http://www.smh.com.au/articles/2004/...879374510.html


Warning on gaps in doctor training
By Mark Metherell, Political Correspondent
July 5, 2004


Three thousand foreign-trained doctors are practising
in Australia without having been subject to normal
medical exams that many of them would probably fail,
according to research published today.

The provisionally registered doctors, recruited by
state governments to serve in areas of need, do not
have to sit the rigorous tests required of others -
and their numbers are ballooning because of critical
shortages, particularly in rural Australia.

The study warns that the Government's MedicarePlus
plans to recruit 1500 more overseas-trained doctors
places further pressure on the system.

Exam results showed that just over half the doctors,
including repeat candidates, passed the Australian
medical exams set for overseas-qualified doctors
seeking to practise here.

But there has been no systematic assessment of the
capacity of the provisionally registered doctors who
have not sat the tests, researchers Bob Birrell and
Lesleyanne Hawthorne say.

There were several thousand temporary resident doctors
practising in Australia, "an increasing minority of
whom may not have experienced a training program
equivalent to that prescribed for local doctors", they
say in an article in People and Place journal,
published by Monash University's Centre for Population
and Urban Research. "Very few have had to undergo
rigorous examination of their skills prior to practice
commencement. An increasing proportion is coming from
nations where the training programs are not tailored
to the health-profile characteristics of Australian
patients."


Dr Birrell, the head of the research centre, declined
yesterday to detail any instances where
overseas-trained doctors had been implicated in
medical misadventures because of training
deficiencies. But he said he had been told such
doctors tended to need more supervision and there was
an official reluctance to allow them to practise
independently.

According to Australian Medical Council exam figures
cited in the study, graduates from one of the biggest
source countries, India, had a 47 per cent pass rate
on a theoretical test and 63 per cent pass rate on
clinical. Another large group, from Bangladesh, scored
an 80 per cent pass rate on theory but 48 per cent on
clinical.

These exams were sat by medical graduates already in
Australia and it is an issue of aggravation to them
that state health departments have focused on
recruiting doctors directly from overseas who can take
up temporary medical appointments without having to
pass an equivalent test, the researchers say. Out of
Australia's 25,000 non-specialist doctors, 3000 or
more are overseas doctors in training, or practising
under provisional registration, the study says.

The federal and state governments have been tardy in
committing the money to fill the gaps in supply by
providing the bridging and other training for overseas
graduates already living in Australia, the researchers
say.

The Australian Medical Association has voiced concerns
about excessive reliance on overseas-trained doctors
and the difficulties some face when thrown into
service in remote communities, but there had been no
sustained campaign on the issue, they note.

A spokesman for the federal Health Minister, Tony
Abbott, said he was concerned that all practising
doctors met registration requirements but the issue
was in the hands of state medical boards.

The NSW Government had provisionally registered the
doctors without exams in order to provide urgently
needed doctors to areas of shortage, said a spokesman
for the NSW Health Minister, Morris Iemma. The foreign
candidates for areas of need did have to satisfy the
Medical Registration Board they were appropriately
qualified for their position, he said. Once appointed,
they were supervised by their medical college and
required to undertake continuing training.

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http://www.abc.net.au/cgi-bin/common...4/s1146663.htm

ABC Online


[This is the print version of story http://www.abc.net.au/am/content/2004/s1146663.htm]


AM - Monday, 5 July , 2004 08:00:00
Reporter: Rachel Carbonell
TONY EASTLEY: Australia's shortage of GPs in the bush and other areas in need, is increasingly being filled by unaccredited overseas trained doctors. The number of unaccredited overseas trained GPs working in Australia has doubled in the last four years.

A Monash University study shows there are more than 3,000 doctors on temporary visas who aren't required to sit the Australian Medical Council examination.

The report's authors say the recent Medicare reforms will only make the problem worse and within a few years up to a fifth of the country's non-specialist medical workforce will be doctors on temporary visas.

Rachel Carbonell reports.

RACHEL CARBONELL: Co-author of the report, Dr Bob Birrell, from Monash University's Centre for Population and Urban Research says there's no doubt Australia needs to recruit from overseas to cope with doctor shortages.

But he says the current system of recruiting is flawed because it now relies too heavily on overseas trained doctors on temporary visas, who don't have to sit the Medical Council exam.

BOB BIRRELL: The medical establishment's commitment in Australia to a domestically trained workforce, trained at a higher standard, is being abridged because we are appointing thousands of people, none of whom have been formally assessed to see whether they actually meet Australian standards.

Now, I should say that this has not been a major problem in the past since a majority of these temporary doctors have come from the UK, but because of the growth of the numbers, the draw now is increasingly on people trained in non-western medical schools – issues of language, relevance of training and skills – are increasingly important.

It has to be remembered that these people are out on the front line.

RACHEL CARBONELL: Dr Birrell says the number of doctors on temporary visas working in Australia has jumped from about 1,500 to more than 3,000 in the last four years. And he says the recent Medicare reforms mean that number will continue to rise.

BOB BIRRELL: It will increase by up to a 1,000 over the next year or two given the initiatives the Federal Government put in place, which include appointing a labour training… labour recruitment companies to actually go out and identify prospective doctors for the various employer bodies.

This sudden change in policy, or the intensification of existing policies, reflects the sense of urgency the Government now feels about the decline in bulk billing, the difficulties people are having in accessing general practitioners without appointments in advance.

Even now in the metropolises, and it has been a long standing problem in the regional areas, but it is now starting to bite in the major capital cities as well.

RACHEL CARBONELL: Dr Birrell says the lack of accreditation isn't the only problem.

He says the use of doctors on temporary visas creates a two tiered medical system where Australian trained doctors work in the cities and overseas trained doctors work in undesirable and remote areas, and thus those areas suffer from a lack of continuity.

Meanwhile, he says, overseas trained doctors who have become permanent residents and are struggling to pass the Medical Council exam are unable to get work.

The report criticises the Australian Medical Association for staying silent on the issue. But AMA Vice President Mukesh Haikerwal agrees it's a major problem and says the AMA will shortly release its own report which mirrors many of the findings in the Monash report.

MUKESH HAIKERWAL: What we would like to see is that when people are recruited that they actually pass some degree of competency before they actually enter the country.

When they are here we would like to make sure they are orientated and mentored both culturally, linguistically and also into the system in which they are working. It is so important that they are not left to sink or swim, and more importantly that the patients they are looking after get attention of a standard that they expect.

RACHEL CARBONELL: A small training program has been set up for overseas trained doctors but the AMA admits more needs to be done and it plans to start lobbying State and Federal Governments to address the issue.

TONY EASTLEY: Rachel Carbonell reporting.

A spokesman for the Federal Minister for Health Tony Abbott says it's up to individual state and territory medical boards to ensure that overseas doctors are adequately trained to Australian standards, before authorising a provisional registration for them to practise.

In New South Wales, the Medical Board does require medical graduates from other countries to complete the Australian Medical Council Examinations, but it does have the right to waive that requirement in special circumstances. That includes areas of need, often rural and regional areas.

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