Fresh fears for new expedited pathway readiness

As the launch of the Medical Board of Australia’s new expedited pathway for overseas doctors draws closer, the RACGP has questioned its readiness to take on an influx of international medical graduates (IMGs).
 
So far, limited details have been released on how these IMGs will be trained and supported to practice in Australia, leading to fears that the rush to fill workforce shortages could put patient safety at risk.
 
Key details of the initiative are yet to be released just weeks out from the program’s launch, including what qualifications will be eligible and what support services and resources doctors will have when entering the workforce in Australia.
 
As of 21 October, and subject to ministerial approval, specific overseas specialist qualifications will be recognised, and upfront specialist registration will be granted to eligible doctors.
 
RACGP President Dr Nicole Higgins says she is ‘deeply concerned’ the pathway is going ahead despite the unanswered questions.
 
‘We have yet to hear how supervision will be guaranteed, particularly in a rural context,’ she told newsGP.
 
‘We have been told there will be a six-month supervision process under an expert Australian GP, but we have yet to hear what that supervisor will be monitoring, what will be measured, and how.’
 
Dr Higgins says central to her concerns is that international doctors need wraparound support services, which have not been outlined by the Board.
 
‘We’ve got a different system with Medicare and medicines,’ she said.
 
‘Working in rural and regional Australia is very different from the countries of origin, as well as understanding Aboriginal and Torres Strait Islander culture.
 
‘We’re concerned that the pressure to get this done quickly from the health ministers means that the Medical Board may not have the processes in place in time.’
 
An AHPRA and Medical Board spokesperson told newsGP they remain on track to launch the expedited pathway and said it is important to recognise that the cohort of IMGs is highly experienced and well trained.
 
‘[The Medical Board] is grateful for the advice of the RACGP. A lack of medical practitioners is also a risk to community,’ they said.
 
‘They will have qualified from similar systems to Australia. They will need support in relation to becoming orientated to the Australian health care system and cultural safety.
 
‘That is why they will be required to undertake further training in these areas. They will also have a supervisor who will support them.’
 
However, when asked why there has been no confirmation of what qualifications will be eligible, they simply said ‘that information will be available by the start date’.
 
RACGP Rural Chair Associate Professor Michael Clements says those who go out to work in regional settings could quickly find themselves in over their head without proper support.
 
‘In this new fast-track pathway, people can come from their overseas Fellowship and be put straight into a community town where they are there by themselves, with some remote supervision, as deemed by AHPRA to be suitable,’ he told newsGP.
 
‘If they’ve come from the middle of the UK, they are probably in the habit of referring on into the NHS for many of the conditions that our rural practitioners are expected to prescribe.
 
‘They won’t get the same approach to their orientation and training and support, but also the ongoing support even once they get that specialty recognition, to make sure that they’re actually prepared for these rural [and] remote communities.’
 
The AHPRA spokesperson said, ‘supervision will be a condition on registration’ and that the Board will approve supervisors and supervision arrangements,’ they said.
 
‘Supervisors will have agreed to undertake this role, and the Board will be explicit about the responsibilities of supervisors so they will know what they are signing up to,’ they said.
 
‘We are grateful for the advice provided by the RACGP and ACRRM who have proposed a small number of qualifications.
 
‘These have been referred to the Australian Medical Council (AMC) for advice. That advice is expected shortly and in time for a late October commencement.’
 
New Australian Health Practitioner Regulation Agency (AHPRA) data shows there has been a 27% increase in the number of IMGs approved to work in Australia in the past year.
 
RACGP Rural Chair Associate Professor Clements says he is nervous for the doctors that come in through this new pathway, without the support of a college.
 
‘The only agencies that would be out there to provide support to them to make sure they’re getting that appropriate remote supervision, that they’re actually meeting those training goals, is AHPRA and the AMC, and this is new territory for them,’ he said.
 
‘This is not their core business, it’s not what they’ve been training for, and this is not what they’ve been resourced for or staffed for.
 
‘They haven’t been doing this kind of role in providing the support, yet the Government’s put it on them now.’
 
But Associate Professor Clements is worried about the actual cost to regional and remote communities in the rush to fill gaps in the GP workforce.
 
‘These people might come in cheaper and quicker, but then what cost is that to our communities?’ he asked.
 
‘This is coming from an approach the Australian Government has had in the past, where any doctor will do and communities, particularly our rural and remote communities that actually need the most support, the most skilled workforce, are the ones that are at risk of suffering here.’
 
Dr Higgins said this all raises questions if the Board is ready for a process that is due to start in weeks.
 
‘Approving doctors on the expedited pathway is more than a “tick-a-box” exercise,’ she said.
 
‘If this is going to start so soon, it needs to be with a cautious rollout.
 
‘Anything more would reflect a recklessness we do not expect and have not experienced from the Board and AHPRA.’
 
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