IMGs a ‘simple solution’ to boost GP numbers: RACGP

Anastasia Tsirtsakis

20/03/2023 4:21:47 PM

The college is urging government to support international medical graduates and make it easier for them to work in Australia.

A GP smiling at a patient.
IMGs account for almost 50% of Australia’s GP workforce.

As Australia’s health system faces a crisis, amid a growing shortage of GPs and mounting pressure on both primary and secondary care services, the RACGP is calling on the Federal Government to support international medical graduates (IMGs).
College President Dr Nicole Higgins said the workforce shortage is a significant part of the crisis, and that it is widespread, from general practice to pharmacy and nursing.

She said IMGs could help to address the issue in the short-term, and that many are eager to work in Australia, but are being held back and becoming disillusioned by red tape and a lack of support.

‘Rural and remote communities are particularly affected,’ Dr Higgins said.

‘But there is a simple solution to boost the number of GPs in the short-term: we can and should be doing much more to attract IMGs to Australia, and to support and retain them as valuable community members.

‘This includes cutting red tape and making the application process easier for doctors who want to work in areas of need.’

To help address the issue, the RACGP put forward a series of recommendations in a submission to the Senate Joint Standing Committee on Migration. They include:

  • fast-tracking applications for IMGs planning on working in areas of need
  • reinstating the subsidy for IMGs’ training to become a specialist GP in Australia and supporting relocation
  • boosting support for GPs with advanced skills in rural and remote communities
  • working with Aboriginal and Torres Strait Islander groups to develop cultural training for doctors before they start practice in Australia. 
In December, the Australian Health Practitioner Regulation Agency (AHPRA) announced it would cut the time to safely assess applications for IMGs, as part of a suite of new actions to bolster the medical workforce.
But the college is saying that more needs to be done, recommending that AHPRA, the Department of Home Affairs and Medicare all work together with the medical colleges to fast-track applications for GPs.

‘There also needs to be a coordinated approach to processing applications, and we recommend the Rural Workforce Agencies or similar, are tasked with this job,’ Dr Higgins said.

Alice Springs is among the areas bearing the brunt of the health workforce crisis, with the ABC reporting the area was down to a third of GP numbers required just weeks ago.

‘If nothing changes, some of the life expectancy gains — which have been hard-fought and hard-won in Aboriginal health in Central Australia — will go backwards,’ Dr John Boffa, Chief Medical Officer at Central Australian Aboriginal Congress, said.

Among the recent challenges prospective IMGs are facing is a lack of funding, with the defunding of the Practice Experience Program (PEP) in 2022. Since January 2019, the program had supported non-vocationally registered doctors on their pathway to RACGP Fellowship.

In response, the RACGP developed the Fellowship Support Program (FSP), with the first intake earlier this year in January. However, without government funding, the FSP is entirely self-funded for participants.

Dr Higgins said the previous Federal Government’s decision to defund PEP, and as a result add an extra barrier for IMGs ‘makes no sense’ in the current climate.

‘We are calling for the Government to return the subsidy for IMGs who want to work as a specialist GP in Australia through the RACGP’s FSP,’ she said.

‘It’s an easy way [to] boost GP numbers in communities in need.’

RACGP Rural Chair Associate Professor Michael Clements is in agreement. He said the goal should really be to make Australia the destination of choice for IMGs.

‘Australia’s health system is world class and there are countless highly qualified medical graduates overseas in places like the UK, Europe and Asia, who want to come here to work and live,’ Associate Professor Clements said.

‘This is reflected in the fact that IMGs account for almost 50% of Australia’s GP workforce. They are a valuable part of our health system and contribute to communities across our nation every day.’

The RACGP’s calls to streamline the process for IMGs to travel to and work in Australia is also backed by the Rural Workforce Agencies.

‘IMGs currently make up 53% of the rural medical workforce,’ Peter Barns, Chair of the Rural Workforce Agency Network, said.

‘They, and their families, enrich the communities they work in … We look forward to working with the Government and key stakeholders to add concrete actions to our best intentions.’

Associate Professor Clements did, however, note that the call to support IMGs does not ignore the need for governments to do a lot more in encouraging people born in Australia to want to become a GP through ‘adequately funding and valuing’ general practice care.

But he says IMGs can go a long way in helping to address areas of need in the short-term.

Meanwhile, the rural Chair says offering more incentives to GPs in rural communities with additional skills training is another way to boost numbers.

‘Rural GPs often do additional training so they can provide medical services that would not otherwise be available in their communities, such as emergency care, obstetrics, or palliative care,’ Associate Professor Clements said.

‘If we reward GPs more for obtaining and providing these additional skills, particularly in more remote areas, it will be more attractive to work there.’

He said that it is a ‘simple solution’, but one that needs ‘action urgently’.

‘There is no substitute for GP care and too many people across the country are missing out,’ Associate Professor Clements said.

‘The evidence shows ongoing GP care results in better health and wellness – and everyone needs it, no matter their income or postcode.’

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FSP health worker shortage IMGs international medical graduates PEP RACGP Fellowship Support Program subsidy

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Dr MT   21/03/2023 5:17:06 AM

The easiest way is to increase intake of domestic medical students. Lots of year 12 students are highly intelligent but cannot make it into medicine. It is too competitive

Dr Richard Peter Shorrock-Browne   21/03/2023 11:05:29 AM

In the past, bringing in more IMGs has been a way for the government to maintain "competition" in General Practice.
Competition for patients in city and inner metropolitan practices has assisted in keeping bulk-billing rates high over the years.
Sadly it did little to maintain the rural Doctor shortage.
The reality now is different. Even these practices can no longer meet the costs of running the business with the bulk-billing rebates. IMGs like locally trained GPs will not (can not) remain in General Practice if the business is not viable.
I agree with MT that opening more training places to local graduates, and funding General Practice appropriately would attract locally trained Doctors back in to the otherwise rewarding discipline. IMGs certainly have a role, but they can't magically make a practice viable.

Dr Bradley Arthur Olsen   21/03/2023 11:45:23 AM

Certainly without IMG doctors , regional Queensland would be in absolute chaos (well more than presently) let alone rural/remote. The trouble with training more local graduates is having them work outside cities (no moratorium). This would require 2 things - 1/ adequate remuneration for the high hourly workload and no your extra $3-4 for bulk billing isn't enough and 2/ Queensland health back up and support rather than harassment (yes I do expect them to fly their helicopter in the dark for MI retrieval).

Dr Richard Peter Shorrock-Browne   21/03/2023 1:09:19 PM

In the past there were bonded scholarships to see new Medical Graduates retained rurally for a couple of years. In my graduating year I had a colleague who took this up, and spent many years in a Western Queensland mining town, well past his bonded requirement.
Making extra places available at a slightly lower ATAR with a bonded commitment could be one answer even without scholarship support.
I agree with Dr Olsen that the back up and support needs to be better.
Maybe a system of locum support by training Registrars on rotation would help.
It would also give a taste of rural medicine that might see people return?

Dr Jennifer Rachel Brown   23/03/2023 1:15:06 PM

I welcome and enjoy working with my internationally trained colleagues in rural areas. They often bring advanced skills and new perspectives and add to cultural life. There is no doubt rural areas would be even worse off without them. I am however troubled with the moral aspect of poaching doctors from other countries without reimbursement. Should we be paying for scholarships at the universities where these IMGs have trained when they receive their permanent residency to compensate for this?

Dr Greg Saville   23/03/2023 9:42:03 PM

Taking medical graduates from other countries that need doctors more than we do, is robbing Peter to pay Paul. It does not serve the countries where the graduates studied, nor Australia (in the long term).