IMGs, workforce shortages and the 10-year moratorium: Is there need for change?

Medical recruiters are calling for changes to the way the Department of Health (DoH) deals with shortages of GPs in the bush.
 
Corrine Taylor, Chair of the Association of Medical Recruiters Australia New Zealand, told newsGP that the existing District of Workforce Shortage (DWS) system is not effective in determining the real need for GPs.
 
At present, overseas-trained GPs arriving in Australia must work in an area with a lack of GPs  – essentially, anywhere in the country other than major cities and towns – for up to 10 years if they want to be able to bill Medicare.
 
The approach, known as the 10-year moratorium, is designed to encourage overseas-trained GPs to move to areas of need and fill doctor shortages throughout the country. There are no such restrictions on local GPs.
 
Ms Taylor said the DWS system does not consider individual circumstances.
 
‘For example, in a single-GP town where the GP plans to retire, an individual case cannot be put forward for review,’ she said. ‘This creates unacceptable gaps in the health service being offered to a community.’
 
Ms Taylor said the recent GP crisis on the Woy Woy Peninsula, on the NSW Central Coast, is illustrative of the issue. Woy Woy is not classified as a DWS area, but had struggled for years to attract local GPs to replace doctors who wanted to retire.
 
‘Without a DWS status, we were forced to turn away many substantially comparable GPs, inclusive of Fellowship Ad Eundem Gradum [FAEG] GPs from the UK, Ireland and Canada,’ Ms Taylor said.
 
‘You can get to Sydney from Woy Woy, you can see the water. It’s an appealing location for someone moving from overseas. But it’s not a DWS area.’
 
Ms Taylor argues the existing assessments undertaken by state health departments on Area of Need certification and the visa application process at a national level both require more detailed and targeted labour market testing, taking into account any inability to attract local GPs.
 
Her calls are backed by Martina Stanley, Director of Alecto Australia medical recruiters, who told newsGP that the DWS and moratorium have led to ‘stigmatisation’ of the bush.
 
Ms Stanley added that many country towns and outer-metropolitan areas are ‘screaming out for doctors’, but are hamstrung by the fact they are not considered DWS areas.
 
‘[Outer] urban areas that are experiencing significant disadvantage are not considered simply because they are in an [urban] zone,’ she said.
 
National Rural Health Alliance CEO Mark Diamond told newsGP that overseas-trained doctors, despite any shortcomings of the current system, have been able to fill gaps in many areas of need.
 
‘A lot of country towns would not have a doctor if not for the moratorium and the visa arrangements,’ he said.
 
‘We have difficulty in recruiting GPs in remote areas – there’s no denying that. But if you look at all the subsidies, incentives and allowances, about half the [rural GP] improvement is from overseas medical graduates.’
 
However, Mr Diamond said the reliance on overseas-trained doctors was never meant to be as a lasting answer to the question or doctor shortages.
 
‘We’ve solved half the problem with overseas doctors, but it was never intended to be a long-term solution, and nor should it be,’ he said.
 
‘We must be in a position to train, recruit and retain people. If we can’t supply our own workforce, we’re in serious strife.’
 
According to Mr Diamond, local GPs who stay in the country long term are likely to be born and raised in rural areas, or had a good experience in the country during their training. He said the collaborative work between the RACGP and Australian College of Rural and Remote Medicine (ACRRM) on a rural generalist pathway is key to training more rural GPs.
 
On paper, Australia’s persistent GP deficit seems to be shrinking, with the number of new medical graduates almost tripling between 2003 and 2017.
 
But a 2017 ANZ–University of Melbourne report on trends in general practice found there were almost 10 new specialists for every new GP, and GP numbers grew by only 2.4% between 2005 and 2015, while specialists were up 22%.
 
The RACGP has never supported the 10-year moratorium and has called for its review. A 2014 position statement states that, ‘[A] highly motivated future rural workforce is an invaluable resource unlikely to be obtained through coercive measures, as was demonstrated by the ... moratorium scheme for international medical graduates.’
 
The DoH did not respond to requests for comment. However, The Australian recently reported that the Government would soon introduce a new health agency with more control over the distribution of overseas-trained doctors, with the ability to approve or veto specific job proposals. 
 
The paper reports that approval will be given only when an advertised position responds to genuine workforce need.

GP shortage moratorium rural health workforce shortage