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17 Aug 2015

In nearly 25 years as a practising doctor, I’ve been fortunate to have worked with hundreds of overseas-trained doctors or, to be precise, doctors who did their primary medical training outside Australia. They have enriched my professional and personal life, and I have learned much from them. Indeed, many have become life-long friends and colleagues.

These doctors, or international medical graduates (IMGs) as we know them, have made an enormous contribution to the health system over the last couple of decades, especially in rural and regional Australia.

The AMA last published a position statement on IMGs in 2004. Let's consider what was happening over a decade ago. For a start, it was apparent that Australia was experiencing a serious shortage of doctors, and there was a growing need to tackle medical workforce shortages in rural areas in particular. In response, the Government moved to relax the arrangements for recruiting IMGs, and we saw them enter the Australian workforce in large numbers. This situation, perhaps more than anything else, illustrated the shortcomings of medical workforce planning in this country.

There were also problems with assessment processes for IMGs working in Australia.

Many IMGs wanting to start or continue working in Australia faced unnecessary delays in their registration and renewal.

The AMA was also aware that some IMGs were being exploited by employers, sometimes using them in preference to locally trained graduates. Of particular concern was the poor access to supervision and oversight for many IMG doctors working in more isolated clinical settings.

Fast forward to 2015. Twenty five per cent of doctors in Australia are IMGs.

So what else has changed over the last 11 years?

A positive development has been the introduction of nationally consistent standards for assessing and supervising IMGs, and medical colleges now have a clear and mandated role in assessing applicants for specialist positions.

Also, the Australian Medical Council has far better processes in place. Its capacity to conduct examinations has been boosted, and there is now a competent authority assessment pathway.

There have been other beneficial changes, as well.

But one thing that has not changed are the flaws in workforce planning.

Unlike in the 1990s, the issue is not one of too few doctors.

Instead, we now face burgeoning numbers of junior doctors who deserve – but cannot obtain – the training jobs they need to enable them to complete their training. In many respects, we now have a flooded training pipeline.

Publicly available statistics show that large numbers of doctors are employed by health departments around Australia using 457 visas.

At the same time, there are insufficient training positions for the increasing number of Australian medical graduates.

This is an imbalance that has to change.

Recent modelling by Health Workforce Australia indicates that while Australia is likely to suffer from an oversupply of medical practitioners in the next 10 to 15 years, IMGs will continue to be a significant and important part of the medical workforce.

Many continue to work in very challenging environments and need our ongoing support.

In light of the changes since 2004, the AMA Medical Workforce Committee is revising the AMA Position Statement on International Medical Graduates. It will focus on the problems that continue with assessing, recruiting, training and supporting IMGs. I will write about our new document in a future column.

In conclusion, it's essential to remember that in the global profession of medicine, many Australian-trained doctors have benefitted enormously from training and working overseas. I am one of those beneficiaries, and I hope the international cross-pollination of our profession may long continue.

Published: 17 Aug 2015