WA News News & Reports IMGs for the Bush
IMGs for the Bush
Written by Jan Hallam
Friday, 30 September 2016

A few weeks ago, The Australian newspaper released an unpublished Health Department submission to the Government’s review of Immigration’s Skilled Occupation List (SOL) – and 41 health jobs were on the hitlist to chop, among them GPs, resident medical officers, surgeons and anaesthetists.
The cuts were supported by the AMA and the Rural Doctors Association of Australia. The RACGP had made a similar call back in May. Their arguments were based on the increased number of local medical graduates finding it difficult to secure training places and internships.
However, the CEO of WA’s largest rural recruiter, Rural Health West, has cautioned against any hasty decision to halt the supply of IMGs until effective strategies were in place to attract and retain Australian-trained graduates to rural and remote locations.
CEO Tim Shackleton said while recent strategies to draw Australian graduates into these areas was proving successful, Rural Health West was currently seeking candidates for 90 GP vacancies in rural and remote locations across the State – the highest number of vacancies on record.
“This high number of vacancies and the significant proportion of IMGs working in rural WA demonstrates that, at present, the increased number of locally-trained medical graduates are not yet making their way to more rural and remote locations,” Mr Shackleton said.
Don’t underestimate IMGs
“The contribution of IMGs to the rural WA medical workforce should not be understated.”
201610-RHW-GraphsThe most recent census of WA’s rural general practice workforce (as of 30 November 2015) showed that of the 897 GPs working bush, 493 (55%) had obtained their basic medical qualification overseas and that proportion had not changed much since 2008.
Last year, a report from Rural Health West showed that the largest proportion of IMGs had gained their basic medical qualification in the UK (19.5%); followed by Pakistan (8.5%) and Nigeria (7.3%).
“While the UK continues to be a significant source of new GPs, the proportion of doctors who initially trained there is declining annually (19.5% in 2015 compared to 25.6% in 2012),” the report said.
Medical Observer opened a comment line on the issue of the SOL and, of the 320 respondees, two thirds wanted a stop to IMGs coming to Australia. The arguments ranged from the need to give the increasing number of local graduates a job to stopping what some described as poor-calibre IMG candidates practising in Australia.
Are standards sufficient?
Criticism of the clinical standards of some IMGs has continually dogged all overseas-trained doctors, for why, if you read the Medical Board’s criteria, it’s difficult to understand. It is rigorous, however, the perceptions prevail. Rural Health West requires recruits to have a minimum of three years’ experience after graduation (the MBA, two years).
Medical Forum spoke to one rural GP who believed that “most of the overseas-trained doctors I could think of were probably not as well suited as perhaps Australian graduates might be” to rural practice. He said that in some instances an IMG’s poor English skills were a barrier to clear communication with patients as well as body language and cultural difference creating a “mismatch” in some rural communities.
However, he was also critical of the apparent lack of interest by Australian graduates in obtaining rural practice experience.
Locals lack of interest
“International students are the ones keen to do a four-week rotation in the country. They seem much more prepared to come and see what it’s all about out here. Australian students just seem to want to stay in the city.”
More GP registrars, recruited by WAGPET, are heading to the bush – in 2015, 25 who completed their specialist training through the RACGP or ACCRM, elected to take up positions in rural WA, the highest ever.
However, as MF reported last year, federal funds for the vocational GP training program dried up as of December 2015. Perhaps the government needs to review that decision in the light of the evidence.

While communication is one thing, investigation of notifications is another. We believe good doctors want the bad ones weeded out but they don’t want to be part of a witch hunt or get buried in lawyers, politics or paperwork.

The national Medical Board can respond to a complaint or act on the advice of the WA Medical Board to establish an assessment panel to either examine the health or performance and professional standards of a doctor. Health consumers are represented on panels along with medical practitioners.

The Medical Board and AHPRA have undisclosed lists of doctors who are approved by them as panellists and probably as expert witnesses. Many of these people, we believe, were ‘grandfathered’ across when National Law first came in (2010). Their impartiality is as unknown as they are. Then we have expected biases of the legal assessors, chosen by AHPRA, possibly thrown into the mix.

Is there a problem, Houston?

It is important this is sorted to everyone’s satisfaction as 42% of doctors in our survey thought panellists could lack impartiality to a serious extent.

In fact, only one quarter of doctors we surveyed (n=195) were happy with the impartiality shown by AHPRA or the Medical Board in processing a complaint (with 36% unhappy and 39% undecided). Nearly all of those who were unhappy said they were concerned that unfairness will be seriously damaging to someone. Investigation is a very confronting experience.

If someone is being investigated by a panel, either the panel or the person being investigated can opt for a more out-in-the-open State Administrative Tribunal (SAT) judicial hearing – the panel usually refers because it feels the evidence before it constitutes more serious professional misconduct.

What Fair Doctors Want

Talking to doctors, they appear to want an apolitical system of investigation that is fair and timely. They want to be treated reasonably. Unlike the legal profession, their work is mostly built around trust and honesty. They do not want a return to the ‘good old days’ where those with a political bent in the medical profession could influence what the Medical Board did.

While this is a very difficult area for us to investigate, with arguments and counter-arguments at every step, we cannot understand why the Medical Board would turn to arguably the most political organisation, the AMA, for its counsel (the national Board Chair met earlier this year with “senior leaders from AHPRA and representatives of the AMA” to workshop doctor complaints).

Why? Our e-Poll responses raise a question mark over the AMA’s involvement (and we don’t think AMA members have been polled on this issue.)

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