteed that the hospital would survive. We took to the 2007 election $2½ million and within a month of coming to office this government had walked away from any support whatsoever for Warley Hospital. They deliberately chose to let a rural facility collapse. It was unjustifiable, it was unforgivable, and it will be remedied in time. What is the proposal to remedy it?

We have worked on a four-stage proposal for health services on Phillip Island. It is the community health hub. Stage 1 begins with a GP clinic and stage 2 emerges to include community health services such as dental, physio and occupational therapy. Stage 3 is nursing and hospital-type services such as palliative care, dialysis or consulting rooms and stage 4 is to have this community health hub integrated into the Wonthaggi Hospital as an annex, a satellite, a campus, with the appropriate facilities. It will not do everything, of course, but it would be a permanent facility. That is our task, our commitment and our responsibility to work to that end.

It will not be the stand-alone independent community hospital that Warley once was. Sadly, the destruction wrought by the current government will be almost impossible to mend, but we have a four-stage plan built by the community, designed by the community, which will take the legacy of over $1 million from the Warley Hospital Trust. It would also integrate federal funding and state funding. We will just work until we get there.

The disappointment is that the federal government had led the community to believe that they would receive funding as compensation for the failure to support Warley Hospital in the budget released two weeks ago. The community had sought this and hopes were raised. They were short-listed and the impression was that everything had been done properly and that it was merely a formality. Yet, when the moment came, the money was missing. The hospital vision was, again, postponed. There was not $1 million, not $100,000, not $10,000, not $1,000 and not even $1. That is a cruel neglect of, arguably, Victoria's premier regional tourism destination.

What we see are inadequate health facilities and inadequate medical facilities, all because the government failed to match and to respond to a critical need which could have had bipartisan support. It already had a pledge from the coalition. It already had a funding commitment. Yet that money was taken away by the incoming government with the destruction of a rural hospital which had been in place for 80 years.

Where do we go from here now that not only was the Warley Hospital taken away but the community health hub, which was indicated as coming, was not funded? Well, we keep going. We have our four-stage plan and we will fight for that. On our side we committed $2.5 million at the last two elections to the people of Phillip Island towards that hospital with the four-stage plan, and we will renew that commitment. We have had it confirmed internally that there will be $2.5 million. We will add that to the Warley Hospital funding and we will, hopefully, add it to funding from the state. Therefore, we can have a permanent facility which is about rebuilding medical, health and hospital facilities on Phillip Island.

Very briefly, what occurred was unforgiveable. What has transpired since is merely negligence. What will happen in the future is that the people of Phillip Island will be successful in rebuilding their medical facilities, their health facilities, and we will simply not stop until there is an integration into the broader Wonthaggi Hospital system.

Dan Tehan (Wannon, Liberal Party) Share this | Link to this | Hansard source

I rise tonight to support the report by the Standing Committee on Health and Ageing inquiring into registration processes and support for overseas trained doctors. I do so because it is of particular relevance to my electorate of Wannon. As a matter of fact, one of the best submissions which was presented to this inquiry came from the Western District Health Services. It goes to the nub of this issue, and that is that more and more in regional and rural areas we are relying on overseas trained specialists and GPs to support the provision of medical and surgical services.

There are two ways to address this problem and, hopefully, we can address the first by making sure that we get our Australian doctors trained more and more in regional and rural areas. There is no question that if we want to make sure that we have doctors for regional and rural areas, the best way we can do that is by training them out in regional and rural areas.

Deakin University have started that process in my electorate at their campus in Warrnambool, and they are doing an excellent job. We need to see more of that occurring across the country, because that should be the primary way we address this issue. I hope that it will be, and I hope that we will see a coalition policy which goes to the heart of this issue and continues what was started under the Howard government in this regard.

Alan Griffin (Bruce, Australian Labor Party) Share this | Link to this | Hansard source

Any coalition policy would be good!

Dan Tehan (Wannon, Liberal Party) Share this | Link to this | Hansard source

Absolutely—all coalition policies are good and in particular this one will be a beauty. I have full confidence that Peter Dutton will deliver—

Alan Griffin (Bruce, Australian Labor Party) Share this | Link to this | Hansard source

Name one of them!

Dan Tehan (Wannon, Liberal Party) Share this | Link to this | Hansard source

I have just named it, the one that started the medical school in Warrnambool. It means that we will start to see Australian doctors having trained in regional and rural areas wanting to provide the services out in those communities. That is what we want to see.

In the meantime, we have to ensure that those services can continue, and we are becoming more and more reliant on overseas trained specialists and GPs to do this work. What does that mean? It means that those overseas trained doctors and specialists have to have a proper pathway into Australia. We need a pathway which can be relied on, a pathway which is consistent, which has consistent time frames and which requires consistent regulation with regard to the information that is provided so that we can ensure that our communities—and it is often the smaller communities—have that critical mass of GPs and specialists to enable the health services to continue.

I referred to the excellent submission by the Western District Health Services to this inquiry, and I want to quote from their submission. In the report they also quoted from the Western District Health Services and I think it is important that we once again state on the record what the problem is. The submission says:

The recruitment of overseas trained Specialists in particular is extremely complex and complicated and requires Western District Health Service to engage the services of recruitment agencies which is a costly exercise in itself.

Despite the use of experienced and well credentialed recruitment agencies our experience in the recruitment of overseas Specialists is one of extreme frustration, extreme delays (in one instance nearly 2 years) which often results in the potential Specialist giving up on pursuing an offer of employment. Unfortunately this often appears as a deliberate strategy by the respective College.

This is a very serious point. What is occurring here is that applications by overseas doctors and specialists to get in and work in areas where these services cannot get local doctors or specialists to do the work seem to have been obstructed or had delaying tactics used so that these professionals end up going to other countries to do this vital work. We have to ensure that this issue is taken seriously because once you lose the critical mass of the specialists and the GPs you can often see services unwind to such an extent that they can no longer provide those important services to these rural and regional communities. The submission goes on:

Western District Health Service fully appreciates and supports a robust process to ensure that Specialists are appropriately skilled to provide a high quality service that we are accustomed to in Australia.

They understand that we have to meet high standards. That is not at issue here. We want the high standards met. We want to know that consumers of health services in regional and rural areas understand that the people looking after them have the required skills and the required studies to do so. That is not at issue here. What is at issue is making sure that, when overseas specialists and GPs apply, the pathway is one where the applications can be dealt with appropriately and within appropriate time constraints. The submission goes on:

It is often not understood by the Australian Medical Council and the respective Colleges that in regional and rural areas one Specialist vacancy can make all the difference in terms of providing a sustainable on call roster system for the provision of emergency medical and surgical services. Delays of 12 months and more in the recruitment process are just not acceptable. It is not only costly, but also places regional and rural communities at great risk in terms of providing medical and surgical services in an emergency situation.

I think that goes to the crux of the matter. It is very interesting that that was picked up in this report and it is important that it has been. People understand that the complexity and the time delays make it more and more difficult to get these much needed GPs and specialists into Australia to provide these services. The Western District Health Service submission concludes by saying:

Therefore our system for processing OTD's—

overseas trained doctors—

need a major overhaul and restructure to:

1. Provide better coordination and integration of the processes and procedures.

2. Streamline and simplify the entire process.

3. Ensure that an OTD who is compliant is able to be dealt with within a 6-9 months period.

4. Ensure there is a clear and transparent process.

5. Provide financial support to health organisations who require OTD's to ensure their communities have access to an appropriate and safe range of services.

6. Establish a single assessment/registration process and simplified procedure whilst maintaining a robust process to ensure safety and quality.

7. Establish a pathway between the OTD assessment and registration process and immigration.

As I have mentioned, I am glad to see that this report has picked that up. I am also glad that the shadow minister for health and ageing, the Hon. Peter Dutton, has recognised this as well. The submission of the Western District Health Service was of such merit that I made sure that I provided a copy to the shadow minister.

In his letter back to me he said: 'As mentioned in my previous correspondence addressing the maldistribution of the health and medical workforce is a policy priority for the coalition. In particular, the coalition remains committed to improving access in rural and regional areas to the increasing number of Australian medical graduates as a result of the increase in number of medical schools under the previous coalition government,' which is a point I made at the start. 'As part of our policy review process the coalition will examine issues relating to the registration and recruitment of overseas trained doctors including the recent findings of the House of Representatives Standing Committee on Health and Ageing.' I congratulate the shadow minister for acknowledging these two areas of concern and in committing the coalition to make sure that under a coalition government—and I think the majority of Australians are now hoping that that is what will occur at the next election—we will be able to implement these two key policy priorities.

Michael McCormack (Riverina, National Party) Share this | Link to this | Hansard source

The first recommendation by the House of Representatives Standing Committee on Health and Ageing Lost in the labyrinth report on the inquiry into registration processes and support for overseas trained doctors goes to the very core of this most important issue. The seven-member committee firstly recommended that the Australian Medical Council, in consultation with the Medical Board of Australia and international medical graduates, take steps to assist IMGs having problems and delays with primary source verification. This would include continuing to help IMGs who have passed all requirements of a pathway towards registration as a medical practitioner, excepting primary source of verification; liaising with the Educational Commission for Foreign Medical Graduates to ascertain and address any obstacles to gaining timely primary source verification; and giving IMGs the latest information relevant to their application including the anticipated time frame for response based on their application, or options as to how they could speed up the process such as contacting the institution directly. This was one of 45 recommendations by a committee which wants the best outcomes for rural and regional health.

I know and appreciate the commitment of the committee to the promotion and welfare of country health. Two of the committee's representatives in particular have a deep sense of purpose and passion for and on behalf of those who live beyond the coastal fringe and who expect, and rightly deserve, the same health delivery as people in metropolitan areas. I refer to my coalition colleagues the members for Hasluck and Parkes, who both for many years have campaigned for improved access to medical services for the regions. Their actions are admirable.

Prior to entering parliament, the member for Hasluck served as a senior public servant in the fields of Aboriginal health and education in New South Wales and Western Australia. The member for Parkes represents almost a third of the land mass of New South Wales, a huge area with many hospitals, many multipurpose health facilities, and many challenges. For the member for Parkes, the sheer distance between health outposts is understandably a major factor. Getting specialists, general practitioners and allied health professionals to the far-flung parts of the state's far north is something for which Mark Coulton has continually and loudly lobbied, both in his capacity as Mayor of Gwydir Shire Council for three years and, since 2007, as local federal member. So I commend the members for Hasluck and Parkes and the other five on this lower house standing committee for their efforts to improve regional health. It needs all the help it can get. As experienced rural GP and obstetrician Dr Maxine Percival observed only recently at a function in this very building:

If rural practice was a patient, I would say that its condition would be critical.

The situation is critical and it is fair to say that, but for IMGs, it would be far worse for regional areas.

I would like to quote from an article in last week's The Land in a supplement entitled Rural Health 2012. Dr Paul Mara has for almost 28 years run a busy practice with his wife in Gundagai in my electorate of Riverina. He and his wife, Virginia Wrice, have also been founders of the Rural Doctors Association of Australia, an organisation of which Dr Mara is the president. In the article he said:

There are not enough doctors in the bush. Basically what a lot of communities have done is taken on the idea that it's about having a doctor. Any doctor.

And the headline on this article was 'A doctor, any doctor won't fix GP crisis', and that is so true. Dr Mara went on:

Whereas, at the association level what we are looking at is how we can improve the quality of service delivery through improved training for doctors to better meet the needs of communities.

And that is regional communities. He continued:

And there is no doubt in my mind that federal government policy has put us in this situation.

We have got a lot of doctors from overseas, many of whom are not fully qualified and many of whom don't really want to be in the bush. And we see that as being a key problem.

He is right, of course. Dr Mara went on:

So at the association level we have looked at a training program which we hope will be rolled out nationally to provide doctors from Australia or overseas with the skills and expertise they need to practise in the bush.

That program would be modelled on the Queensland Rural Generalist Pathway and would be aimed at ensuring all GPs working in the bush, whether trained locally or overseas, have the wide range of skills and knowledge needed to provide high-quality service, the best-quality service, to rural communities, communities which need and deserve that sort of quality health care. Quoting Dr Mara again:

You can't have it both ways, you can't say we can just get a doctor from overseas and plug him into a country town and, on the other hand, say we want to have high-quality care.

To be a rural doctor you need to do 10 years of training. You can do a six- or four-year medical degree in Australia.

The four-year medical degree involves undergraduate degrees as well.

And then we (RDAA) are saying you probably need (another) three to five years (training) after that is to have the skills to meet the special needs of (rural) communities.

And rural communities do have special health needs. They are different in some ways to metropolitan areas. We do not have the same sort of wide range of specialists available—obstetrics is not available in many areas. So they are special areas and they are certainly challenging places.

Those extra skills short cover areas such as obstetrics, anaesthetics, surgery, emergency medicine, advanced training in paediatrics, indigenous health, acute mental health, geriatrics and palliative care, Dr Mara says.

"All of those things require a higher level of training (in the bush) than what you might necessarily need if you are a metropolitan GP."

Dr Mara also gave evidence to the inquiry which produced this report, Lost in the labyrinth. On 31 May he gave evidence at a public hearing here in Canberra, in which he said:

I think the key thing to state is that there is an ongoing medical workforce crisis in the country. The policy of importation of overseas-trained doctors is not really solving that problem. When I first did the research I alluded to, we said that there were about 1,000 doctors needed in the bush. Since then, we have imported from overseas literally hundreds of doctors, yet the situation is still much the same at the present time. So the policy of importing overseas-trained doctors is not solving the situation, but that does not mean we are opposed to having doctors from overseas working in the country so long as those doctors have access to the highest quality education, training, support and supervision if they need it and they and their families are not discriminated against. The association is clearly opposed to the moratorium (1) because we believe it does not work and (2) it imposes hardship on those doctors out there and makes them prone to manipulation and exploitation by different groups.

… … …

In regard to the issue [of] assessing these doctors, we have a position that, in their variety, the colleges should be ensuring that these doctors have the same capacity, skills and qualifications as Australian trained doctors; however, there needs to be some flexibility around assessment procedures, particularly for doctors who have been working in the bush for a number of years and have clearly been performing adequately, but are at risk now of deregistration.

Finally, in Wagga Wagga, there are concerted moves afoot at the moment to bring about a rural medical school for the city. Money—$20 million—has been provided for building such a facility in Port Macquarie, which, like Wagga, has a rural clinical school. That would be an ideal fit for New South Wales. If we had a rural medical school in Port Macquarie and also one in Wagga Wagga, we would have one in the north and one in the south.

As the member for Wannon just proclaimed loudly and passionately: we need more Australian trained doctors, particularly Australian trained doctors gaining their skills in the bush, in regional areas. That is the desirable outcome. A very hard-working group of clinicians, former member for Riverina Kay Hull, state member for Wagga Wagga Daryl Maguire and myself are working hard at achieving that very outcome. Hopefully, with federal government support in the future, that will become a reality, because it would be a great thing for Wagga to have a rural medical school to take that additional step from the rural clinical school that it has now. Working in conjunction with the University of New South Wales and possibly Charles Sturt University, both of which have very good form on the board as far as these sorts of things are concerned, it would be a desirable outcome and would certainly provide well-trained medical professionals in the bush, because let me tell you, Madam Deputy Speaker, that is exactly what we need to meet many of the challenges that regional health is confronted with.

Debate adjourned.