CHARLES WOOLEY: Every time we talk health in the bush, the phone screen lights up.

One of those calls was from Wynyard on the northwest coast of Tasmania, and the caller told me that she thought her doctor was on the verge of being shipped out of town. He was an Englishman. He'd achieved the hearty old age of 50 or something, and I didn't quite understand; nor did she. So we said we'd find out about it.

Now there's another case in central Victoria where another GP looks like being exported, because he didn't come up to scratch on his exams.

I did want to know more, so let's talk with the man who knows everything medical - the Australian Medical Association boss Mukesh Haikerwal. Hello, Mukesh.

DR HAIKERWAL: Hi, Charles Wooley. How are you?

CHARLES WOOLEY: Now what is the story about? Have you heard - I mean, I can't expect you to know about the bloke in Cygnet; but is - in Cygnet; in Wynyard - but is that a possibility, that he's a 50 year old immigrant who suddenly either runs out of visa or years or something, and has to go?

DR HAIKERWAL: Yeah, Charles, it's hard to say, as to what reasons people have for having to leave. If it's a visa problem, then obviously the visa's a problem.

If it's not, and if it's not about getting exams - and some people come in on the basis that they will reach a certain standard and pass an exam in order to - then that's another issue.

But a general issue is one that's sort of was reflected upon- I've just come in to Canberra from Mildura. I was in northwest Victoria yesterday in Mildura, and the same situation occurs around there, and other places around the country where I go; and that is that when people are coming in from overseas, often they're thrust into positions of working independently, without being properly worked up through the system.

CHARLES WOOLEY: Yeah.

DR HAIKERWAL: So they don't understand the system. They don't understand the culture. They don't understand the processes that are going on. And it's not so much the medical knowledge is lacking, but sometimes it needs to be brought up to Australian standards, or the way in which we do things.

And, you know, I think there is a very important case to be made for people that are bringing - the recruitment companies that recruit people into Australia, to have some responsibility for getting people into the right frame; so they understand what they're doing. And some of that work needs to be done with the local medical association, obviously, but certainly the local doctors that are working there would have a part to play in mentoring some of these people through to give them, I suppose, a coach, a life coach for this sort of thing; both medically, but also getting into the community.

CHARLES WOOLEY: I suppose it is perfectly reasonable that the medical profession will want these people to be up to scratch at it were, and the only way to do that is to exam [sic] people isn't it?

DR HAIKERWAL: Yes.

CHARLES WOOLEY: I mean, as I always say - hanging over this argument is the spectre of Jayant Patel isn't it?

DR HAIKERWAL: Well, I mean, that's right. That's the big cloud that looms over us, as we try and...

CHARLES WOOLEY: How did he slip through, and why didn't he get - did he pass his exams?

DR HAIKERWAL: Well, to use that case as an example; the medical board in Queensland said, this guy's got to work supervised. And the Queensland Health Department decided to let him work unsupervised. And then, he was also supposed to have got his qualifications ticked off by the College of Surgeons to say that he was up to speed. They were part of that process.

So, not only was he put out away from other people's scrutiny, he was made head of service. He didn't have the proper sort of monitoring whilst he was being checked off by the College of Surgeons, and he was, you know, the medical board recommendation of working under supervision was ignored.

So, all those proper checks and balances were sidestepped, and that's why it's important to make sure that they're there, but we need to help people through the process.

And I think that that's the real issue now. So government says, look, we'll bring people in. That's not good enough. The government has got to put money into bridging courses; into making sure people actually understand what the needs of the doctors coming in are, so that they stay for a longer time, rather than this coming in and bounding out because they fail an exam or their time expires, or whatever else it is.

CHARLES WOOLEY: Mukesh, we still get to the truism that, where in many cases the doctors who find themselves in this cultural situation, this situation of cultural conflict or misunderstanding, are being brought into this country because we have failed to train our own doctors, and we're bringing people from countries where there's an even greater shortfall in medical services than there is in our modern first-world democracy.

DR HAIKERWAL: Well - and that's exactly right. I mean the...

CHARLES WOOLEY: There's no real answer is there?

DR HAIKERWAL: It's not the real answer. People who are being recruited often are from areas where they are desperately short of doctors in their own countries. And, it's good to come and train; and it's good to come and see how things work, and good to get some additional training; but ultimately we should be training our own doctors within Australia.

CHARLES WOOLEY: And ultimately training even more than we need so that we can help in the region.

DR HAIKERWAL: Well, exactly, and I think as a regional, you know, economy we are very strong, and we're certainly helping in things like tsunami and earthquakes and all these other things.

CHARLES WOOLEY: And as a regional policeman, but not as a regional medical service.

DR HAIKERWAL: Well, we need to be able to help our neighbours out in that way, and I think it's something we can do.

But, you know, in, on Saturday last week I was in Melbourne for a meeting where we actually had a whole group of international medical graduates or overseas doctors there, and some of their issues really did come out very clearly that, first of all they're recruited; they're asked to do an exam; they pass the exam; and then they can't get their foot into the door to do any additional training. And the reason is, that if they're going to work with a GP for instance, the GP has actually got to see patients to keep the practice thriving, and if they take time off to do some mentoring, that's not properly allowed for in the work that they do.

CHARLES WOOLEY: Yeah.

DR HAIKERWAL: And therefore they're actually, you know, putting their practice at risk by training these other people. Whereas they could actually enhance their practice by training these people; not only from having a resource after they've got them across the line, but also they, you know, by doing that training and teaching, they keep their own skills up. The benefits, the cost benefits, the benefits to the community of people teaching, have been lost.

CHARLES WOOLEY: Yeah. I'm talking about Dr Maan Bashour in fact, in Cohuna. He's the latest of the doctors who have failed to pass his medical examination. He hasn't been re-registered, but he's not able to practice either. And I imagine that in Cohuna, which is what, near Terang, I imagine they don't have an oversupply of doctors there.

DR HAIKERWAL: No, Cohuna is doing it tough, and I know that the previous doctor that used to be there retired some time ago, and there is a very significant need. And what we need to do is when people are being asked to work in these areas, is to make sure that they are comfortable; that they are working with somebody else to get them up to speed if you like and make sure they understand the nuances; the way in which we practice.

CHARLES WOOLEY: I'm talking to my regular guest on this program, Mukesh Haikerwal, who is the President of the AMA. Mukesh, did you watch the Four Corners program on Monday?

DR HAIKERWAL: Well, I did actually, and again, some of the themes there are themes I hear in each place I go to across the country.

CHARLES WOOLEY: Yeah, no surprise to, not even a surprise to me. they're exactly the things that people ring about. I thought the power of television was when you see the old, infirm, and the sick, actually getting into their car and having to negotiate traffic to the big smoke.

DR HAIKERWAL: Yes. Well, I mean, there are several things - and I'm sure Ross [Maxwell, RDAA] would have said about these as well - and that, the support that we need in rural areas for those smaller hospitals needs to be put in place. We need the doctors to have those skills that are there and able to work; to be allowed to work to do that. And if the powers that be say well look, you know, you're not doing enough deliveries to keep your skills up, then by all means take them to a teaching centre and get their numbers up so they can keep doing the work they need to do back in the rural area. And whilst they're doing that, backfill their position.

CHARLES WOOLEY: I know not all doctors were happy with the report, and they felt that, that it was more rural hospitals who had been dealt with unfairly.

DR HAIKERWAL: Well, there are some extremely good examples of people doing extremely important and good work; who would probably feel a bit besmirched by that. But I think that we've got to sort of cut through that, and say what are the real problems? And that the problems are that often State Governments are pulling support from the smaller hospitals, and by pulling that support, it means that the communities, the patients, are having to travel further.

And I think that on the one side, we've got to make sure we put support into the regional and rural centres. But on the other side, if people can't get their treatment locally - and often you can't - we need to make sure there's facilities in the big smoke so that they are properly catered for there. So they're not sort of feeling like a shag on a rock, and that they're actually looked after, and you know, nurtured. They are in a very vulnerable position - the patient and their family are vulnerable. They need nurturing and some care whilst, you know, one partner's undergoing the treatment.

CHARLES WOOLEY: Mukesh, if you and I had five bucks for every time we talk about this, we'd be able to retire shortly wouldn't we?

DR HAIKERWAL: Well, well that's right. I don't think we should give up, because there's a lot of good things that we can do, and I'm getting some solutions while I'm going round these different sorts of places, and we're hoping to hold a rural health summit some time in the second half of the year.

CHARLES WOOLEY: Oh good, will, you let us be part of it? We'd like to...

DR MUKESH HAIKERWAL: Sure.

CHARLES WOOLEY: ...we'd like to spread the word. Thank you very much for appearing again.

DR MUKESH HAIKERWAL: Thanks Charles. Thank you.