Warning over plan to bypass colleges for IMG assessment

Jolyon Attwooll

8/06/2023 4:54:31 PM

Long shadow of ‘Dr Death’ experience in Queensland prompts concern around proposal to sideline specialist colleges in favour of the AMC. 

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A review is underway to find ways to reduce red tape for international medical graduates moving to Australia.

A proposal to shift the assessment of international medical graduates (IMGs) away from specialist colleges has raised concerns around the potential for unintended impacts on patient safety.
The suggestion is included in the Independent review of overseas health practitioner regulatory settings, widely known as the ‘Kruk report’ after the former senior public servant tasked with overseeing it, Robyn Kruk. 
The interim report, published in April, recommends moving equivalence assessments from specialist colleges to the Australian Medical Council (AMC), a move the author says ‘could drive greater consistency in performance and outcomes and reduce costs’.
Under the suggestion, the involvement of the specialist colleges would be limited to a more advisory role, including providing documentation, as well as standards for assessment and curriculum.
‘The MBA, AHPRA and the AMC should determine the transition path and timeline in consultation with specialist colleges, given their ongoing advisory role,’ the report recommends.
However, the proposal has raised the spectre of what has happened previously when the role of specialist colleges is diminished.
One specific example cited by RACGP President Dr Nicole Higgins focuses on past failures in her home state of Queensland in the oversight of overseas medical practitioners.
In 2005, the Queensland Public Hospitals Commission of Inquiry was set to up to look into the assessment, registration and monitoring of overseas-trained medical practitioners, following a series of deaths at Bundaberg Base Hospital linked to US-trained surgeon Dr Jayant Patel.
Nicknamed ‘Dr Death’ by both co-workers and patients after being linked to a number of botched operations, Dr Patel was eventually jailed in 2010 for three manslaughters.
While Dr Patel successfully appealed his conviction in 2012, when a High Court judge ruled some evidence used in the prosecution case as inadmissible, he was ultimately found guilty of obtaining his position by fraud and permanently banned from medical practice in Australia.
Before moving to Bundaberg, Dr Patel had also been restricted from performing certain types of surgery in Oregon and had also been required to surrender his licence in New York. The failure of his Australian employers to pick up those limitations was sharply criticised in the Queensland commission’s report.
Dr Higgins says many of the concerns raised remain relevant today. 
‘I am a Queenslander and this report still casts a huge shadow here,’ she told newsGP.
‘It’s a stark warning to everyone involved about what can happen when the specialist colleges are put to one side in the accreditation process – and it’s something we can never allow to happen again.’
The inquiry heard that during the time of Dr Patel’s employment, processes had ‘mostly avoided’ pathways for ensuring the competence of overseas medical practitioners such as fellowship or registration as a deemed specialist.
‘In my view, the [Queensland Medical] Board has registered many area of need applicants on terms that would deem them to be specialists, but without invoking the safeguards set out in the national guidelines, namely consultation with the relevant college,’ the report author, former Supreme Court judge Geoffrey Davies, wrote.
He concluded that ‘the process of obtaining deemed specialist registration was largely circumvented’.
The then President of AMA Queensland, Dr David Molloy, told the inquiry this was because it was ‘not always easy' to obtain a college’s approval for a candidate, and that the college would ‘almost always impose a condition that supervision be provided and this could be awkward for Queensland Health’. 
He also said the college’s requirement for continuing medical education ‘might be inconvenient for Queensland Health’. 
To avoid any risks in limiting the role of specialist colleges, Dr Higgins believes it would be better to simplify requirements rather than transfer responsibility to the AMC.
‘If the system for comparing the experience of IMGs was more streamlined for the colleges, we’d still get to the place we all want to get to, which is a swift, safe and efficient way of getting IMGs working in Australia, but protecting the standards we are rightly proud of,’ she said.
Dr Higgins reiterated her commitment to working with the Department of Health and Aged Care and AHPRA to address the concerns around the future of the general practice workforce.
‘Almost half of our GPs are international medical graduates; they are part of the lifeblood of general practice and make a massive contribution to communities all around Australia,’ she said.
‘We have been advocating loudly to reduce red tape for our IMGs, and we recognise the Government’s efforts to do something about it.’
A final version of the Kruk Report is due later this year.
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A.Prof Christopher David Hogan   9/06/2023 11:30:01 PM

Being a GP is much harder than almost all of the other specialties- not only for what we have to learn & keep learning but also dealing with ambiguity & uncertainty. On top of this , we are expected to have an intimate knowledge of the formal & informal components of the Health System.
It is my honour to supervise IMGs as they train for GP Fellowship . They learn fast, but there is a lot to learn.
So being a GP is hard.
The transition from training obtained in other countries (even UK) to that needed in Australia can be challenging.
The cultural adjustments from other countries to those of multicultural Australia in metro, outer metro & rural areas can be very challenging .
IMGs are our colleagues & are not slaves to be sent to where they do not want to go without adequate preparation for them & support for their families.
I am sick of uninformed politicians & their desire for simplistic single solutions to ongoing complex problems.

Dr Patrick Fergal McSharry   17/06/2023 9:20:39 AM

I agree, with A.Prof. Hogan.
Yes, as an IMG I found the process to come here incredibly complicated and 3 years is a ridiculous length of time from 1st application to actually starting work.
I compare with my experience entering , qualifying and then working in the Middle East , North America and the UK .
This suggestion that the Colleges not be involved in assessing Qualifications does not make any sense.
More useful would be a discussion on reform of the actual Visa issued to a Doctor ( after the 3 years of hurdles) .

Dr Javier Armando Campuzano Ortiz   17/06/2023 12:06:07 PM

I have to agree Prof. Hogan. but we are also overlooking another issue here and is the issue and transparency and fairness. Every single doctor should go through the same assessment. If local graduates have to go through a college assessment process then the IMGs should too, it standarises the process and as an IMG I find disrespectful to my effort and to the standard that I work hard to obtain being replaced with shortcuts.
In another news outlet about the same issue I read that the proposal was to bypass the college for IMGs from "trusted countries" (US,UK,Canada, etcetera), that is more disrespectful and discriminative, and almost sounds like a "White Australia policy" for doctors. everybody should have the same assessment ( yes, UK doctors too). I always found offensive the Fellowship ad eundem gradum policy the college used to have, If you want to practice safely and competently in Australia the minimum standard is completion of the RACGP assessment process and examinations.

Dr Peter John Killey   19/06/2023 10:26:14 PM

We have plenty of graduates. Why are we taking doctors from needy countries to fill our deficiencies?

Dr Javier Armando Campuzano Ortiz   23/06/2023 10:21:09 AM

Because Dr. kelly. none of the domestic graduates wants to be GP, it really shocks me every time I read it, because I did this by choice, I trained as a physician here in Australia and decided to change to general practice of my own volition. But I have an example right at home, my son is in medical school he finishes next year and he has stated that he will not be a GP.