Coming to Australia...

There have been a couple of articles in the local paper (1, 2, 3) recently about the difficulties facing doctors trained overseas wanting to work in Australia. Undeniably, Australia does depend heavily on recruiting doctors from overseas, and the issues discussed are therefore important ones.

For a clear and rational discussion of medical migration, the issues do need to be separated out somewhat...

Firstly lets look at this pesky moratorium. Under the 10 year moratorium rule, overseas trained doctors or foreign graduates of accredited medical schools who either gained residency or were first registered with an Australian medical board in 1997 or later must work in an area of workforce shortage for at least 10 years. What this basically means is that doctors who are allowed to migrate to Australia in order to address our workforce shortages (which is what skilled migration is about I guess) are obliged to work in those areas where the workforce shortages are at their worst. As a general principle, this does not sound unreasonable and I don't have a problem with the moratorium as such.

In the spirit of informed consent, it is important that the moratorium is clearly explained to applicants before they start the application process. If the Australian Governments own website, DoctorConnect - which supposedly disseminates information for doctors thinking about coming to Australia - is anything to go by, the informed consent process may not be all it is cracked up to be. I mean... "OTDs and FGAMS who are subject to section 19AB are generally required to work in a DWS for a minimum period of 10 years"... I know about the moratorium and I find that hard to understand...

The requirement to pass knowledge and skills assessments as well as English language assessments before being able to work surely cannot be argued with. Our medical schools may not be perfect, but we do have reasonably high standards which the Australian people rightfully expect. In spite of the arguments about Australia being a nation of migrants where many people speak other languages, and how the English language limitations should not be a barrier to working as a doctor in Australia, Australia is an English speaking nation. The majority of the population (and therefore the patient group) speaks English, and English is the language that our laws and formal communications use, and the colleagues that we need to communicate with will mostly use English. The necessity of requiring overseas trained doctors to pass threshold assessments is self evident.

The key thing that makes it difficult for doctors trained overseas to work in Australia is the sheer and utter complexity of the migration system for doctors. I did try to search through the regulations for the different types of visas that can be applied for by doctors and found at least 5. Each different type of visa has different requirements, and the medical registration requirements can vary also. If a doctor's circumstances change, he/she may need to change the type of visa that they come in under, which may or may not in turn change the registration requirements.

To put things simply:

• If Australia is allowing overseas trained doctors in to address workforce shortages under a skilled migration process, then it is surely reasonable to ask the applicants to work in the areas of greatest workforce shortages. 
• If we wish to maintain standards, then there has to be an assessment process for the skills and knowledge of doctors applying to work in Australia. 
• English language skills are important. 
• The migration system as it relates to medical migration is overly complex and lacks transparency.

not enough jobs for junior docs (part 4) ...and yet more Medical Schools...

"CURTIN, Charles Sturt and the University of South Australia will press ahead with their plans to create new medical schools."

In the midst of concerns about intern positions for medical graduates, 3 universities have announced their intent to move forward with plans for more medical schools (and more medical students). Australia is apparently not training enough doctors.

It is undeniable that there is a shortage in the medical workforce, especially in rural areas. However, the bottleneck in training is not at the medical school level. In order to produce doctors that are able to work independently and service areas of medical workforce disadvantage we need to create the supervised junior and training positions to provide vocational training.

Without adequate resourcing of junior medical positions, including indemnity (which is potentially a barrier for moving training into the private sector), and adequate resourcing of the time needed from senior doctors to provide the supervision that junior doctors require, bumping up the number of medical graduates does very little to improve workforce shortages. It makes absolutely no sense to increase the number of medical schools and thereby increase the number of medical students, until the issue of adequate supervised junior positions and vocational training is resolved.

Senior medical folk associated with the universities need to seriously consider wisdom of creating new medical schools at this point in time. If the unit you work in is unable to accommodate any more junior doctor positions (due to funding or availability of adequate supervision) then the rationale for increasing the number of medical graduates is probably difficult to justify.

not enough jobs for junior docs (part 3)

This week, The Australian again reported on the lack of intern places for medical graduates. It is encouraging to see that the various interested parties (students, deans of medical schools, professional organisations) are starting to reach some level of agreement about what needs to happen. Now if only the people who make the decisions will listen...

Creating intern positions involves more than just putting aside money to pay their salaries. Medical interns are just out of university - they have a fair amount of book learning but don't actually have the context with which to use this knowledge safely. They need a hell of a lot of supervision. In order to have interns working safely, there needs to be training and infrastructure to support the senior doctors providing supervision, money to pay for supervisors' time, and adequate senior staffing levels so that supervisors can provide adequate oversight. I haven't heard any murmurings of this happening any time soon.